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Measles

 

Measles (sometimes known as rubeola) is a highly infectious viral illness. It causes a range of symptoms including fever, coughing and distinctive red-brown spots on the skin.

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.

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

How common is measles?

The success of the MMR vaccine means that in Ireland, cases of measles are less common. Before the vaccine was introduced in Ireland it was common for thousands of cases to be reported each year.

Outbreaks still occur in Ireland. During the large measles outbreak in Ireland in 2011 nearly 300 cases were reported.The number of cases reported in 2010 was 405 compared with 162 in 2009 and 55 in 2008. The largest outbreak in recent years occurred in 2000, when more than 1600 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.

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.

Who is affected?

Measles is most common among children aged 1-4 years old, although anyone who has not been vaccinated against measles can catch it.

Outlook

Treatment for measles is normally not necessary as the body's immune system can usually fight off infection in a couple of weeks. Typically, once you have fought off the measles infection, you develop immunity (resistance) to it.

However, possible complications of measles include pneumonia, ear and eye infections and croup (an infection of the lungs and throat).

More serious complications, such as inflammation of the brain (encephalitis), are rarer but can be fatal. There are hundreds of thousands of deaths worldwide from measles every year. Three children died in Ireland of measles following the outbreak in 2000.

Measles and pregnancy

If you are planning to get pregnant and you have not had measles, arrange with your GP to have the MMR vaccine. If you catch measles during pregnancy, it can be passed on to your baby, which can be very damaging or even fatal to your baby. Measles in pregnancy can cause miscarriage, premature labour or a baby with low birth weight. The MMR jab cannot be given during pregnancy.

Around 10 days after you get the measles infection, the following symptoms begin to appear:

  • 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 40.6°C (105°F) for several days, then fall but go up again when the rash appears,
  • 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, and 
  • red-brown spotty rash (see below).

The above symptoms generally last for up to 14 days.

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.

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 symptoms, not just a rash.

Most childhood rashes are not measles, but contact your GP without delay if:

  • you suspect it is measles,
  • symptoms worsen,
  • temperature increases to above 38°C (100.4°F),
  • temperature stays high after other symptoms have gone, or
  • there are signs of other related illnesses (see Complications).

Because measles is so infectious you should phone the GP surgery before you go to the surgery so that you can avoid contact with other patients who may be not be immune and could be infected in the waiting area.

Glossary

Sneezing
Sneezing is an involuntary expulsion of air and bacteria from the nose and mouth.
Aches
An ache is a constant dull pain in a part of the body.

Measles (also called rubeola)  is caused by infection with a morbillivirus of the paramyxovirus family. 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. Infection can also occur without direct contact with the person who has measles. The measles virus can survive in the air and on surfaces and objects for a couple of 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 five days after it appears.

Immunity

Anyone who has not had measles before can be infected. However, cases of reinfection, 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 or in close contact with somebody who is infected will develop the condition. Non-immune people who enter the same closed space occupied by someone with measles a couple of hours earlier increases their risk of getting measles.

Glossary

Immunity
The immune system is the body's defence system, which helps protect it from disease, bacteria and viruses.
Sneezing
Sneezing is an involuntary expulsion of air and bacteria from the nose and mouth.
Contagious
Contagious is when a disease or infection can be easily passed from one person to another through infection.
Lungs
Lungs are a pair of organs in the chest that control breathing. They remove carbon dioxide from the blood and replace it with oxygen.

Your GP will usually be able to diagnose measles from the combination of symptoms, 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 HSE Public health Department 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 five days after the appearance of the rash.

Glossary

Blood test
During a blood test, a sample of blood is taken from a vein using a needle, so it can be examined in a laboratory.

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, symptoms will usually disappear within 7-10 days.

If your child has measles, you may find the following advice useful:

  • Use liquid baby paracetamol or ibuprofen to relieve fever, aches and pains. Do not give aspirin to children under the age of 16.
  • Closing curtains or dimming lights can help reduce light sensitivity.
  • Damp cotton wool can be used to clean away any crustiness around the eyes. Use one piece of cotton wool per wipe for each eye. Gently clean the eye from inner to outer lid.
  • Cough medicines are of little help and should not be given to children under the age of six. Children over 12 months old may benefit from a teaspoon of lemon juice and two teaspoons of honey in a glass of warm water. Honey should not be given to babies under the age of 12 months.
  • Placing a bowl of water in the room will make the atmosphere more humid, which can help relieve a cough.
  • Feverish small children rapidly lose water, which makes a cough worse. Children should drink as much as possible to prevent dehydration.

While antibiotics are of no use to treat the virus, they may be prescribed for any secondary bacterial infections that develop.

In severe cases of measles, particularly when there are more serious complications, hospital treatment may be required.

Glossary

Immune system
The immune system is the body's defence system, which helps protect it from disease, bacteria and viruses.
Fever
A high temperature, also known as a fever, is when someone's body temperature is 38°C (100.4°F) or above.
Antibiotics
Antibiotics are medicines that can be used to treat infections caused by micro-organisms, usually bacteria or fungi. Examples of antibiotics include amoxicillin, streptomycin and erythromycin.
Aches
An ache is a constant dull pain in a part of the body.
Dehydration
Dehydration is an excessive loss of fluids and minerals from the body.

