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Encyclopaedia


Measles

Introduction

Measles is a highly infectious viral illness. It can be very unpleasant and possibly lead to serious complications, including blindness and even death. However, it's now rare in the UK due to the effectiveness of the MMR vaccination.

Anyone can get measles if they haven't been vaccinated or had it before, although it's most common in children aged between one and four years old.

The measles virus is contained in the millions of tiny droplets that come out of the nose and mouth when an infected person coughs or sneezes.

The virus spreads very easily, and measles is caused by breathing in these droplets or by touching a surface that has been contaminated with the droplets and then placing your hands near your nose or mouth.

The initial symptoms of measles develop around 10 days after you are infected. These include:

  • cold-like symptoms
  • red eyes and sensitivity to light
  • fever
  • greyish white spots in the mouth and throat

After a few days a red-brown spotty rash will appear. It usually starts behind the ears, then spreads around the head and neck before spreading to the legs and the rest of the body.

See a slideshow of other rashes and skin conditions.

When to see your GP

You should contact your GP as soon as possible if you suspect that you or your child may have measles.

It's best to phone before your visit as your GP surgery may need to make arrangements to reduce the risk of spreading the infection to others.

Your GP will usually be able to diagnose measles from the combination of symptoms, although a sample of your saliva may be tested to confirm the diagnosis.

Treating measles

There's no specific treatment for measles and your immune system should fight off infection within 7 to 10 days.

If your child has measles, there are several things you can do to help make them feel more comfortable, including:

  • closing the curtains to help reduce light sensitivity
  • using damp cotton wool to clean the eyes
  • taking paracetamol or ibuprofen to relieve fever, aches and pains (aspirin should not be given to children under 16 years old)
  • drinking plenty of water to avoid dehydration

In severe cases of measles, especially if there are complications, hospital treatment will be needed.

Read more about treating measles.

Although vaccinated children are unlikely to catch it, keep your child away from other children for at least four days after the rash has appeared.

Once you have fought off the measles infection, you develop immunity (resistance) to it.

MMR

The most effective way of preventing measles is the measles, mumps and rubella (MMR) vaccine.

The first MMR vaccination should be given when your child is around 13 months old. A second is given before your child starts school.

Adults and 6-13 month old children can also have the MMR vaccine if they are at risk of catching measles. For example, vaccination may be recommended if there is an outbreak of measles in your local area, or if you have been in close contact with someone who has measles

How common is measles?

The success of the MMR vaccine means that in the UK, cases of measles are uncommon. However, the number of cases has risen in recent years and there have been some high-profile outbreaks.

For example, between November 2012 and July 2013 there was a measles outbreak in and around Swansea, during which more than 1,200 cases were reported.

It is thought that the rise in the number of cases of measles is due to parents not getting their child vaccinated with the MMR vaccine, probably due to speculation linking MMR to autism.

Publicity in 1998 highlighted a report claiming a link between the MMR jab and autism. However, numerous studies that were undertaken to investigate this claim found no link between the MMR vaccine and autism.

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Symptoms

The initial symptoms of measles appear around 10 days after you get the measles infection and generally last for 7 to 10 days.

The initial symptoms of measles include:

  • cold-like symptoms, such as runny nose, watery eyes, swollen eyelids and sneezing
  • red eyes and sensitivity to light
  • a mild to severe temperature, which may peak at over 40C (104F)
  • tiny greyish-white spots (called Koplik's spots) in the mouth and throat
  • tiredness, irritability and general lack of energy
  • aches and pains
  • poor appetite
  • dry cough 

Rash

The measles rash appears two to four days after initial symptoms and lasts for up to eight days. The spots usually start behind the ears, spread around the head and neck, then spread to the legs and the rest of the body over the next few days.

The spots are initially small but quickly get bigger and often join together. Similar-looking rashes may be mistaken for measles, but measles has a range of other symptoms too, not just a rash.

