Understanding Measles

Measles is caused by Paramyxovirus (morbillivirus). It is acquired through respiration after direct contact with fluids from the mouth or nose of an infected person, or inhalation via aerosol transmission. Symptoms do not appear for 9 - 12 days after contact, and patients are probably infectious for 2-4 days prior to the onset of symptoms until 5 days after the onset of the rash, although some sources believe patients remain infectious until the rash has completely disappeared.

Measles is a notifiable disease so all patients should contact a doctor to ensure notification, even if they do not require treatment or hospital admission.

Many children are now immunised with the MMR vaccine (usually as babies at 13 months, with a booster at school entry); however, this does not guarantee life-long or full immunity. There is no evidence that the MMR vaccine causes autism, and Healthcare advice is to have the vaccine where possible.

Signs & Symptoms


Fever which persists for 4-5 days
Runny nose with a 'head cold'
Cough
Red Eyes
Generalised maculopapular (spotty) erythematous rash


The rash classically starts on the ears and spreads to the head and neck before spreading accross the whole body. It can be itchy and can change colour from red to dark brown. It usually appears2-4 days after symptom onset and lasts about a week.
Patients often feel very ill and will be listless and anorexic. Classically 'Koplick Spots' can sometimes be seen as greyish-white spots inside the mouth.

Complications

These are relatively common and include:


Diarrhoea
Otitis media


Life threatening acute complications include:

Pneumonia
Encephalitis (which can lead to Brain Damage)
Long term corneal ulceration and scarring can occur, causing blindness

Risk of complications increased in:

Adults
Pregnancy
Vitamin A deficency and malnutrition
Immunocomprimised patients

What you should do if you think your patient has measles

If you think your patient has measles, you should assume they have!

Take routine IPC precautions. The patient either needs to notify their GP or to go to hospital immediately if there is any suspicion of bronchitis, pneumonia or encephalitis.
Antibiotics may be required for bacterial secondary infection.

There is no specific treatment, which should be as for any flu-like viral illness. Most patients need rest and supportive treatment with paracetamol/ibuprofen as indicated. Under 12's should not be given aspirin due to the risk of Reye's syndrome.
Some patients are light-sensitive and may benefit from being in a darkened room. Eyes can be gently cleaned with damp cotton wool.

Normal flu advice with safety netting should be given, to watch out especially for respiratory or neurological complications and seek urgent hospital treatment if symptoms appear

If you think you have come into contact with measles and you do not think you are immune, you should seek advice from Occupational Health or your GP.