The medical term for measles is rubeola. We sometimes call it red measles to distinguish it from German measles, or rubella, a much milder illness. Measles is an extremely contagious disease known as a viral exanthem. This means a disease caused by a virus that produces a skin eruption.
Until a few years ago, most young people had never seen anyone with measles. Doctors thought they had conquered this ancient, deadly disease, but they were wrong. When the measles vaccine was licensed in 1963, public health officials figured measles would be eliminated by 1982. This failed to happen, so the target date for measles elimination was revised to 1990. Instead, measles cases in the United States began to rise from only 1,500 cases in 1983 to 28,000 reported cases—about half in children younger than five years old—in 1990. Many high schools and colleges had measles outbreaks in the late 1980s and early 1990s. As a result, athletic events were canceled and classes were disrupted. Most high schools and colleges now require students to be re-immunized. Since 1991, measles is again on the decline.
Rhazes, a tenth century Persian physician, first described measles that he called in Arabic, hasba. This disease spread across North Africa and into Europe. Measles killed thousands of New World Indians when Spanish explorers infected them in 1517. The Spaniards called it pequena, the little leprosy.
Scientists discovered in 1911 that measles is caused by a virus. It wasn’t until 1954 that two Harvard researchers were able to isolate the actual measles virus in the laboratory. They then began to search for a vaccine to prevent it.
How Do You Get It?
Measles is one of the most highly contagious diseases known. It is an airborne disease* that is spread simply by breathing in air that contains the measles virus. When a measles victim breathes, coughs, sneezes, or talks, the virus is released into the air. These virus particles travel through the air suspended in small droplets and can infect people who are nowhere near the person who has measles. In one hour, over 5,000 virus particles will be breathed into the air by someone with measles. These virus particles can remain in the room for almost two hours.
The virus survives best in rooms with low humidity. If you enter a room as long as two hours after someone with measles has left, you can still catch measles from that person. In several hospitals, including the one where I worked, children caught measles from other sick children whose rooms were at the other end of the hall because the measles virus traveled down the hallway and into their room. Indirect contact such as touching the bedding or towels of the infected person will also give you measles.
Direct contact with the secretions from the infected person’s runny nose, eyes, or cough can also spread the disease. If these secretions get on your hands and you touch your eyes, nose, or mouth, you will infect yourself.
There is a milder form of the illness, which occurs in people who are not able to develop adequate immunity from just one dose of vaccine. These people can get measles as their immunity begins to wear off. We don’t know why this happens. They may have low fevers and rashes that appear only on their faces or trunks.
In September 1991, three female teenage gymnasts from New Zealand came down with this milder form of measles while taking part in an international competi-tion in Indiana. Hundreds of athletes, coaches, and 60,000 spectators from 51 countries were at risk of exposure from these three athletes. Officials acted quickly and vaccinated more than 1,100 participants within three days.
Babies will have some immunity to measles when they are born if their mother was immune, either through a vaccine or by having had measles herself. This “maternal immunity” lasts about six months.
How Do You Know If You Have It?
The first signs of measles will appear about ten days after the virus enters your body. This ten days is the incubation period. You will get a fever, as high as 105°F (40.6°C), and a general sick feeling. The next day you will develop a cough; red, puffy, painful eyes (conjunctivitis); a runny, stuffed-up, congested nose (coryza); and a cough. You may only get one or two of these other symptoms, but you will always get the fever, which will last for about six days.
Tests
Doctors usually diagnose measles by symptoms. However, blood tests that look for antibodies to the measles virus are available in large commercial and state labs. Large hospital labs can do rapid tests to detect antibodies in throat specimens and can also grow the measles virus in culture.
How Sick Will You Be?
Everyone who gets measles is miserable, but babies and adults are usually the most seriously ill. Measles is a serious illness. I saw many hospitalized babies and toddlers sick with measles in the winter of 1990 to 1991. They all had the same miserable “measles look.” Children with measles are much sicker than they are with a simple cold or flu or chicken pox.
On the second day of the fever, Koplik’s spots, which are tiny white spots on a red base inside the mouth, will appear. You may not be able to see these spots in your child’s mouth, and they will disappear in a few days. Four days into the fever, all of these symptoms will be worse, and the measles victim will get a rash that usually starts on the face, especially the forehead. It will then spread downward and outward. It will be a bright red, raised, blotchy rash that tends to run together. It is easily seen on all complexions. The rash will probably spread all the way down to the feet in three days, and then will start to fade. Altogether, the rash lasts about six days.
Your child’s fever will begin to fall on the second day of the rash. The runny, congested nose and red eyes usually clear up as the fever falls and the rash fades. The cough, however, can last a long time. Your child may cough for as long as two weeks.