When to seek medical advice

You should contact your GP as soon as possible if you suspect that you or your child have measles.

It's best to phone before your visit as your GP surgery may need to make arrangements to reduce the risk of spreading the infection to others.

Your GP will usually be able to diagnose measles from the combination of symptoms, although a sample of your saliva may be tested to confirm the diagnosis.

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Causes

Measles is caused by infection with the rubeola virus. This virus is contained in the millions of tiny droplets that come out of the nose and mouth when someone with measles coughs or sneezes.

You can catch measles by breathing in these droplets or, if the droplets have settled on a surface, by touching the surface and then placing your hands near your nose or mouth. The measles virus can survive on surfaces for a few hours.

Once inside your body, the virus multiplies in the back of your throat and lungs before spreading throughout your body, including your respiratory system and the skin.

Someone with measles is infectious for two to four days before the rash appears and for about four days after it appears. Therefore, school or work should be avoided for at least four days from when the rash first appeared to limit the spread of infection.

Immunity

Anyone who has not had measles before and hasn't been vaccinated can be infected. However, cases of re-infection after you have had the virus are extremely rare because the body builds up immunity (resistance) to the virus.

Most people who are not immune from measles and are sharing a house with somebody who is infected will catch it.

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Diagnosis

Your GP will usually be able to diagnose measles from the combination of symptoms you may have, such as the characteristic rash and the small spots inside the mouth.

A simple blood or saliva test can confirm the diagnosis and identify the rubeola virus.

Doctors have a duty to notify the local Public Health Unit of all reported and suspected cases of measles. They will also notify the child's school if necessary.

Your child should not return to school until at least four days after the appearance of the rash.

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Treatment

There is no specific treatment for measles. Once the rash starts, you will need to rest and treat the symptoms until your immune system fights off the virus.

If there are no complications due to measles, the symptoms will usually disappear within 7-10 days.

Relieving symptoms

If the symptoms of measles are causing discomfort for you or your child, there are some things you can do to treat these while you wait for your immune system to fight off the virus.

Controlling fever and relieving pain

If necessary, paracetamol or ibuprofen can be used to reduce a high temperature (fever) and treat any aches or pains. Liquid infant paracetamol can be used for young children. Aspirin should not be given to children under 16 years old.

Speak to your pharmacist if you are not sure which medications are suitable for your child.

Drink plenty of fluids

If you child has a high temperature, make sure they drink plenty of fluid because they may be at risk of dehydration. Keeping hydrated will also help reduce discomfort caused by coughing.

Treating sore eyes

You can gently clean away any crustiness from your eyelids and lashes using cotton wool soaked in water.

Closing curtains or dimming lights can help reduce any light sensitivity.

Treating cold-like symptoms

If you have cold-like symptoms such as a runny nose or a cough, there are a number of things you can do to feel more comfortable.

For example, steam inhalation may offer some relief from a cough. This involves sitting with your head over a bowl of hot water. Place a towel over your head, close your eyes and breathe deeply, while trying not to get the hot steam in your eyes.

Steam inhalation is not advised for children because of the risk of scalding, but it might help your child if they sit in a hot, steamy bathroom. Alternatively, putting a wet towel on a warm radiator will release more water into the air.

Giving your child warm drinks, particularly ones containing lemon or honey, may also help to relax their airways, loosen mucus and soothe a cough. However, honey should not be given to babies under 12 months.

Limiting the spread of infection

While you have measles, it is important to reduce the risk of spreading the infection to other people.

If you or your child have the condition, you should avoid work or school for at least four days from when you first developed the measles rash.

You should also try to avoid contact with people who are more vulnerable to the infection, such as young children and pregnant women.

Spotting signs of serious illness

If you or your child have been diagnosed with measles, you should keep an eye out for any signs of the serious complications that can develop while your body is trying to clear the infection.

