Measles in children and adults - symptoms, consequences, prevention

2018-01-03

• Routes of infection
• Periods of measles
• Measles in an adult
• Complications
• Vaccines

Measles is one of the most contagious infectious viral diseases and has a significant impact on mortality rates among children worldwide, despite the availability of a vaccine. In 2021, there were 89,780 measles-related deaths worldwide.

From 2000 to 2021, measles vaccinations prevented 20.4 million deaths, according to the World Health Organization (WHO). Vaccination against measles is one of the best public health methods to prevent an increase in the incidence. Globally, thanks to the use of the measles vaccine, deaths from the disease have fallen by 84% from approximately 550,100 in 2000 to 89,780 in 2021. The peculiarity of this disease is that it was previously considered a typical childhood infection, but is now increasingly being reported in adults.

Before the introduction of the measles vaccine in 1963 and widespread vaccination, major epidemics occurred approximately every 2-3 years, and measles was estimated to cause approximately 2.6 million deaths per year. According to WHO data as of December 1, 2021, measles vaccination and, as a result, morbidity and mortality are at different levels. Therefore, the following categories have been proposed to classify countries based on their incidence, control, and likelihood of achieving and maintaining elimination of measles and rubella:

• endemic countries (continuous transmission of the measles/rubella virus that persists for more than 12 months in any geographical area);
• countries where transmission of the virus has been excluded or interrupted, but not verified (no endemic transmission of the virus for more than 12 but less than 36 months);
• eliminated and verified (no endemic transmission for more than 36 months with a high quality surveillance system);
• recovered endemic transmissions (unbroken chains of transmission more than 12 months after the previous exclusion test).

There is a direct relationship between the level of vaccination and the forecast for eliminating the disease in a certain area, and the higher the vaccination coverage, the lower the likelihood of endemic transmission of the virus and the greater the likelihood of eliminating measles.

Measles is an acute infectious disease that is caused by a virus and is characterized by airborne transmission. The causative agent of measles is the RNA virus Polinosa morbillarium. It is unstable in the environment, sensitive to ultraviolet rays, sunlight, and drying.

Outside the human body, the virus dies within 30 minutes. Therefore, there is no need for final disinfection for measles.

Measles is a human disease and is not known to occur in animals.

The source of infection for measles is exclusively a sick person who is contagious in the last 24-48 hours of the incubation period (the time from infection to the appearance of clinical manifestations). The virus is then released throughout the catarrhal period (during cough, runny nose, conjunctivitis) and five days from the onset of the rash.

The mechanism of transmission of measles is airborne. The virus enters the environment in large quantities during talking, sneezing, and coughing. Measles is a highly contagious disease (the probability of infection through contact is 95-98%), the virus is contained in droplets of mucus and can be transported through the air over long distances, for example, from room to room, to different floors of the same building, and even from one room to another. The virus is not transmitted through household items, food products or third parties.

Susceptibility to infection does not depend on age. Those who have been vaccinated and children under 3 months who are born to mothers who have measles immunity are protected from infection. Over time, innate immunity decreases and by 6-9 months children become susceptible to infection. But if the mother did not have measles immunity, then the child will be sensitive to measles infection from the first day of life. The state of measles immunity is also influenced by the state of the environment. It was found that children who live in regions with high concentrations of industrial pollution in the air and water have a higher incidence rate than children from ecologically clean areas. It was also found that even small doses of ionizing radiation adversely affect the condition as a general, and specific anti-measles immunity.

Definition of disease

Measles is an acute infectious disease caused by an RNA virus of the Morbillivirus genus.
It is characterized by low stability in the external environment. At room temperature it remains active for 24–48 hours. It dies quickly when dried, heated to 50°C, or exposed to ultraviolet radiation. The first detailed descriptions of the signs of measles appeared in the 17th century, although the disease itself has been well known to mankind since ancient times. In those days, the disease was often called the “childhood plague”, since it was practically not observed in adults. This was explained by the fact that more than 90% of people suffered the infection at an early age - from infancy to 10 years.

Measles is easily transmitted from one person to another, which is why epidemics have occurred regularly in the past. In many children, the disease progressed with the development of serious complications that led to death.

The measles virus was isolated and described in 1954. Nine years later, the first measles vaccine was created. By 1990, about 80% of the population had been vaccinated against measles in most countries. Thanks to this, a steady decline in the number of cases began. If in 1983 about 4 million cases of the disease were registered in the world, then in 1990 - 800,000¹. The mortality rate has also decreased significantly.

An unvaccinated child came into contact with a person with measles. What to do?

“An unvaccinated child who has not reached vaccination age (3-12 months) is given immunoglobulin. This must be done no later than 3-5 days from the moment of contact with the patient. A child over 12 months of age who has not previously been vaccinated for any reason or has been vaccinated once is given post-exposure prophylaxis with a live measles vaccine - within 72 hours of contact with the patient.”

