A Beginner's Guide to the Measles

Red measles (rubeola, sarampión) hasn't been widely seen for over a generation because the vaccine introduced in 1963 and the improved vaccines introduced over the next 46 years brought the number of cases in the USA to near zero. The current generation of parents has no direct experience with measles and may learn the hard way why measles was considered significant enough to develop a vaccine to prevent it. Thanks to an egregious case of scientific fraud and media hysteria, measles is making a comeback.

Here's what to expect, translated from the medicalese, during a typical case of measles.

The contagious stage of measles: Measles is contagious from 1 to 2 days before the symptoms show up until 4 days after the rash appears. Yes, your child can catch measles from an apparently healthy playmate. And before you have any idea your child is ill, the child can be spreading measles to classmates, siblings and even to persons they will never see or touch.

The measles virus can stay in the air and infect people for as long as a couple of hours after the infected child has gone. The next one in the chain of infection doesn't have to touch or even see the source of the virus. Just breathing the air in a classroom, pediatrician's office, or pizza parlor where a measles victim has been recently can be enough.

The respiratory stage of measles: After a 7- to 14-day incubation period, your child will appear to have a cold. They will have a fever, a hacking cough, a runny nose (coryza), and watery reddened eyes (conjunctivitis). If you know where to look, you may see "Koplick's spots" in the mouth, looking like tiny white dots inside a larger red circle. Your child may complain of a sore throat and have a hoarse voice. Some children, especially young ones, may have febrile convulsions.

The rash stage of measles: A few days after the illness begins you will see the rash starting to form. The measles rash almost always begins on the face, producing bright red cheeks. It spreads downward to the body, then the arms and legs including the palms of the hands and the soles of the feet. The rash starts out flat and blotchy (macular), then develops distinct bumps (papules). In some cases capillary blood vessels break and leak into the skin, making small marks called "petechia" and larger bruise-like "ecchymoses".

The extent of the rash varies widely. Some children only have a light dusting of spots and others are almost 100% covered by the blotches.

The "crisis stage" of measles: At the worst of the measles infection, your child may have a temperature near 104F, a rash-covered body,"prostration" (extremely weak and listless), diarrhea, extreme sensitivity to light, the hacking cough, and itching skin. That will last for 3 to 5 days, then the fever abruptly falls and your child will begin to feel better.

The rash will fade in the order it appeared, leaving a brownish shadow of itself that lasts for a few weeks, and in many cases the child's skin "desquamates" (the top layer comes off in large flakes) over the area that was covered by the rash as the virus-damaged skin cells are shed.

When measles becomes serious: A virus that causes a predictable week or so of misery to your child, probably with lots of home nursing on your part, isn't exactly a "mild childhood disease" is it? And that's just the uncomplicated cases.

In recent outbreaks, 20% to 30% of the infected persons have been sick enough to be admitted to a hospital. Some were admitted to treat the primary symptoms of the viral infection - the dehydration from diarrhea, the high fever, viral pneumonia, and encephalitis. Most were admitted to treat problems caused by secondary infections.

The measles virus actually suppresses the victim's immune system, leaving them more suceptible than usual to the opportunistic bacteria that lurk almost everywhere. Otitis media (infection of the middle ear) and various types of pneumonia are the most frequent secondary infections. Diarrhea from bacterial infections during the convalescence from the virus is common.

Rarely the virus may cause "hemorrhagic measles", also called "black measles" from the dark color of the rash. This is accompanies by clotting problems and tissue death. If your child's skin takes on a dusky or blue-tinged appearance, do not pause on your way to the hospital.

Subacute sclerosing panencephalitis (SSPE), the rarest of the complications, deserves its own paragraph. 1 in 100,000 people infected with measles develop SSPE. It is more likely to appear if the infection happened before the age of 2. It doesn't appear until several years after the infection. When the measles virus persists in the brain, a progressive encephalitis develops. If caught early, the victim can be treated by life-long anti-viral medications.

SOURCES:

Practice of Medicine, J. C. Meakins, M.D. Published by C.V. Mosby Co., 1944

Measles Selina SP Chen, MD, Glenn J Fennelly, MD, Jan 17, 2008 URL: http://emedicine.medscape.com/article/966220-overview

Encyclopedia Britannica, 11th Edition, 1911 (also available online at: http://www.1911encyclopedia.org/Measles