Measles Is Not a Little Red Rash, But Has 2 Big Problems
Measles continues to infect 20-30 million individuals every year, mainly in sub-Saharan Africa and in Asia, in areas where access to vaccines is limited. The Phillipines saw a large outbreak in January. In the United States, the CDC declared Measles as eradicated in 2000, but the recent months have seen the largest spike (700 cases in 22 states since January). Here’s explaining why Measles is such an important public health hazard.
Measles is a virus, and it infects the respiratory system. By invading and growing in the trachea and lungs, it rapidly multiplies and grows in the body. In about 4 days after contracting the virus, infected individuals will have a high fever (104 degrees), with a cough, runny nose, conjunctivitis, and a unique rash presenting as red and white spots appearing first behind the ears, spreading down to the head and neck, and eventually involving the entire body. Physicians will often refer to the pathognomic rash of measles as a maculopapular rash. Another unique clinical symptom is the presence of Koplik’s spots - unique white spots or lesions on the inside of the mouth. Since the virus grows in the respiratory system – it is transmitted, just like the common cold, through airborne respiratory droplet infection when an infected individual coughs or sneezes into the air.
So what's wrong with that – you may wonder? Little red rash and a fever? What's all the fuss about anyway?
Well – two big problems.
A. what happens next to the entire exposed population exposed to the virus, and B. the potential complications of patients infected with the virus – remain disconcerting.
In susceptible individuals and populations (who are not vaccinated against measles or who have not had the disease), the rate of contracting an active infection is 90%. This figure means 9/10 unvaccinated children will contract measles when exposed to the virus. The high rate of transmission explains its rapid spread among groups of unvaccinated individuals in the United States in the last three months. Making things even more contagious is the hardy resilience of the measles virus; it survives for up to 3 days on surfaces and in dust contaminated with the infected respiratory droplets. Just think of all those infected door handles, public restrooms, airplanes and airports, dusty carpets and tabletops in shared spaces - all potential public health problem for the spread of measles.
Furthermore – measles can turn into something far worse than a rash and a fever in some of the infected. In the majority of infected children, symptoms resolve spontaneously after 3-4 weeks. Milder complications appearing 3-5 days after exposure to measles include mild diarrhea, middle ear infection (otitis media), and conjunctivitis. More severe clinical sequelae of infection include conjunctivitis, corneal scarring, and potential blindness. 1/1000 children infected with measles will develop encephalitis (infection of the brain tissue), seizures, and potentially permanent brain damage. 1-2 /1000 children infected with measles will die from the complications of measles – usually from a severe brain infection. Adults unimmunized with the measles virus will usually manifest more severe symptoms and complications. Furthermore, measles produces a suppression of the body’s immunity, worse in adults than children, causing additional bacterial infections to body organs and systems, lasting months after initial exposure. These infectious complications resulting from the measles virus make the morbidity (loss of functional life) from the disease very high in adults.
Treatment of Measles
There is no definitive treatment for Measles once contracted. Meaasles is a virus, not a bacterial infection treatable with antibiotics.
Treatment of Measles involves supportive fluids, hydrations, antipyretics to lower temperature. If patients do develop superadded infectious sequalae from their immunocompromised state, antibiotics are added. Severe brain injury and encephalitis will be managed by qualified medical personnel as required.
So how do we prevent measles? A hallmark achievement of modern medicine is achieving the eradication of once common communicable disease, including mumps, measles, rubella, polio, diptheria, and tetanus. By injecting a small amount of virus into young children (the measles vaccine is administered at 12 months and another booster is administered at age 4), the body’s natural immune system will produce anti-measles IgM Antibodies. When the vaccinated individual is re-exposed to the air born infectious droplets, these IgM Antibodies will automatically attack the virus, preventing the development of any disease.
A common myth concerning the Measles vaccine is that it is linked to autism. My sequela to this article will address this fictional. Escomplication, as well as shedding light on how to treat established measles outbreaks to avoid further transmission. But scientific evidence shows only 1/1,000,000 of individuals receiving the measles vaccine will develop any sort of complication at all.
I do hope you have enjoyed this article, and it will shed some light on your decision and thought process to weigh the benefits of vaccination vs. risking children to complications of measles vaccination.
1. The Washington Post April 19 2019, page 4
2. Milner, et al. Diagnostic Pathology and Infectious Diseases: an Ebook. Elsevier Health Sciences 2017-2018 pp 24-28
3. Stanley, Jacqueline. Essesntials of Immunology and Serology.Cengage Learning 2017 pp 323-328
4. Atkinson, William Epidemiology and Prevention of Vaccine Preventable Diseases (12th Ed). Public Health Foundation 2012 pp 310333
5. Measles (Rubeola): Signs and Symptoms. Cdc.gov publication November 3 2017