Vanina Yulia Evgenievna

expert

Children's clinic "RebenOK", pediatrician

Measles continues to be a serious problem today. This infection has “matured” and now often affects not only children, but also adults. The last major measles outbreak was reported in almost all countries in 2017–2018. Experts from the World Health Organization largely attribute its occurrence to a decrease in the level of vaccination of the population. This was largely facilitated by the “anti-vaxxer” movement.

The WHO called population distrust in vaccination in 2021 one of the global problems of modern health care.

Measles symptoms

The clinical picture of measles infection includes:

• incubation period - the time from the moment of infection until the first signs of illness appear;
• prodromal period - the appearance of general symptoms that are characteristic of many viral diseases;
• skin rashes;
• convalescence - recovery.

The incubation period lasts from 7 to 17 days. It can increase to 21–28 days in the case of prophylactic administration of gamma globulin.

Measles is characterized by an acute onset. Body temperature rises and signs of intoxication appear:

• headache;
• general weakness;
• decreased appetite;
• sleep disorders.

After a few hours, the listed symptoms are accompanied by a dry cough, runny nose with mucopurulent discharge. Conjunctivitis develops - inflammation of the mucous membrane of the eyes. Bright light causes discomfort in the eyes. This symptom is called photophobia. Upon examination, redness and swelling of the pharyngeal mucosa are revealed, and enlarged lymph nodes are possible.

Figure 1. Symptoms and complications of measles. Image: Artjita/Depositphotos

In some cases, signs of dyspepsia may be observed with measles:

• nausea, vomiting;
• softening of feces;
• belching air;
• heartburn.

The temperature lasts from 3 to 5 days. Then it decreases, and the person’s condition improves. But the next day the temperature rises again, general weakness, cough, runny nose and photophobia intensify. When examining the oral cavity at this moment, you can detect a specific symptom of measles - Belsky-Filatov-Koplik spots. They are located on the mucous membrane of the cheeks in the area of ​​small molars and take on the appearance of “semolina” - small whitish dots that slightly rise above the surface of the mucosa. At the same time, small red spots of irregular shape - enanthema - become clearly visible on the surface of the soft and hard palate. With the appearance of skin rashes, enanthema and Belsky-Filatov-Koplik spots disappear.

With the beginning of the period of rashes, body temperature rises even more, the severity of symptoms of intoxication and catarrhal manifestations intensifies. The main sign of measles infection is a clear sequence of occurrence of the rash. On the first day it appears on the head and neck, on the second it goes down to the shoulders and torso, on the third it covers the skin of the limbs.

"Hello" from measles

“Having measles can affect a person’s health after several years.
The formation of chronic encephalitis (slow infection of measles in the central nervous system) is possible. This condition is accompanied by headache, lethargy, fatigue, and memory impairment. There may be a decrease in intelligence and the appearance of epileptic seizures.” Vanina Yulia Evgenievna

expert

Children's clinic "RebenOK", pediatrician

Elements of the measles rash appear bright pink or red, slightly raised above the surface of the skin. They can merge, forming quite large figures, separated from each other by areas of unchanged skin.

Approximately 7–10 days after the appearance of the first signs of the disease, the period of convalescence begins. The elements of the rash turn pale, and light brown spots remain in their place, which persist for 5–7 days. Regression of rashes occurs in the reverse order of their appearance, that is, it goes from bottom to top. Body temperature decreases, general condition quickly improves.

During the period of convalescence, there is a significant weakening of the body's defenses. As a result, the risk of developing other viral or bacterial diseases increases dramatically.

How to distinguish measles from other diseases

Measles must be differentiated from other infectious diseases that also occur with the appearance of a skin rash and, above all, from rubella (Table 1).
Table 1. Main differences between measles, rubella, scarlet fever

Measles clinic

The measles clinic consists of the following four periods: incubation (from infection to the appearance of clinical symptoms), catarrhal (prodromal), rash and recovery.

1. The incubation period lasts from 8 to 17 days. It can last up to 21 days if post-exposure prophylaxis with immunoglobulin was carried out.
2. The prodromal period begins with an increase in temperature, general intoxication symptoms and the typical measles triad: cough, runny nose, conjunctivitis. Usually this period lasts 2-3 days, but sometimes reaches 8 days. A symptom that makes it possible to make a diagnosis before the rash occurs is the appearance of Filatov-Koplik spots. These are white-gray elements, 1-3 mm in size, which are surrounded by a hyperemic edging, and are located on the oral mucosa opposite the molars. When you try to remove them, they are not removed because they are an area of ​​epithelial necrosis.
3. Rash period. Here a new wave of temperature rise is observed, the general condition worsens, the runny nose and cough intensify, photophobia and lacrimation occur. Moderate diarrhea occurs less frequently during this period. The first rash usually appears behind the ears, then on the face and upper neck, and on the same day it spreads to the scalp and entire neck. On the second day, the rash appears on the torso, shoulders and thighs, on the third day - on the forearms, legs and feet, and the face begins to turn pale. The descending phasing of the appearance of rash elements is a distinctive feature of measles from other diseases characterized by exanthema. The elements of the rash are spots and papules, the size of which is up to 10 mm. They tend to merge, but even with dense rashes you can find areas of completely normal skin. In severe cases, hemorrhages (petechiae) may appear. Typically, the rash elements are not localized on the palms and soles. The rash begins to disappear in the same order in which it appeared. On average, rashes begin 14 days after exposure to the virus (range 8 to 17 days). Until the fifth day from the appearance of the rash, all its elements disappear, leaving only pigmentation and then pityriasis-like peeling. Pigmentation lasts up to 1.5 weeks.
4. Recovery period. During this period, characteristic symptoms are severe general weakness, increased fatigue, drowsiness, irritability, and decreased immunity. The cough persists for up to 2 weeks.