Incubation Period
The incubation period is usually 10 days to the fever and 14 days to the rash, but this can range from 8 to 18 days to the fever. This means that 10 days after you are exposed to measles and the virus enters your body, you will develop symptoms.
Infectiousness
You are infectious from just before the fever begins to the fifth day after the rash appears. The most infectious time is the period before the rash begins. You may not know that you have measles at this time, but you can give it to other people. This period between the first sign of illness and the appearance of the rash is called the prodromal period.
Anyone in the infectious stage of measles must stay away from school and work. If your child has any of the symptoms of measles without the rash, especially the high fever, she should not be sent to school, child care, or any place where there are other children.
Immunity
You can catch measles only once in your life. Before the vaccine, almost everyone got measles as a child. Once you have had the measles infection, your body will develop lifelong immunity. You will have antibodies in your blood that will destroy the measles virus if it tries to enter your body. The vaccine also gives you lifelong immunity to measles. If you receive two doses of the vaccine at the right ages, you will not get measles.
Complications
Babies will get dehydrated more quickly, are more likely to have diarrhea and vomiting, and often are struck with middle-ear infections. A child who develops measles pneumonia may require oxygen or mechanical ventilation to assist breathing. Measles encephalitis, a rare complication, can lead to death or permanent brain damage. Adults can also suffer from very high fevers and dehydration.
Small babies, older people, and people with other serious health problems often get severely ill or even die from measles because their body’s immune systems are unable to develop enough antibodies to destroy the measles virus, and the virus wins the battle. These people may die even if taken to the hospital. Measles is a common cause of death and blindness among malnourished children in developing countries because they have weakened immune systems and cannot fight the infection.
How Do You Treat It?
There is no medicine to cure measles. The disease is going to take its natural course, and the body’s defenses will eventually get rid of it by developing antibodies that destroy the measles virus.
Treatment is symptomatic, that is, doing things that will make your child feel better. A child with measles requires good nursing care and is best cared for at home in familiar surroundings. A parent, reliable babysitter, or friend can provide care. Be sure the caregiver is familiar with the symptoms of the illness and what danger signals to watch for.
Nursing Care
For fever higher than 101°F (38.3°C), give acetaminophen (Tylenol) every four hours. Offer the child plenty of clear fluids to prevent dehydration. Give small sips to prevent vomiting.
Your child needs plenty of rest, so provide quiet activity. Keep the room dark, as bright light may bother your child’s eyes. To soothe itchy, watery eyes, wipe them gently with a warm washcloth. Ease the cough with a cool-mist vaporizer.
Call the doctor immediately for these signs:
■ Vomiting all liquids
■ Signs of dehydration
■ Wheezing or trouble breathing, which may be a sign of measles pneumonia, caused by the spread of the measles virus to the lungs
■ Fever that last more than four days after the rash appears or a fever that goes away and then returns, which may signal the beginning of a secondary bacterial infection
■ Unusual drowsiness, extreme fussiness, stiff neck, or inability to be consoled, which may be signs of measles encephalitis caused by the spread of measles virus to the brain
■ Ear pain, or pulling at the ears, which may be a sign of a middle-ear infection
How Do You Prevent It?
Measles is a completely preventable disease. Two doses of measles vaccine are now needed for complete protection. The first dose should be given to all babies after 12 months and not later than 15 months of age. About 95 percent of people will be protected after this first dose. The booster, which is now recommended at 4 to 6 years old, or at 10 to 12 years, will protect 95 percent of those who may have failed to become immune after their first vaccine dose. Then, 99 percent of the population will be immune. This will leave such a small number of nonimmune people that measles will no longer be a problem. Herd immunity will protect these people. This means that because almost everyone in the population is immune to measles, its spread will be blocked to those few who are not.
In areas where there is a measles epidemic, three doses of vaccine are needed. The first dose is given at 6 months, a booster at 15 months, and a second booster at 4 to 6 years of age.
Measles killed 89 people, more than half of whom were children, in the United States in 1990. In the winter of 1991, nine children in Philadelphia alone died from measles. Two children with weakened immune systems died from measles in the children’s hospital where I worked, despite aggressive intensive medical care.
Measles is again on the decline. In the United States, cases dropped to just under 10,000 in 1991, and to 700 in 1994. Before the vaccine, measles epidemics came in two- to three-year cycles. Public health officials think this may explain the dramatic drop in measles in the United States in 1992 to 1993. Immunization rates among preschool children have improved, but many young children are still not being vaccinated. A few small outbreaks occurred in spring of 1994- Measles will reappear unless all children receive the measles vaccine on time.
Now we understand why the late medical historian Dr. Samuel Radbill wrote that the “measles demon may always be lurking … in some unknown reservoir, ready to strike again at the first opportunity.”