What do we need to know in a Measles outbreak? Part One

Signs and symptoms and complications of Measles

Boy with Day 3 Measles rash, photo courtesy of CDC: https://phil.cdc.gov/details.aspx?pid=1150

Measles is a viral infection that was declared per the CDC eradicated in the USA in the year 2000. It has however returned with a vengeance. As physicians we need to know how to handle these patients, as well as give clinical guidance to concerned family members and healthcare personnel. I have never seen a case of measles. In fact, I was not vaccinated for it as a child! I was only vaccinated for it when I was in my twenties and starting out in healthcare. I know I have immunity now based on my serology levels. I know what I know from the text books.

Let me remind those of you who are similar to me: Measles occurs only in humans. It is passed by aerosolized respiratory droplets and by direct contact. It is highly infectious and in the pre-vaccination period more than 90 % of individuals were infected by age 10 years. That’s how contagious it is!

Signs and symptoms of measles:

Per the WHO the incubation period is 10-14 days from exposure to onset of rash and patients are contagious from about 4 days before onset of rash until 4 days after the rash. In temperate zones, the incidence tends to peak in late winter and in early spring, whereas in tropical zones it occurs during the dry season. The patient presents with symptoms of high fever (can be as high as 105 degrees), cough, coryza (URI type symptoms with rhinorrhea) and conjunctivitis. Do you remember the 3 C’s as a medical board question? The typical maculopapular rash appears after 3-4 days and this is accompanied by a fever 102-104 degrees.

Child with measles with conjunctivitis, taken in 1999, picture courtesy of the CDC: https://phil.cdc.gov/details.aspx?pid=989

At the onset of the rash there are bluish-white spots seen in the oral mucosa (Koplik spots).  These are pathognomonic of measles. Patients should improve after the 3rd day after the rash appears and should be fully recovered 7-10 days after onset of the disease.  

Koplik spots seen in mouth, pathognomonic for measles. Photo courtesy of CDC:
Complications of measles:http://www.immunize.org/photos/measles-photos.asp

The severity of measles depends on the host and environmental facts including overcrowding, malnourishment and if immunocompromised. Common complications include otitis media resulting in deafness, laryngotracheobronchitis, pneumonia and diarrhea with a protein losing enteropathy.  Post infectious measles encephalitis (Roald Dahl’s daughter died of this) occurs in about 1 in 1000 and subacute sclerosing panencephalitis occurs rarely and can occur up to 10 years after the acute infection and is fatal. A Vitamin A deficiency, in the setting of measles, can result in permanent blindness. In addition Vitamin A deficiency contributes to a delayed recovery and high rate of post measles complications and may precipitate Acute Vitamin A deficiency and xerophthalmia (pathologic dryness of the eyes).

In my next blog I will discuss the treatment, complications, post- exposure prophylaxis and incidence of Measles in recent years. Stay tuned for Part 2.

Dr. Lynell Newmarch, MD can be found athttps://www.adoctorsview.com

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  1 comment for “What do we need to know in a Measles outbreak? Part One

  1. mamadoc
    May 2, 2019 at 10:39 pm

    This old woman had the measles as a kid and it wasn’t fun. I have only seen one case in my career and that was as a resident in the late 1970’s. In our clinic we’re checking titers on the 40-60 age group if they don’t have 2 doses (and most of them don’t and even if they did records are unobtainable) and offering boosters if not immune. The under 40s are mostly fully vaccinated, unless their parents are lunatics. NEVER thought I’d have to worry about seeing measles.

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