Treatment of measles

Measles can be treated at home in most cases. Hospitalization is indicated only in severe cases of the disease and the development of complications.

Important!

Bed rest is recommended throughout the entire period of fever. It is important to avoid bright light and maintain good oral hygiene.

Treatment is aimed at preventing complications and relieving symptoms of the disease. To eliminate the manifestations of intoxication, you need plenty of warm drinks - still mineral water, rosehip infusion, herbal teas, fruit juice, compote. In severe cases, detoxification therapy may be required - intravenous administration of glucose and saline solutions, taking vitamins. According to indications, antihistamines, expectorants and non-steroidal anti-inflammatory drugs are used.

Interferons and normal human immunoglobulin are used in the treatment of severe forms of measles infection. They are most effective when prescribed in the early stages of the disease. Treatment of bacterial complications is carried out with broad-spectrum antibiotics.

Figure 2. Measles in the facts. Sources: WHO and Israeli Ministry of Health

Measles in an adult and a child - differences

The clinical picture of measles in children and adults differs in characteristic features, which are presented in Table 2.
Table 2. Differences in the clinical picture of measles infection in children and adults³.

Measles in children occurs in a milder form than in adults. So far, experts cannot clearly explain this phenomenon. Perhaps it is associated with the peculiarities of the child’s immune response. In children, the thymus gland actively functions, in which the differentiation of special cells - T-lymphocytes - occurs. They play an important role in protecting the body from various microorganisms, including viruses. But after 5–6 years, the activity of the thymus gland decreases, and by 30–40 years it is almost completely replaced by adipose tissue and ceases to perform its functions.

In addition, in young children the number of lymphocytes in the blood prevails over the number of neutrophils. At the age of 5–6 years, the so-called crossover of the leukocyte formula occurs. As a result, the content of neutrophils in the blood increases and the number of lymphocytes decreases. Neutrophils provide protection against bacterial infections, and lymphocytes provide protection against viral infections. Perhaps this circumstance is associated with a more severe course of measles in adults.

Lifetime immunity

“Children who have had measles or received a full course of vaccination develop lasting immunity to this disease.”
Vanina Yulia Evgenievna

expert

Children's clinic "RebenOK", pediatrician

“Measles in adults: how dangerous is the disease and how to avoid it?”

28.01.2020 00:00

Measles is an acute viral disease that is one of the most contagious and common infections. Although we are accustomed to thinking of measles as a common childhood disease, it is very dangerous. Every hour in the world, 15 people die from measles, which amounts to 165,000 people a year. Is it possible to avoid a dangerous infection?

How can an adult get measles?

Measles infection occurs through airborne droplets. The contagiousness index is 95%, which means that this disease is highly contagious. To transmit the infection, direct contact with the patient is necessary; transmission of the virus through common things and third parties is impossible.

Today, measles is actively spreading among the adult population.

Cases of the disease are recorded all year round, but more often during the cold season. Children aged 4 and 5 years are most often affected. Babies under one year old who have received antibodies against the virus from their mother are immune in the first 4 months of life. In the future, the immune system weakens and the child (through contact with a sick person) may become infected. The patient remains contagious until the fifth day from the appearance of the rash, and in case of complications - until the tenth day.

Doctors say that the only bright spot in all this is a very powerful lifelong immunity after an illness.

Symptoms of measles in adults

When measles occurs in adults, the main symptoms remain the same as in children, but the severity of the disease in an adult will be more pronounced. The main symptoms of measles in adults are:

• increase in temperature (fever) up to 38 - 40 ° C;
• headaches, weakness;
• decreased appetite;
• conjunctivitis, rhinitis, photophobia;
• dry, hacking cough;
• hoarseness of voice;
• measles enanthema - large red spots on the soft and hard palate;
• rash on the skin (on the face, torso, arms, legs);
• possible delirium, impaired consciousness;
• intestinal dysfunction, etc.

The incubation period for measles infection lasts 1-3 weeks in adults. In the typical course of the disease, three successive stages can be distinguished: catarrhal, rash and convalescence stages.

In adults, measles is especially severe. Pneumonia and bacterial complications are often associated with the underlying disease. Sometimes the disease can result in blindness and significant hearing loss. One of the most dangerous complications of measles is viral meningoencephalitis (inflammation of the meninges), leading to death in 40% of cases. The measles virus greatly suppresses the immune system of an adult, as a result of which chronic diseases worsen and new ones are acquired.

