Measles 101: The Facts You Need to Know

Measles is a highly contagious respiratory illness caused by the measles virus.^1-3  The illness is characterized by fever, cough, runny nose and rash.  Although measles is no longer present regularly in the United States (U.S.), sporadic outbreaks still occur.  The number of cases has been drastically reduced by the measles vaccine.

What are symptoms of measles?

Initial symptoms of measles include fever, cough, muscle aches, pains, stuffy nose, and red eyes.^1-3 After the initial onset of symptoms, Koplik spots (blue-grey spots on a red background) appear inside the mouth.^2,3  A  rash can develop 2 to 4 days after onset of the fever. It can appear first on the head and face, and then spread to the trunk and extremities.^1-3  Symptoms can develop 7 to 21 days after exposure to the measles virus.^1,4

How common is measles?

Since 2000, measles has been declared eliminated from the United States by the Centers for Disease Control and Prevention.¹  However, cases continue to be reported in the U.S. due to an increase in the number of unvaccinated persons and  transmission from other parts of the world.^1-3  As of February 2015, 170 current cases had been reported in the U.S., 15 of which were in the state of Illinois.^5,6 Worldwide, it is estimated that 20 million people are infected with measles each year, and 146,000 die from the illness.¹ 

How is measles diagnosed?

Measles is suspected in patients with characteristic symptoms.^1,2  Confirmatory diagnostic tests include blood, throat, mouth, nose, and urine testing.  Exposure to persons with measles and potential travel should also be considered when evaluating symptoms.

How does measles spread?

Once a measles infection has developed, the virus lives in the lungs, mouth and nose.  It is highly contagious and can be spread by coughing and sneezing.¹  The virus may remain in the air or on a surface for up to 2 hours after an infected person leaves an area.  Spread of measles has been reported in physician offices, daycares, amusement parks, and sports complexes.^1-5  The virus is particularly stable in times of low humidity, which may account for a higher incidence of measles during the winter months.³  It is estimated that 9 out of 10 susceptible people who are within close contact of a person with measles will develop the disease.¹ 

How can measles be prevented?

Measles can be prevented with administration of a measles virus-containing vaccine.^1-3  It is administered as 2 doses of a combined measles, mumps, and rubella (MMR) vaccine.^1-3,7,8  Within 2 to 6 weeks, the vaccine induces production of antibodies against these viruses in 97% of children.⁸  

Persons who are considered protected from measles include the following:⁷  

• Immunization records of 2 MMR vaccine doses
• Documented bloodwork confirming immunity against measles
• Documentation of previous measles infection
• Born prior to 1957

Individuals who do not fall into these categories should consult with a physician regarding their need for measles vaccination. 

In children, the first dose of the MMR vaccine is administered at 12 to 18 months of age, followed by a second dose at 4 to 6 years.^1,2,7,8  Children younger than 12 months do not have a mature immune system and cannot produce an adequate response to the vaccine.^3,7,9  The MMR vaccine is safe and effective, and adverse reactions are generally mild and temporary.^2,7  Serious  side effects are rare, but common adverse reactions include burning, stinging, pain, hardening of skin, and redness at the injection site.⁸  Symptoms that mimic the measles infection with fever and rash are also possible.^3,8  

Very rarely, adverse effects involving the central nervous system may occur; however, the risk of this type of severe reaction is much less with the vaccine than with an actual measles virus infection.⁸  Despite concerns voiced by certain consumer advocate groups, the medical and scientific communities have extensively evaluated all available data and concluded that the MMR vaccine is not linked to autism spectrum disorders or bowel disease.^2,3,7,8,10

In the U.S., each state mandates vaccination of children older than 5 years prior to enrolling in public schools and daycares.¹⁰  There are possible exemptions that different states may offer, which can be classified as medical contraindication, religious, and philosophical.  The submission and review processes for obtaining an exemption vary by state.

How is measles treated?

There is no specific medication to treat infection with the measles virus.^1-3 Treatment of infected individuals is directed toward management of symptoms and prevention of possible associated bacterial infections. Fevers that lead to discomfort can be treated with acetaminophen or a nonsteroidal anti-inflammatory medication, such as ibuprofen.¹¹  It is also important to stay hydrated through consistent fluid intake.  Pharmacists or other medical professionals can be consulted for further recommendations on anti-fever product selection and dosing.

