Measles - Symptoms, Transmission and Vaccine

Measles is an infectious disease of viral origin, extremely contagious, capable of provoking diverse symptoms, like stains for the body, fever, cough, pharyngitis, conjunctivitis, etc.

Measles symptoms
Measles symptoms
 

Prior to the vaccine, measles even affected up to 90% of children up to 5 years of age. Currently, however, measles is an uncommon infection, having been practically eradicated from Brazil since the year 2000. The approximately 200 cases per year still registered are usually imported by non-vaccinated persons who have become contaminated abroad.

Obscurantist anti-vaccination campaigns, however, have been responsible for the resurgence of measles outbreaks in countries in Europe, Japan and the United States.

Transmission

Measles is a disease caused by a virus, extremely contagious and transmitted from person to person through secretions of the respiratory tract, such as those eliminated in coughing, sneezing or even during speech.

Infectious droplets from respiratory secretions of a measles patient may remain in the air for several hours. Therefore, direct contact with an infected person may not be necessary for the transmission of the virus. Measles can be transmitted in hospitals and doctors' offices, between in-flight passengers and in densely populated schools and communities.

The measles incubation period is from 6 to 19 days (mean of 13 days). The period of contagion occurs between 5 days before the appearance of skin eruptions up to 4 days later. The peak of the contagion occurs 2 days before and 2 days after the onset of the skin lesions.

3 out of 4 unvaccinated people exposed to the virus will become infected and develop symptoms. Unlike what occurs in several other common childhood viruses, such as rubella and mumps, measles usually does not cause mild cases with mild and nonspecific symptoms that may go unnoticed. Anyone who has measles, has it truly, with a right to all the classic symptoms.

Symptoms

Measles initially manifests as a nonspecific viral infection, with a high fever, malaise, coryza, cough, loss of appetite, sore throat and conjunctivitis. This early stage of the disease is called prodrome and lasts for 2 to 3 days. In the transition from the prodromal phase to the phase of classic measles symptoms, small white spots appear on the mucosa of the mouth, close to the molar teeth, which are called Koplik spots. These spots usually appear 48 hours before the onset of classic measles rash.

Typical measles skin rashes (measles rash) are reddish males with discrete relief that initially appear on the face and spread down the rest of the body. The lesions can be abundant, melting, to create large reddish spots.

In general, the extent and degree of confluence of the rash correlate with the severity of the disease. Palms of the hands and soles are rarely involved.

Other characteristic findings during the exanthematic phase include lymphadenopathy (enlarged lymph nodes), high fever (sometimes above 40�C), pharyngitis, and conjunctivitis. Coughing is also common and can persist for up to 2 weeks.

During the exanthematic period, the patient gets compromised immune system, being an easy target for other infections of bacterial or viral origin.

48 hours after the onset of the rash, the patient begins to improve. With three to four days, the rash darkens, turning brownish, and then begins to flake and fade. The rash usually lasts a full six to seven days. The fever usually goes away when the rash begins to relieve. A fever that lasts more than 3 or 4 days after the onset of the rash may be a sign of an ongoing complication such as pneumonia, diarrhea, otitis or encephalitis (inflammation of the brain).

Pneumonia and encephalitis are the most dangerous complications of measles.

The diagnosis of measles is made through clinical findings and blood serology (antibody screening). The IgM antibody against measles becomes positive from the third day of rash and disappears after 30 days. The IgG antibody appears on the seventh day of the rash and is positive for the rest of life.

Treatment

Once the symptoms of measles have already arisen, there is no specific treatment for the disease. The only thing to do is support and expect the disease to heal itself. In children, vitamin A administration appears to reduce the incidence of severe cases.

Fever can be controlled with common antipyretics such as Paracetamol. Never use aspirin (ASA) in measles because of the risk of Reye's syndrome, a rare but high-mortality disease characterized by cerebral edema and liver damage. Antibiotics are only valuable if there is some bacterial infection complicating the measles picture.

Prevention and vaccine

As there is no effective treatment during the symptom phase, measles control should be focused on prevention. In the last few decades, due to the widespread vaccination coverage in most countries, measles has become an uncommon disease. In Brazil, for example, there is no circulation of the virus among the population since the beginning of the 2000s. The measles vaccine is made with a live attenuated virus and is part of the national vaccination schedule.

In the last 10 years, however, there has been a drop in vaccination rates in several countries around the world, which has been responsible for the outbreak of measles outbreaks and has hampered their complete eradication. Only in the first months of 2017 have been reported more than 1500 cases of measles in Europe.

Like most vaccines, the measles vaccine should be administered before the patient has any contact with the virus, preferably during the first year of life. However, since the measles incubation period may reach 19 days, a person who has never been immunized, who has had contact with a contaminated person, can be vaccinated as long as it does not exceed the limit of 72 hours after exposure to the virus. This form of vaccination is not ideal, but usually is effective in many cases.

Another form of prevention for people exposed to the measles virus is the administration of immunoglobulin. Patients at high risk for complications, such as immunosuppressants, pregnant women, and children under 1 year of age who are not yet vaccinated can use immunoglobulin if they come into contact with infected persons. This medication must be administered within the first 6 days of exposure to the virus.

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