Measles vaccinations in adults

If vaccinations were previously carried out:

The only possible method to prevent measles in adults is vaccination. Measles vaccination is usually given to children in several stages, providing protection against the virus. But over time, its effectiveness weakens. It is believed that measles vaccination can provide reliable immunity for nine to twelve years or more. Therefore, to maintain protection against viruses, revaccination may be carried out in adulthood. For it, so-called mono-vaccines are used, containing only the measles component. If desired, it is possible to use combination products that also contain weakened rubella and mumps viruses. In order to find out whether an adult’s body can resist measles (whether there is immunity from this disease), it is necessary to take a special blood test that will show the level of immunity tension. This test allows you to detect the presence of antibodies to the measles virus and is carried out within one to several days.

If vaccinations have not been carried out

Adults who have not been vaccinated before, have not had measles, or do not know about their vaccination will also benefit from taking tests to determine their antibody levels. It is quite possible that their measles occurred in a latent form, and they do not need vaccinations. But if it is not possible to carry out such a study, doctors recommend vaccination. Vaccination of unvaccinated adults is carried out with a single vaccine at an interval of three months. If a person was previously vaccinated once, then vaccination is carried out again - twice.

If you have been in contact with someone with measles

Adults who have been in contact with people with measles may be given measles immunoglobulin to prevent infection. This medicine contains synthesized human blood proteins containing antibodies to measles. Its administration promotes the formation of passive immunity and helps reduce the likelihood of measles infection. The use of measles immunoglobulin makes it possible to achieve passive disease prevention for two months.

Doctors warn that adults who have not had measles and have not received vaccinations should pay special attention to the symptoms that begin the development of the disease (and the first symptoms are very similar to a common cold) and never delay contacting a doctor and begin appropriate treatment .

Complications of measles

The measles virus suppresses the activity of the human immune system. This causes an increased risk of developing many infectious and inflammatory complications, which can be caused by both viruses and bacteria.

Measles is most often complicated by the development of otitis media (7–9% of cases) and pneumonia (1–6% of cases)⁴. In young children, measles infection provokes the development of laryngitis, an inflammation of the larynx. Against this background, a condition of false croup often develops, which is accompanied by attacks of suffocation and requires emergency medical care.

Dangerous complications of measles are:

• meningitis - inflammation of the pia mater;
• meningoencephalitis is an inflammatory process that affects the brain and its soft membrane;
• polyneuritis is a lesion of the nerve trunks, which causes paralysis and paresis of the lower extremities.

Delayed complication

One of the most dangerous complications of measles can develop several years after the illness. This is brain atrophy - the gradual death of neurons and the destruction of connections between them. The clinical picture unfolds slowly. Initially, changes in character are noted, then regression of brain functions becomes noticeable, and convulsive seizures may occur. The risk of developing brain atrophy is significantly higher in children who had measles before the age of 12 months.

Routes of entry of the measles virus

The virus enters the mucous membranes of the upper respiratory tract and the conjunctiva of the eye. It then penetrates the submucosa and regional lymph nodes. There it is fixed and the virus multiplies. Somewhere from the third day, the pathogen enters the blood (viremia). If immunoglobulin is used at this time, the virus can be neutralized, because there is still a small amount of virus in the blood. With the blood, the pathogen enters the spleen, liver, bone marrow, lymph nodes, and infects blood cells (mononuclear cells and lymphocytes). From the seventh day, repeated viremia occurs, which leads to fixation of the virus in the epithelial cells of the skin (resulting in a rash), respiratory tract, intestines, and conjunctiva of the eye.

After suffering from the disease, lifelong anti-measles sterile (without the presence of a pathogen in the human body) immunity is formed.

Routes of infection and risk groups

The source of measles infection is an infected person. Virus shedding begins 1–2 days before the first signs of illness appear and lasts 4 days from the appearance of skin rashes. Sometimes a person can remain infectious to others for longer - up to 10 days from the moment the rash appears. With measles infection, asymptomatic carriage is not observed.

Figure 3. What an unvaccinated person should do after contact with a sick person. Source: Israeli Ministry of Health

Infection occurs through airborne droplets during communication, sneezing and coughing. Contact and household transmission of infection for measles is excluded, since the pathogen is extremely unstable in the environment.

During illness in pregnant women, the measles virus can penetrate the placental barrier and infect the fetus. This route of transmission of infection is called transplacental.

Susceptibility to measles is close to 100%. And if a person has not previously had measles and has not received a vaccination, then if he comes into contact with a sick person, he will almost certainly get sick.

After suffering from the disease, lasting immunity is formed for life.

Before the start of mass immunization, the main characteristics of the epidemiological process for measles were:

• massive outbreaks of the disease that recurred at intervals of 2–5 years;
• the peak incidence occurred in the winter-spring period;
• the infection was predominantly in children aged 1 to 5 years².