Signs of a more serious problem can include:

  • shortness of breath
  • a sharp chest pain that feels worse with breathing
  • coughing up blood
  • drowsiness
  • confusion
  • convulsions (fits)

Visit your nearest accident and emergency (A&E) department or called 999 for an ambulance if you or your child develop any of these symptoms as they may be a sign of a serious bacterial infection requiring admission to hospital and treatment with antibiotics.

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Complications

Complications can develop from measles, some of which can be extremely serious.

It's estimated that around one in every 5,000 people with measles will die as a result of a serious complication.

Complications resulting from measles are more likely to develop in certain groups of people, including:

  • babies younger than one year old
  • children with a weakened immune system, such as those with leukaemia or AIDS
  • children with a poor diet
  • teenagers and adults

Children who are older than one year and otherwise healthy have the lowest risk of developing serious complications.

Common complications

Some of the common complications of measles are:

Less common complications

Less common complications of measles are:

Rare complications

In rare cases, measles can lead to the following conditions:

  • serious eye disorders, such as an infection of the optic nerve (the nerve that transmits information from the eye to the brain), known as optic neuritis, which can lead to blindness
  • heart and nervous system problems
  • a serious brain complication known as subacute sclerosing panencephalitis (SSPE), which can sometimes occur several years after measles – however, although the condition is fatal, it is very rare, occurring in only 1 in every 25,000 cases of measles 

Pregnancy complications

If you are not immune to measles and you become infected while you are pregnant, there is a risk of:

  • a miscarriage
  • stillbirth
  • your baby being born prematurely (before the 37th week of pregnancy)
  • your baby having a low birthweight

If you're pregnant and you think you've come into contact with someone with measles and you know you're not immune, you should see your GP as soon as possible. Your GP can advise you about treatment to reduce your risk of developing measles.

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Prevention

Limiting the spread of infection

While you have measles, it is important to reduce the risk of spreading the infection to other people.

If you or your child have the condition, you should avoid work or school for at least four days from when you first developed the measles rash.

You should also try to avoid contact with people who are more vulnerable to the infection, such as young children and pregnant women.

Vaccinated children and anyone who has already had measles are extremely unlikely to catch measles.

MMR vaccination

The first dose of the measles, mumps and rubella (MMR) vaccine should ideally be given to babies who are between 12 to 13 months old.

Children are given a second dose (often known as the booster dose) before they start school, usually between the ages of three and five years old, although the second dose can be given three months after the first.

Between 5%-10% of children aren't fully immune after the first dose. The second dose provides increased protection, with less than 1% of children remaining at risk after having it.

If a child younger than 13 months old is exposed to the measles virus, the action taken to prevent them developing the disease will depend on whether they are under or over six months old.

Children aged 6-13 months old

A child aged between 6 and 13 months who is exposed to the measles virus will normally be given the MMR vaccination to protect them from developing measles.

However, if a child is given the vaccine before their first birthday, they should still be given two further doses as part of the childhood vaccination programme. These doses should be given at around 13 months of age and before the child begins school.

Children aged under 6 months

If the child's mother has had measles in the past, or has been fully vaccinated against measles with the MMR, the child will usually be immune to the measles infection because the mother's protective antibodies will have been passed to the baby in the womb.

However, if the mother has not had measles, the child may be given an injection of human normal immunoglobulin (HNIG). HNIG is not a vaccine. It is a special concentration of antibodies that can give short-term but immediate protection against measles.

Pregnant women

If you're planning to get pregnant and you have not had measles in the past, talk to your GP about having the MMR vaccine.

The MMR vaccine is not recommended during pregnancy, so you may be offered a HNIG injection instead if there is a risk you have been exposed to the measles virus while you are pregnant.

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Selected links

NHS Direct Wales links

MMR

Mumps

Rubella

External links

Public  Health - Measles

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The information on this page has been adapted by NHS Wales from original content supplied by NHS Choices.
Last Updated: 20/05/2015 08:37:44

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