Measles

The first symptoms of measles develop 7 to 14 days after contact with the virus. They include:

• Cough
• Runny nose
• Watery eyes
• Fever

Measles rash appears 3 to 5 days after the initial symptoms.

1. Initial symptoms

The initial symptoms develop after 7 to 14 days of infection. They begin with a high temperature that reaches around 104°F. Other symptoms include:

• Cough
• Runny nose
• Swollen eyelids
• Weakness
• Loss of appetite
• Watery eyes
• Red eyes that may be sensitive to light

2. Koplik spots

A day or two before the rashes appear, Koplik spots may develop inside the mouth. These are small grayish-white spots that usually last for a few days, but not everyone will have them.

3. Measles rash

A measles rash typically appears 2 weeks after the initial symptoms. The symptoms become more severe, signaling the host’s immune response to the replicating virus. The rash usually begins as small red spots, which can join together to form large blotchy patches. It first appears on the neck or head before spreading to the rest of the body. The rash fades slowly in the same order in which it appeared. Resolution of the rash may be followed by desquamation, particularly in undernourished children. Since the rash is a consequence of the immune response, it may be absent in immunocompromised individuals.

4. Other symptoms

Additional symptoms may include:

• Headache
• Abdominal pain
• Vomiting
• Diarrhea
• Myalgia

Measles is caused by an extremely contagious virus called morbillivirus, a member of the paramyxoviridae family. It is spread by:

• Contaminated droplets that are transmitted through the air while coughing, sneezing, talking, or coming in direct contact with infected nasal or throat secretions. The virus remains contagious in the air for up to two hours.
• Sharing food, drinks, and utensils with someone who has measles.
• Kissing someone with measles.
• Shaking hands or hugging someone who has measles.
• Transmission from pregnant women to their babies during pregnancy, delivery, or while breastfeeding.

It can take one to three weeks to show symptoms of measles after being infected. This is the incubation period, which may be shorter in infants and longer in adults. One is contagious about four days before developing a rash to about four days after the rash appears.

Risk Factors of Measles

While measles can affect anyone, certain risk factors elevate the likelihood of contracting the disease. These include:

• Vitamin A deficiency: Measles is a major cause of morbidity and mortality. Individuals with Vitamin A deficiency have a significantly higher risk of measles infection.
• Being unvaccinated: Unvaccinated young children are particularly susceptible to measles and its complications, including death. Unvaccinated pregnant women and non-immune individuals are also at risk of infection.
• International travel: Traveling to countries where measles is common and less controlled increases the risk of developing the disease.
• Countries experiencing a measles outbreak: Regions undergoing or recovering from natural disasters often see damage to health infrastructures, which interrupts routine immunization and significantly increases the risk of infection.

It is important to detect measles as soon as possible since it is a contagious disease. Establishing a diagnosis for measles involves the following:

1. Clinical evaluation

   Healthcare providers should consider measles in patients with febrile rash symptoms and white centers in the mouth (Koplik spots). Koplik spots are especially helpful because they appear early. If the child has recently traveled or is unvaccinated, measles is even more likely. Sometimes other diseases can be complicated with measles, but measles rashes are easy to differentiate from other rashes. The rash starts on the hands and face rather than the trunk.

2. Lab tests

   Laboratory confirmation is important after the clinical evaluation is done by the doctor.

   • IgM antibody: Detection of measles-specific IgM antibody in serum. The antibody is usually present soon after the rashes appear. The level of antibody is highest during the 14th day and is not present after 30 days.
   • IgG antibody: A four-fold or greater increase in measles virus-specific IgG antibody levels is seen between acute and convalescent phase serum specimens.
   • Virus culture: Measles can also be diagnosed by isolation of the virus in cell culture from respiratory secretions, nasopharyngeal or conjunctival swabs, blood, or urine.
   • Giant cell test: Direct detection of giant cells in the respiratory secretions, urine, or tissue obtained by biopsy provides another method of diagnosis.
   • Real-time polymerase chain reaction (RT-PCR): Measles RNA by RT-PCR is a common method for confirming measles. Serum samples as well as throat swabs are used for sample collection.
   • Urine sample: A urine sample can also contain the virus. Collecting urine samples can increase the chances of detecting the measles virus.
3. Molecular analysis

   Genotyping is done to map the transmission pathway of the measles virus. Genotyping distinguishes between wild-type measles virus infection and rashes induced by measles vaccination.

As measles is a viral disease, antibiotics cannot treat it. The best approach is to learn how to prevent it:

1. Measles, mumps and rubella (MMR) vaccine
   Getting vaccinated is the best way to prevent measles. You can choose between the measles, mumps, rubella and varicella (MMRV) combination vaccine or the MMR vaccine. Periodic boosters of the vaccine are necessary to maintain immunity. The following individuals should get vaccinated to protect themselves:
   • People who have never had measles
   • Infants between 6 to 11 months of age
   • Individuals unsure of their vaccination history
   • The second dose should be administered at 3 years and 4 months of age
   
   Note: The measles vaccine is well tolerated and immunogenic in HIV-1 infected children and adults, though antibody levels may decrease over time. Due to the potential severity of wild type measles virus infection in HIV-1 infected children, routine measles vaccination is recommended, except for those who are severely immunocompromised. The measles vaccine is contraindicated in severely immunocompromised individuals due to the risk of progressive pulmonary or CNS infection with the vaccine virus.
2. Human normal immunoglobulin (HNIG)
   HNIG is a concentrated source of antibodies that provides short-term but immediate protection against measles. It is recommended for individuals in the following groups if exposed to someone with measles:
   • Babies under 6 months of age
   • Pregnant women who have not been fully vaccinated
   • People with compromised immune systems
   