Currently, there is a sharp decline in cases of the disease; there is no pronounced seasonality or frequency. Measles continues to be considered a childhood infection, since it is most often diagnosed in children under 10 years of age. But in the overall structure of cases, there is an increase in the number of adolescents and adults.

Dear patients!

What kind of disease is measles? How to recognize in time what its consequences are, how is it treated? We will talk about everything in this article. Measles is a viral disease that is transmitted through airborne droplets directly from an infected person.

A little history.

When did a disease like measles appear? The medical history will help us understand this issue. The first case that was recorded occurred in the 9th century, and was described by one Arab physician, Rhazes. The doctor mistakenly believed that the patient had a mild form of smallpox. Therefore, at first, measles was called “small disease” (morbilli), and smallpox was called morbus, which means “great disease”. What kind of disease is measles? What symptoms does it have and how does it proceed? This was only established in the 17th century, thanks to Sydenham (England) and Morton (France). But these doctors were unable to establish the cause of the disease, and only in 1911 experiments were carried out on monkeys, and it was possible to establish that measles is an acute viral disease that is transmitted by airborne droplets. The causative agent of the disease was identified only in 1954. Measles is a disease that everyone should know about its dangers. From the mid-19th century to the early 20th century, measles was the deadliest childhood disease, often fatal. The epidemic of the disease was reduced only after a vaccine was developed. Mandatory vaccination has been able to reduce the activity of the disease, and in some countries it has completely eliminated it. However, cases of the disease are still recorded today; according to WHO statistics, about 30 thousand people die every year.

Symptoms in children.

First of all, it is worth noting that children aged from one to 7 years are most susceptible to infection; cases of infection of children over 7 years of age and adults are less frequently recorded.

It is important to know: measles begins to manifest itself in 7-14 days. What kind of disease is measles? How to diagnose it? In order to start treatment on time, you need to be able to recognize the disease.

Measles disease symptoms in children have the following:

• Bad feeling.
• Sleep disturbance.
• Lethargy.
• Fatigue.
• Headache.
• Poor appetite, or its complete absence.
• Temperature increase.

The catarrhal stage lasts from 3 to 5 days. The symptoms are as follows:

• The throat becomes inflamed.
• A cough appears.

It gets worse. The disease begins to affect blood vessels, small capillaries in the eyes and skin begin to burst. A runny nose with purulent discharge begins. Swelling appears on the face, and the eyes become numb. An infected child develops a fear of light, causing him to constantly squint his eyes. The temperature rises to 40 degrees, the cough gradually becomes stronger, and vomiting may occur.

Only after the child develops the main symptoms of measles is he given an accurate diagnosis.

To make a diagnosis, the doctor must prescribe:

• General blood analysis.
• General urine analysis.
• Test for virus isolation in blood.
• Chest X-ray.
• In some cases, electroencephalography.

Main symptoms of the disease: measles in children

• Small rashes, the size of a grain, on the inner surface of the lips and cheeks. If such symptoms are present, the child must be isolated.
• Unlike other childhood diseases, the measles rash does not appear in a chaotic manner, but in stages. First of all, pink spots appear on the scalp and behind the ears. Then they move to the bridge of the nose, and gradually spread over the entire face. On the second day, the rash begins to spread over the upper body (arms, chest). The third day is legs.
• From the moment the rash appears, the body temperature rises sharply to 40 degrees.
• The dry period lasts from 4 to 7 days.

Signs of measles disease in adults.

Although measles is considered to be a childhood disease, adults are not immune from infection. How does the disease progress in adults, what symptoms indicate the disease? We will look at the main signs of the disease. Measles is something that cannot be ignored!

• First of all, your health deteriorates sharply, your appetite disappears, terrible headaches and insomnia appear. The sick person feels like he has a cold, his throat is sore, his nose appears runny, his temperature rises sharply, and his lymph nodes become enlarged.
• After 2 - 5 days, all symptoms disappear, strength and vigor appear.
• A day after the improvement, the disease sets in with renewed vigor. All symptoms return, but more acutely and painfully.
• The next stage is a rash. Many spots appear, which subsequently connect and turn into one continuous spot. The rash appears in a certain sequence: behind the ears, head, upper body, lower body.

Therapy

A very insidious disease is measles. Treatment should begin immediately. How should it happen in children? After the doctor has ordered tests and the diagnosis has been confirmed, treatment is prescribed. Unfortunately, to date, no single cure for measles has been developed, so all efforts are aimed at treating the symptoms.

Antipyretic drugs for children based on ibufen and paracetamol are prescribed.

High fever and vomiting lead to dehydration of the body, so it is imperative to maintain a drinking regime.

• Since the child develops a fear of light, the windows in the room where he is located must be curtained with dark thick curtains. Use a night light in the evening.
• Antihistamines are used to relieve swelling and itching from the rash.
• The doctor prescribes expectorants to help relieve coughing attacks.
• Drops are placed in the nose (vasoconstrictor) and in the eyes (for conjunctivitis).
• The throat and oral cavity are treated with chamomile.
• Antibiotics are taken.
• Chapped lips from high temperatures should be lubricated with a damp handkerchief.