People with measles can spread the virus in the 4 days before and after the onset of rash.^1,2,4  People who have symptoms consistent with measles should remain isolated from others, at least through the fourth day after rash development.  Exposed individuals should notify their local health department if symptoms occur.

Individuals who have been exposed to measles may be eligible for preventative therapy within 3 to 6 days of exposure.^1,2,4  These measures may offer protection or modify the disease course.  Individuals in this situation should contact a physician as soon as the exposure has been identified.  If preventative therapy is given, the patient cannot return to a healthcare setting and must be excluded from high risk settings, such as infant childcare,  for 21 days after the exposure to maintain effectiveness of the preventative treatment.^1,4  Development of symptoms should be monitored for an additional 7 days after the 21 day quarantine.⁴  Healthcare workers who are not immune to measles should be excluded from the healthcare setting from 5 days after the first measles exposure to 21 days after the last measles exposure.^1,4

What are possible complications of measles?

Possible complications include ear, throat, and lung infections, as well as diarrhea.^1,2  Pneumonia is the most common complication of measles that causes death.²  Rarely, complications involving the central nervous system can occur.^1-3  Headaches, seizures, or changes in behavior or consciousness may indicate these complications.  Complications can occur from 2 days to 15 years after exposure to the measles virus.²  Children less than 5 years of age, adults older than 20 years of age, pregnant women, and individuals with a decreased immune system are at the highest risk of developing complications from measles infection.¹ In children, 1 to 2 deaths occur from respiratory or nervous system complications out of every 1,000 cases of measles.

More information about measles can be obtained from the following sources:

•        Centers for Disease Control and Prevention (www.cdc.gov)
•        Illinois Department of Public Health (www.dph.illinois.gov)
•        California Department of Public Health (www.cdph.ca.gov)

Written by:

Alexandra Riskus

PharmD Candidate, 2015

UIC College of Pharmacy

References:

1. Centers for Disease Control and Prevention. Measles (Rubeola): For Healthcare Professionals. http://www.cdc.gov/measles/hcp/index.html. Updated February 24, 2015. Accessed February 24, 2015.
2. Measles. In DynaMed [database online]. EBSCO Information Services. http://web.b.ebscohost.com/dynamed/detail?vid=7&sid=c3c636ac-4abc-4246-ae5d-fee22a0668a4%40sessionmgr115&hid=118&bdata=JnNpdGU9ZHluYW1lZC1saXZlJnNjb3BlPXNpdGU%3d#db=dme&AN=116399. Updated February 24, 2015. Accessed February 26, 2015.
3. Gershon AA. Measles virus (rubeola). In: Bennet JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases. 8th ed. Philidelphia, PA: Elsevier Saunders; 2015. https://www.clinicalkey.com/#!/content/book/3-s2.0-B9781455748013001624. Accessed February 23, 2015.
4. California Department of Public Health- February 2015 (V.2). Measles Investigation Quicksheet. http://www.cdph.ca.gov/programs/immunize/Documents/CDPHMeaslesInvestigationQuicksheet.pdf. Accessed February 16, 2015.
5. Centers for Disease Control and Prevention. Measles (Rubeola): Measles Cases and Outbreaks. http://www.cdc.gov/measles/cases-outbreaks.html. Updated March 2, 2015. Accessed March 2, 2015.
6. Illinois Department of Public Health. Measles. http://www.dph.illinois.gov/topics-services/diseases-and-conditions/diseases-a-z-list/measles. Updated February 25, 2015. Accessed February 26, 2015.
7. Jin J. Measles in the United States. [published online ahead of print]. JAMA. 2015. doi:10.1001/jama.2015.1555.
8. Grabenstein JD. Measles, mumps & rubella virus vaccine live. In: ImmunoFacts; Vaccines and Immunologic Drugs.St. Louis, MO: Wolters Kluwer Health; 2012;300-309.
9. Leuridan E, Sabbe M, Van Damme P. Measles outbreak in Europe: Susceptibility of infants too young to be immunized. Vaccine. 2012;30(41):5905-5913.
10. Lawrence O, Gostin JD. Law, ethics, and public health in the vaccination debates: politics of the measles outbreak. [published online ahead of print]. JAMA. 2015. doi:10.1001/jama.2015.1518.
11. Feret B. Fever. In: Berardi RR, ed. Handbook of Nonprescription Drugs: An Interactive Approach to Self-Care. 16th ed. Washington, DC: American Pharmacists Association; 2009:83-94.