2014/11/26 1st edition
Measles
Abstract
Measles is a highly contagious disease which spread by contaminated
air or humor. Typical signs and symptoms include high fever, cough,
rhinitis (coryza), conjunctivitis, Koplik spots and skin rash.
Complications included ear infection, diarrhea, pneumonia and
encephalitis. Several years after acute infection, some of patient will
develop Subacute sclerosing panencephalitis (SSPE).
Vaccination is the best prevention from measles. Post-exposure
prophylaxis, including administration of vaccine or immunoglobulin, will
provides some protection.
Transmission
Measles is a highly contagious virus that lives in the nose and throat
mucus of an infected person. It can spread to others through coughing and
sneezing. If other people breathe the contaminated air or touch the infected
surface and then touch their eyes, noses, or mouths, they can be infected.
Measles is so contagious that if one person has it, 90% of the people
close to that person who are not immune will also become infected.
Infected people can spread measles to others from 4 days before to 4 days
after the rash appears.
Signs and Symptoms
The symptoms of measles generally appear about 7~14 days after a
person is infected. Measles typically begins with high fever and 3Cs
(cough, coryza and conjunctivitis). 2~3 days after symptoms begin, tiny
white spots (Koplik spots) may appear at buccal mucosa.
3~5 days after symptoms begin, a rash breaks out. It usually begins as
flat red spots that appear on the face at the hairline and spread downward
to the neck, trunk, arms, legs, and feet. Small raised bumps may also
appear on top of the flat red spots. The spots may become joined together
as they spread from the head to the rest of the body. When the rash appears,
a person’s fever may spike to more than 40℃(104°F). After a few days,
the fever subsides and the rash fades, with skin exfoliation and brown
pigmentation.
Complications
People younger than 5 years old, older than 20 years old, with
pregnancy and under immunocompromised situation are more likely to
suffer from measles complications. Common measles complications
include ear infections (may cause permanent hearing loss) and diarrhea.
Severe Complications include pneumonia and encephalitis. They may need
to be hospitalized and could die.
SSPE is a rare but fatal degenerative disease of the central nervous
system, which characterized by behavioral and intellectual deterioration
and seizures. It generally develops 7 to 10 years after measles infection.
Measles may cause pregnant woman to give birth prematurely or have a
low-birth-weight baby.
Post-exposure prophylaxis and vaccination
People exposed to measles and cannot readily show the evidence of
immunity against measles should be offered post-exposure prophylaxis or
be excluded from the setting (school, hospital, childcare). MMR vaccine, if
administered within 72 hours of initial measles exposure, or
immunoglobulin, if administered within 6 days of exposure, may provide
some protection or modify the clinical course of disease
Measles can be prevented with measles-containing vaccine, which is
primarily administered as the combination measles-mumps-rubella (MMR)
vaccine. The combination MMR vaccine can be used for children aged 12
months through 12 years for protection against measles, mumps, rubella
and varicella. Single-antigen measles vaccine is not available. One dose of
MMR vaccine is approximately 93% effective at preventing measles; two
doses are approximately 97% effective. Almost everyone who does not
respond to the measles component of the first dose of MMR vaccine at age
12 months or older will respond to the second dose. Therefore, the second
dose of MMR is administered to address primary vaccine failure.
Traveler vaccination recommendation
(1) Infants: 6~11 months of age should receive one dose of MMR
vaccine.
(Taiwan: infants younger than 12 months are not suggested to travel
internationally)
(2) Children: 12 months of age or older should have documentation of
two doses of MMR vaccine.
(3) Teenagers and adults born during or after 1957 without evidence of
immunity against measles should have documentation of two doses
of MMR vaccine, with the second dose administered no earlier than
28 days after the first dose.
Edited by NDU medical office
Resource: American CDC http://www.cdc.gov/