An infected child should not have contact with other children; he is prescribed bed rest and complete rest. In addition to medications, it is imperative to ventilate the room, do wet cleaning 2 times a day, and humidify the air. A prerequisite for treatment is adherence to a diet. All food that a child eats must be high in calories, since the body needs considerable strength to fight the virus. But at the same time, food should be easily digestible and natural. Hospitalization for measles rarely occurs, only in cases where the symptoms of the disease are very acute. Mostly, patients stay at home and be sure to follow all the doctor’s instructions.

Treatment of measles in adults

The first thing to do is to alleviate the patient’s condition. Antibiotics are used to combat inflammation. If the disease is mild, there is no need for hospitalization. In order to replenish the loss of fluid in the body, you need to drink a lot of water, syrups, tea, and compotes. –

Since the mucous membranes of the mouth become inflamed during measles, it is necessary to pay special attention to hygiene. The throat should be gargled with chamomile infusion and a water-salt solution. Treatment also necessarily includes cough medications with an expectorant effect, prednisolone, and antipyretics.

Measles: complications

• The most dangerous and common complications that measles can lead to:
• Pneumonia is an infectious inflammation of the lungs.
• Visual impairment, rarely complete blindness.
• Otitis is an inflammatory process in the ear.
• Laryngitis is an inflammatory process in the mucous membranes of the larynx.
• Encephalitis is inflammation of the brain.
• Stomatitis is an inflammation of the oral mucosa.
• Polyneuritis is multiple damage to nerve fibers.
• Bronchopneumonia is an acute inflammation of the bronchi.

Complications in adults

In most cases, measles does not leave behind any consequences, but still, although rarely, the disease does not allow itself to be forgotten even after treatment. So, why is measles dangerous?

The consequences of the disease in adults may be as follows:

• Bronchiolitis is an acute inflammation of the bronchioles, transmitted by airborne droplets.
• Croup is an inflammation of the airways. Bronchitis.
• Mild myocarditis is damage to the heart muscle.
• Sometimes the disease leaves its mark on vision and can lead to complete blindness.

Prevention

There are two types of prevention: emergency and planned. Emergency prevention is carried out if the fact of contact with an infected person is accurately established. But it must be reliably known that the child has not previously had measles and has not been vaccinated. In such cases, immunoglobulin is administered. The drug must be administered within 5 days from the date of contact. Planned prevention is nothing more than a vaccination. What is a vaccination? This is the artificial introduction of a virus so that the body can develop immunity. According to the vaccination schedule, a child receives the first routine vaccination against measles at 1 year of age, and the second at 6 years of age.

After a routine vaccination, every mother is warned about the possible consequences and reactions of the child’s body. Therefore, the mother must carefully monitor the child’s condition after vaccination. There are symptoms that, when they appear, parents should immediately react and seek medical help. Among them:

• Runny nose.
• Conjunctivitis.
• Temperature increase.
• Cough.

Particular vigilance must be exercised from 5 to 20 days after the introduction of the virus. Any rash on the body is a reason to go to the doctor. After all, it’s better to be on the safe side than to risk your child’s health. Any mother should know that each vaccination is given only to a healthy child. From the moment of the last illness, 1 to 6 weeks should pass. Anyone can get vaccinated against measles; to do this, they need to go to the clinic at their place of residence. You must have a card with you with records of previous vaccinations. An unpleasant disease is measles. The photos clearly demonstrate this. The patient's body itches and itches.

Rubella, chickenpox, measles are infectious diseases most often found in children. However, adults can also get them. In this case, the disease measles is much more difficult to tolerate. Photos of infected adults are not much different from images of the manifestations of the disease in children, but the child’s well-being is much better throughout the entire period of the disease.

Quarantine

It is very important to isolate the patient from healthy people, especially children. But as we know, infected patients are admitted to the hospital only in special cases, so it is necessary to allocate a separate room at home. If this is not possible, then healthy children should be temporarily taken to relatives. In the room where the patient is located, wet cleaning and ventilation must be done. All windows must be covered with thick curtains so that the room is twilight. It is very important to provide separate cutlery for the sick family member: plates, mugs, spoons. It is important to wear a gauze bandage, both for the patient and for those caring for him. An adult who has been vaccinated or who has had measles should care for a sick child. It is definitely worth remembering that the childhood disease measles is highly contagious.

