The US government announced in 2000 that measles had been eradicated but this statement was premature as 288 cases were reported in 2014. This year in January 2015, 102 people from 14 states in the USA were reported to have measles which authorities traced back to Disneyland, California.
In the UK, newspaper headlines declare that we are also on the brink of a measles epidemic due to the decreasing rate of children being immunised. The MMR vaccine has been around for over a decade but concerns about side effects have lowered parents’ confidence and this has reduced the number of children being vaccinated to a serious level. Government figures confirm 99 cases of measles for 2014.
We look at measles; its signs and symptoms, complications, treatment and prevention.
What is measles?
Measles is a notifiable disease in England and Wales meaning that doctors have to notify the authorities of any suspected cases. If the patient is a child the doctor will also notify the school.
The World Health Organisation (WHO) states that measles is one of the leading causes of death among young children. In 2013, there were 145,700 measles deaths globally – about 400 deaths every day or 16 deaths every hour. During 2000-2013, measles vaccination prevented an estimated 15.6 million deaths making measles vaccine one of the best buys in public health.
Measles is caused by the rubeola virus of the paramyxovirus family. The virus lives in the mucus of the nose and throat of an infected child or adult.
The earliest signs and symptoms may include:
- High fever
- Runny nose
- Dry hacking cough.
- Conjunctivitis - swollen eyelids, inflamed eyes.
- Watery eyes
- Photophobia - sensitivity to light.
- Koplik spots (small red spots with bluish-white centres) inside the mouth
- Rash. After several days, a rash appears, usually on the face and upper neck. The rash spreads, eventually reaching the hands and feet and lasts 5 to 6 days before fading. Measles is commonly confused with other infections that can lead to a rash.
It is highly contagious and spreads through coughing and sneezing (contaminated small droplets in the air can remain suspended for up to two hours), and direct contact with an infected person. The virus can be spread within 15 minutes of close contact with an infected person. People with measles are infectious for about four days before and four days after the appearance of the rash.
According to the WHO severe measles complications are “more likely among poorly nourished young children, especially those with insufficient vitamin A, or whose immune systems have been weakened by HIV/AIDS or other diseases”.
Complications of the disease
About one-fifth of people with measles will develop complications, the most common being:
- Ear Infections
- Vomiting and diarrhoea leading to dehydration.
- Laryngitis and bronchitis – Inflammation of the voice box and branches leading into the lungs
- Convulsions – due to the high temperature
- Pneumonia –infection of the lungs. This can be fatal in some people with a weak immune system.
- In pregnancy, measles can cause miscarriage, premature labour or low birth weights.
- Encephalitis, an infection that causes the brain to swell is a less common side effect.
Confirmation of measles is done by testing blood or saliva but there is no specific anti-viral treatment.
Most people will recover with rest, medication to lower the temperature and plenty of fluids to prevent dehydration. Any bacterial infections should be treated with antibiotics.
Isolation - Children who are contagious should be kept away from school and from activities that involve other people. People who have not had measles or have been vaccinated should be kept out of the house.
Prevention is the only way
Measles is prevented by vaccination. In the UK, the vaccination was introduced in 1988. Children receive two doses of the combined measles mumps rubella (MMR) vaccine as part of their routine childhood immunisation schedule. Typically the MMR vaccine is given as a single injection to infants as part of their routine vaccination schedule around their first birthday. They will then have a second injection of the vaccine before starting school, usually between the ages of three and five.
Controversy regarding the safety of the vaccine came about in 1998 when Dr Andrew Wakefield published a study in the Lancet linking the MMR vaccine with autism. This led to a reduction of parents consenting to the vaccination of their children resulting in an increase in the incidence of measles.
Since then, there have been many counter-studies debunking this claim and The British Medical Journal retracted the study in February 2011 causing Dr Andrew Wakefield to lose his medical license.
Will there be an epidemic of measles?
Ten years ago measles was almost eliminated from the UK but infections came back in 2006 as a result of the decline in immunisation uptake that followed the now discredited theories about measles vaccine being linked to autism. In Swansea, Wales' second largest city, there were 808 confirmed cases of measles between November 2012 and April 18th 2013.
In April 2013, Public Health England, NHS England and the Department of Health announced a national catch-up programme to increase MMR vaccination uptake in children and teenagers.
There is no guarantee that measles will be eradicated but it will make it harder for another outbreak to develop.