Complications resulting from measles are more likely to develop in certain children, for example:

  • children with a weakened immune system, such as those with leukaemia or AIDS,
  • children with a poor diet, and
  • children under the age of five.

Complications are also more likely to develop in adults who are over the age of 20.

Common complications

Some of the common complications of measles are:

  • diarrhoea,
  • vomiting,
  • eye infection (conjunctivitis), and
  • inflammation of the voice box (laryngitis).

Inner ear infection and inflammation (otitis media), which often causes earache, may also be a complication of measles.

Fits that are caused by a fever (febrile convulsions) are also possible complications of measles. However, the fits, although alarming, are not usually dangerous.

Less common complications

Less common complications of measles are:

  • meningitis,
  • pneumonia (lung infection), signs of which are fast, difficult breathing, chest pain and deteriorating condition,
  • hepatitis (liver infection),
  • encephalitis (inflammation of the brain), which can be fatal, so watch for drowsiness, headache and vomiting,
  • low platelet count, known medically as thrombocytopenia, which affects the blood's ability to clot,
  • bronchitis and croup (infection of the airways), characterised by a hacking or barking cough, and
  • squint, if the virus affects the nerves and muscles of the eye.

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. Although the condition is fatal, it is very rare, occurring in only 1 in every 100,000 cases of measles. t is more common among people who got measles early in life.

Glossary

Brain
The brain controls thought, memory and emotion. It sends messages to the body controlling movement, speech and senses.
Blood count
A blood count is when a sample of blood is taken, usually from your arm, and then examined in a laboratory to look at the number of cells it has.
Drowsiness
Drowsiness is when someone feels extremely tired and uncontrollably near to sleep.
High temperature
A high temperature, also known as a fever, is when someone's body temperature is 38°C (100.4°F) or above.
Immune system
The immune system is the body's defence system, which helps protect it from disease, bacteria and viruses.
Vomiting
Vomiting is when you bring up the contents of your stomach through your mouth.
Platelet
Platelets are cells in the blood that control bleeding by plugging the broken blood vessel and helping the blood to clot.
Pain
Pain is an unpleasant physical or emotional feeling that your body produces as a warning sign that it has been damaged.
White blood cell
White blood cells are the part of blood that fight infection and disease.
Heart
The heart is a muscular organ that pumps blood around the body.
Inflammation
Inflammation is the body's response to infection, irritation or injury, which causes redness, swelling, pain and sometimes a feeling of heat in the affected area.
MMR
MMR stands for measles, mumps and rubella. It is a vaccine that prevents measles, mumps and rubella by making the body produce antibodies that will fight off the viruses.
Diarrhoea
Diarrhoea is the passing of frequent watery stools when you go to the toilet.
Lung
Lungs are a pair of organs in the chest that control breathing. They remove carbon dioxide from the blood and replace it with oxygen.

If you think that your child may have measles, keep them away from other children for at least five days after the rash has appeared.

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

MMR vaccination

The first MMR vaccination should be given to all children at around 12 months of age. A booster dose is given at school entry. Between 5% and 10% of children are not fully immune after the first dose, so the booster jab helps to increase protection. Less than 1% of children remain at risk after the booster.

If a child who is younger than 12 months of age 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 of age.

Children aged under 6 months

If the child's mother has had measles in the past, 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.

Children aged 6-11 months

A child aged between 6 and 11 months who is exposed to the measles virus will normally be given the MMR vaccine to protect them. 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 children should have another dose between 12-15 months of age, at least one month after the first dose given in the first year of life. It the risk of measles is no longer higher it may be best to allow three months  between doses in order to maximise the response to the vaccine in children less than 18 months of age. Another dose should be given at 4-5 years of age

Travelling on a plane 

If you or your child has measles, you will not be able to fly until at least four days after the rash has appeared and you are well enough to travel. Inform the airline as soon as measles is diagnosed.

If you or your child has been exposed to measles and you are not already immune there is a high risk that measles will develop. You or your child should not travel if infectious. Speak with your GP and seek advice.

It is also important to let your travel insurer know if you or your child have had measles or been exposed to measles. You need to make sure that you'll be covered if you have to delay or cancel your holiday, or if you need to extend your stay until your child is well enough to fly home.

Glossary

MMR
MMR stands for measles, mumps and rubella. It is a vaccine that prevents measles, mumps and rubella by making the body produce antibodies that will fight off the viruses.
Immunisation
Vaccination or immunisation is usually given by an injection that makes the body's immune system produce antibodies that will fight off a virus.
Immune
The immune system is the body's defence system, which helps protect it from disease, bacteria and viruses.
Dose
Dose is a measured quantity of a medicine to be taken at any one time, such as a specified amount of medication.
Womb
The uterus (also known as the womb) is a hollow, pear-shaped organ in a woman where a baby grows during pregnancy.
Antibodies
Antibodies and immunoglobins are proteins in the blood. They are produced by the immune system to fight against bacteria, viruses and disease.
Epidemic
An epidemic is a sudden outbreak of disease that spreads through a population in a short amount of time.
Immunoglobulin
Immunoglobulin (antibodies) is a type of protein in the body that fights off infection.

Content provided by NHS Choices www.nhs.uk and adapted for Ireland by the Health A-Z.