Measles during pregnancy

What if a pregnant woman gets measles? How dangerous is the disease for the baby and the expectant mother? Any viral diseases (measles, chickenpox or rubella) are extremely dangerous during pregnancy. As for measles, if a woman becomes infected with the virus in early pregnancy, this is fraught with various defects in the development of the fetus. And despite all modern diagnostic methods, doctors have no way to determine to what extent the disease has affected the child’s brain. This can only be detected after birth. If a pregnant woman gets measles late in pregnancy, the likelihood of infecting the child is very high. This only means that the child will be born with the virus. This is fraught with the fact that a child’s still fragile body will most likely not be able to tolerate the disease. Despite all the dangers, measles is not an indication for abortion, for example, as is the case with rubella. But still, if a woman gets measles in the early stages, the doctor must warn the expectant mother about possible irreversible consequences. But the choice always remains with the woman. Naturally, any expectant mother does not want her child to have any diseases. Therefore, during pregnancy, a woman should not only eat right and take all the necessary vitamins, but also carefully monitor her health.

Brief summary of the above

What kind of disease is measles? This is a dangerous disease that is spread by airborne droplets and has an acute course. The disease is quite ancient, however, there are no treatments for measles. Only the symptoms of the disease are treated. Fortunately, the signs of childhood illnesses (measles) are clearly visible and cannot be ignored.

Children of preschool and primary school age most often suffer from measles, but this does not mean that adults are protected from infection. The best prevention is a timely vaccination: the first at 1 year, the second at 6 years. Further as desired. A sick family member must be isolated from healthy relatives.

Vaccination

In Russia, routine vaccination against measles is carried out simultaneously with vaccination against other childhood infections - mumps and rubella. The first vaccination is given to babies at the age of 12 months. At this time, the protective antibodies they received from their mothers almost completely disappear in their body. Revaccination is performed before the child enters school - at 6 years of age.

Routine measles vaccination is also carried out for all adults under 35 years of age, if they have not previously had measles and have not been vaccinated.

The best protection against measles is vaccination. Photo: Amaviel/Depositphotos

The measles vaccine is usually well tolerated. There may be side effects - a slight increase in body temperature and mild soreness at the injection site.

Revaccination - once every 10 years

Some studies show that 10 years after vaccination, the level of antibodies in the blood of 30-40% of people decreases so much that the body can no longer provide protection against measles¹. Therefore, adults are recommended to have a booster vaccination every 10 years. It is especially important for workers in the fields of education, public utilities, social protection, and healthcare.

Diagnosis of measles

Catarrhal symptoms, the appearance of Belsky-Filatov-Koplik spots and enanthema, the characteristic stages of the spread of skin rashes are the main signs that allow the doctor to make the correct diagnosis. To confirm it, the type of virus is determined using the polymerase chain reaction method. The material for analysis - a swab from the nasal or pharyngeal mucosa - is taken 1-3 days after the appearance of the rash. An enzyme immunoassay, which detects antibodies to the virus in the blood, can also confirm the diagnosis. These laboratory research methods are rarely used in clinical practice, only in the case of an atypical course of the disease and difficult diagnosis.

A general blood test for measles reveals changes that are characteristic of viral diseases:

• slight leukopenia - decrease in the number of leukocytes;
• an increase in the erythrocyte sedimentation rate indicates an active inflammatory process;
• lymphocytosis - increased level of lymphocytes.

When bacterial complications occur in the blood, the number of leukocytes increases - leukocytosis occurs, and the content of neutrophils increases.

In case of measles, a biochemical blood test and a general urine test must be performed. They help to promptly identify possible complications from the liver and kidneys.

If indicated, other types of laboratory and instrumental studies are also carried out:

• electrocardiography;
• chest x-ray;
• cerebrospinal fluid analysis.

Classification

Measles can be very severe and require emergency care. It is important to know that the disease can be not only typical, but also atypical:

1. Mitigated (weakened) measles. The disease develops in people who were administered anti-measles gamma globulin at the very beginning of the incubation period for the purpose of prevention. It is less common in previously vaccinated individuals who have not developed a full immune response. In this form of the disease, intoxication and catarrhal symptoms of measles are mild, the rash is faint and not abundant, Belsky-Filatov-Koplik spots are often absent.
2. Abortion measles. It begins in the same way as a typical form of measles. But the temperature lasts no more than two days. Skin rashes are observed only on the head and torso and do not affect the limbs.
3. Hemorrhagic measles. An extremely severe form of the disease that can be fatal. It is characterized by a rise in body temperature to very high values, severe intoxication, and the appearance of hemorrhages on the skin and mucous membranes. Blood may appear in the urine - hematuria.
4. Hypertoxic measles. Body temperature rises to 40–41°C. The general condition is rapidly deteriorating. Signs of cardiovascular failure appear and increase - decreased blood pressure, a sharp increase in the number of heartbeats, pale skin, cold sweat. It is possible to develop neurotoxicosis - a toxic lesion of the central nervous system. Its signs are headache, nausea, repeated vomiting, disturbances of consciousness, and convulsions³.

Measles can be very severe and fatal. Photo: PHIL CDC

Complications

The most serious complication is measles encephalitis. Most often it occurs on days 5-10 of the disease. Acute encephalitis due to measles, unlike other infections (influenza, chickenpox, rubella), is characterized by a greater prevalence of the process, often involving the spinal cord, roots and nerve trunks, with the development of encephalomyelitis or encephalomyelopolyradiculoneuritis.