   In immunocompetent individuals, administering immunoglobulin within 72 hours of exposure typically prevents measles virus infection and almost always prevents clinical measles. Administration up to 6 days after exposure can still prevent or modify the disease.
3. Special circumstances
   A dose of the MMR vaccine can be given to children over 6 months of age under certain circumstances, such as:
   • An outbreak of measles in your area
   • Exposure to measles
   • Traveling to areas where measles is widespread
4. Isolation
   To prevent the spread of measles, maintain distance from individuals infected with the virus. An infected person should be isolated for a few days to a few weeks before returning to normal activities.
5. Practice hygiene and cleanliness
   To reduce the risk of measles, maintain cleanliness and prevent infections. Follow these steps:
   • Avoid touching your nose and mouth as much as possible
   • Use tissue paper when coughing or sneezing
   • Always use hand sanitizer
   
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There is no specific treatment for measles, and the condition usually improves by itself within 7 to 10 days. To avoid spreading the infection, it is important to refrain from contact with vulnerable individuals such as pregnant women, immunocompromised persons, and young children. Additionally, it is advisable to stay away from work or school for at least 4 days after the measles rash first appears. The treatment focuses on relieving symptoms and supporting the body in fighting the infection. If symptoms cause discomfort, they should be addressed while the body combats the virus. The treatment approach includes:

• Controlling fever and relieving pain: Paracetamol and Ibuprofen can be taken to manage fever and associated pain. Liquid infant paracetamol is suitable for young children.
• Taking Vitamin A supplements: Children with low levels of Vitamin A are more likely to experience severe symptoms of measles. Vitamin A has been shown to reduce the severity of the illness. The WHO recommends administering daily doses of 200,000 IU of Vitamin A for 2 consecutive days to all children with measles over 12 months of age, with lower doses for those aged 6-12 months.
• Drinking plenty of fluids: If your child has a high temperature, ensure they drink ample fluids to reduce the risk of dehydration.
• Treating sore eyes: Cleaning your child’s eyelids and keeping curtains closed or dimming the lights can help soothe their eyes.
• Treating cold-like symptoms: If your child exhibits cold-like symptoms, sitting in a hot bathroom and drinking warm drinks with honey can help relax the airway and alleviate a cough.
• Dealing with other illnesses: Medical care is crucial to prevent serious complications associated with the measles virus. Some serious issues include:
  • Shortness of breath
  • Convulsions
  • Sharp chest pain
• Ribavirin (antiviral): Some case reports suggest the use of intravenous ribavirin in immunocompromised patients. However, the benefits of ribavirin for measles have not been conclusively proven in clinical trials.

There is no specific home care treatment for measles. The patient requires care, timely medications, and certain precautions since it is a contagious disease. Home care is essential to make the disease more tolerable:

• Get plenty of rest
• A sponge bath can reduce discomfort due to fever
• Drink plenty of water
• Use pain relievers and analgesics such as acetaminophen
• To reduce itching from the rash, apply witch hazel on the rashes or add oatmeal to a bath

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Measles can cause the following complications:

1. Common Complications

• The most common complications are otitis media and bacterial pneumonia.
• Other respiratory complications include laryngitis, tracheitis, bronchitis, giant cell pneumonia, bronchiectasis, and the reactivation of latent M. tuberculosis infection.
• Gastrointestinal complications include persistent diarrhea, appendicitis, hepatitis, and ileocolitis.

2. Severe Complications in Children and Adults

The severe complications include pneumonia and encephalitis. These complications can be life-threatening, and patients require hospitalization for proper recovery.

3. Long-term Complications

Subacute sclerosing panencephalitis (SSPE) is a rare and fatal disease of the central nervous system that develops 7 to 10 years after a person has measles, occurring at a frequency of 1 per 100,000 cases.

4. Rare Complications

In rare cases, measles can lead to heart and nervous system problems, as well as serious eye disorders.

The following home remedies can aid in recovery from measles:

• Aloe vera: Applied to the inflamed area, it soothes irritated skin.
• Neem leaves: With antibacterial and anti-allergic properties, neem relieves itching from skin rashes. Make a thin paste of neem leaves, apply to the affected area, and allow it to dry.
• Licorice herb: An ancient remedy for measles, licorice tea helps reduce cough associated with the illness.
• Baking soda: Adding one cup of baking soda to bathwater provides quick relief from itching.
• Coconut water: Rich in nutrients, it cleanses the body. Drinking plenty of coconut water flushes out toxins and keeps the body hydrated.
• Turmeric: Known for its antioxidant and antiseptic properties, turmeric is used as a traditional remedy. Drinking hot water infused with turmeric and honey helps alleviate symptoms of measles.
• Green tea: Beneficial for its antioxidant, anti-inflammatory, and immune-boosting effects, caffeine-free green tea is recommended.
• Phyllanthus amarus: This medicinal plant is used in the treatment of measles. However, it may interact with lithium, diabetes, and blood-thinning medications like warfarin; thus, it should be consumed only after consulting your doctor.

Dietary Modifications

• Drink eight glasses of filtered water daily.
• Avoid refined foods, such as white bread, pasta, and sugar.
• Use healthy oils for cooking, such as olive oil, coconut oil, or ghee.
• Reduce or eliminate trans fats found in processed foods, including biscuits, namkeens, and cakes.
• Limit caffeine-containing beverages like coffee.
• Avoid alcohol and tobacco.

Nutritional Supplements

• A daily multivitamin containing antioxidants, vitamins A, B, C, E, and minerals such as magnesium, calcium, zinc, and selenium is recommended.
• Omega-3 fatty acids, such as fish oil and flaxseed oil, can help reduce inflammation and improve immunity.
• Probiotic supplements may be beneficial for maintaining gastrointestinal and immune health.