Measles

Historical Overview  

Measles caused great alarm in the past and the disease is still regarded very apprehensively in remote parts of the world, where case fatality rates may reach high levels.  With improved socioeconomic conditions and the discovery of antibiotics to control secondary pneumonia, mortality due to measles has fallen dramatically this century, although considerable mortality is still being recorded.  This is disappointing in view of the major success of measles vaccination programs.

In the early 1900’s the King of Fiji and his son returned to Fiji from an overseas holiday, taking the measles virus with them, which resulted in the death of one - fifth of the whole population.

In the 20 years from 1966 to 1985, measles caused more deaths in Australia than diphtheria, tetanus, pertussis and poliomyelitis combined.

Recent Developments

Measles is a highly infectious disease and, apart from those living in remote areas, few persons go through life without becoming infected.  

Measles is an acute, highly communicable viral illness due to a morbillivirus transmitted via the respiratory tract.  The disease is often associated with fever, conjunctivitis, coryza, cough and Koplik spots on the buccal mucosa.  A characteristic red blotchy rash appears on the third to seventh day, beginning on the face, becoming generalised, lasting 4-7 days. 

Diagnosis is usually made on clinical and epidemiological grounds, but allergic rashes, perhaps due to drugs, may cause confusion.  Laboratory diagnosis of measles can usually be made by the demonstration of rising antibody titres in acute and convalescent sera.   

Mode of transmission is by direct contact with nasal or throat secretions of infected persons and through the air by droplet spread. 

Incubation period - 7 to 21 days (usually 9-12).  Measles vaccine is effective if given within 72 hours of exposure. 

Communicability - Infectivity is highest during the onset of the disease (prodromal period) and during the first 48 hours of the rash. 

Preventative measures - All persons who have not had the disease or who have not been satisfactorily immunised are susceptible.  Acquired immunity after disease is permanent.  Infants born of mothers who have had the disease are immune for approximately the first 6-9 months if breastfed, if not breastfed antibodies last about 3 to 4 months.

Children under 12 months old should be given normal immunoglobulin.  They will eventually need to be immunised with measles vaccine but not until at least 3 months after the immune globulin.

The measles vaccine is a freeze dried preparation containing live attenuated measles virus currently used as a combination vaccine with mumps and rubella (MMR).  Vaccination results in seroconversion in 95% of recipients.

Children over 12 months old who have not been immunised should be given measles vaccine or MMR unless they are immunocompromised (leukaemia, lymphoma etc).

Children over 12 months old with HIV infection should be given measles vaccine.

Children (in a hospital situation) who are exposed to measles and who have not been previously immunised should if possible be discharged home after receiving active or passive immunisation.  If this is not possible they should be isolated 6-21 days after contact.

Airborne and droplet Precautions - should be practiced at all times and patients should be nursed in a single room.

Notification to the Public Health Unit Measles is a notifiable disease to the Public Health Unit.

References

Benenson AS ed, 15th ed, 1990, Control Of Communicable Diseases In Man. American Public Health Association, Washington. 

Committee on Infectious Diseases, American Academy of Pediatrics, 23rd ed. 1994, Red Book, Report of the Committee on Infectious Diseases, America.

National Health and Medical Research Council, 4th ed. 1991,  The Australian Immunisation Procedures Handbook, Canberra. 

National Health and Medical Research Council, 5th ed. 1994.  The Australian Immunisation Procedures Handbook, Canberra. 

NSW Health Department, 1999, Infection Control Policy.  99/87 AIDS/Infectious Diseases Branch.  Sydney. 

Reid D, Grist NR, Pinkerton IW, 1986, Infections in Current Medical Practice. Butterworth, London. 

The Children’s Hospital, Camperdown, 1992, Prevention of Measles in Hospitalised Patients.  Clinical Cross Infection Committee.  Sydney.

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