The onset of encephalitis is acute, often sudden, with an increase in body temperature and an increase in cerebral symptoms (headache, vomiting, impaired consciousness, the appearance of clonic-tonic convulsions). Some patients may experience focal symptoms (paresis, damage to the optic or auditory nerves, etc.). Serous meningitis can also develop with measles.

According to some researchers, measles can cause a chronic persistent infection of the central nervous system - subacute sclerosing panencephalitis, which most often develops in adolescents and young adults. It is characterized by disorders such as epileptic syndrome, gait disturbances, paresis, blindness, and decreased intelligence. The course of the disease is 1-3 years, the consequences are unfavorable.

It should be noted that the measles virus is now associated with the occurrence of multiple sclerosis, lupus erythematosus, autoimmune hepatitis, Crohn's disease, otosclerosis, and glomerulonephritis.

Prognosis and prevention

With uncomplicated measles, the prognosis is favorable. The disease ends with complete recovery with the formation of stable lifelong immunity. After the rash disappears, no cosmetic defects remain on the skin. If measles meningoencephalitis occurs, the prognosis may become unfavorable. A particularly difficult course of measles is observed in people with HIV infection. In them, the disease often takes severe forms, is accompanied by the development of serious complications and often ends in death.

The best protection against measles is routine vaccination. A healthy person (if he has not had measles and is not vaccinated) is given emergency prophylaxis after contact with a sick person. It can be done in two ways:

• vaccination with live measles vaccine - carried out within the first 72 hours after contact;
• introduction of normal human immunoglobulin - the injection is given within the first five days from the moment of contact with the patient.

Emergency prevention is especially important for children under 5 years of age and adults with weakened immune systems.

To prevent the spread of measles, children from organized groups are separated for 17 days. The countdown starts from the moment the sick child is isolated. If gamma globulin is administered to children, the quarantine period is increased to 21 days.

Preventing measles

For general prevention, contacts are quarantined from 9 to 21 days from the start of contact.

The most effective method of specific planned prevention is vaccination.

Currently, a measles culture-based live vaccine (monovaccine) or combined vaccine (against measles, rubella, mumps - “Priorix”, mumps-measles vaccine) are used. The vaccine is given to children who have not had measles according to the vaccination schedule. Revaccination is also carried out. Its goal is to protect children who, for one reason or another, have not developed specific measles immunity.

Measles vaccines

If for some reason the child has not been vaccinated before the age of 2, he is given emergency prophylaxis with a live attenuated vaccine no later than 3-4 days after contact with a sick person. The killed vaccine is not used throughout the world due to side effects and the frequent atypical course of measles after use.

* * *

To eliminate measles in the United States, the country is focused on ensuring high vaccination coverage among preschool and school-age children. In the 1990s, countries in South and Central America began campaigns to vaccinate all young people between 9 months and 15 years of age to quickly interrupt the spread of the measles virus. This approach was an important factor in the elimination of measles in the Western Hemisphere (2002) and the elimination of indigenous rubella in 2021.

Vaccination is the most effective medical intervention ever invented by man.

Used materials

• 1.https://measlesrubellainitiative.org/ - measles prevention; features of morbidity in the modern world; methods that are aimed at combating the disease.
• 2.https://apps.who.int/iris/bitstream/10665/259533/1/WER9248.pdf?ua=1 – epidemiological features of measles in different countries, ways of control.
• 3. https://www.who.int/immunization/diseases/measles/en/ - immunization for measles.
• 4. https://apps.who.int/iris/bitstream/10665/44855/1/9789241503396_eng.pdf?ua=1 – global strategic plan for combating measles 2012-2020.
• 5. https://www.who.int/mediacentre/factsheets/fs286/en/ - clinical features, goals of the global strategic plan.
• 6.https://www.who.int/immunization/monitoring_surveillance/burden/vpd/surveillance_type/active/measles_monthlydata/en/ - confirmed cases of measles in the last six months.
• 7. Kramarev S. O. Infectious diseases in children (Clinical lectures). – K.: MORION, 2003. – 480 p.
• 8. Golubovskaya O. A. Infectious diseases. - M.: VSV "Medicine", 2012. - 728 p. + 12 s. color. on

Author: Anastasia Lishnevskaya, infectious disease doctor Source: MMK Formed

Sources

1. Measles. Wikipedia
2. Timchenko V.N., Kaplina T.A., Bulina O.V. and others. Current problems of measles infection. Pediatrician, 2021. T. 8. No. 3. pp. 120–129.
3. Yaremushkina Y.M., Vdovina E.T., Kotiv S.I., Kuskova T.K. Algorithm for diagnosing measles in a complex epidemic situation. Analysis of clinical data // Infectious diseases: news, opinions, training. No. 4. 2015
4. Ivanova I.A., Ponezheva Zh.B., Kozlova M.S., Vdovina E.T., Tsvetkova N.A. Features of the course of measles in adults. Medical scientific and practical portal “Attending Physician”. 2021