What is measles?

Measles is a highly infectious disease caused by a virus. In 2001 it was estimated that there were 30 million measles cases and 745 000 measles-related deaths. Measles kills more children than any other vaccine preventable disease.

Because the disease is so infectious, it tends to occur as epidemics, which may cause many deaths especially among malnourished children.2.2

How is measles spread?

Measles is spread through contact with nose and throat secretions of infected people and in airborne droplets released when an infected person sneezes or coughs.

A person with measles can infect others for several days before and after he or she develops symptoms. The disease spreads easily in areas where infants and children gather, for example in health centers and schools.

What are the signs and symptoms of measles?

The first sign of infection is a high fever which begins approximately 10–12 days after exposure and lasts several days. During this period, the patient may develop a runny nose, a cough, red and watery eyes, and small white spots inside his or her cheeks.

After several days, a slightly raised rash develops, usually on the face and upper neck.

Over a period of about three days, the rash spreads to the body and then to the hands and feet. It lasts for five or six days and then fades. The incubation period from exposure to the onset of the rash averages 14 days, with a range of seven to 18 days.

What are the complications of measles?

Unimmunized children under five years of age, and especially infants, are at highest risk for measles and its complications, including death. Infected infants may suffer from severe diarrhoea, possibly causing dehydration. Children may also develop inflammation of the middle ear and severe respiratory tract infections.

Pneumonia is the most common cause of death associated with measles. This is usually because the measles virus weakens the immune system. The pneumonia may be caused by the measles virus itself or by secondary bacterial infection. Encephalitis, a dangerous inflammation of the brain, may also develop.

Severe measles is particularly likely in poorly nourished children, especially those who do not receive sufficient vitamin A, who live in crowded conditions, and whose immune systems have been weakened by HIV/AIDS or other diseases. Measles is a major cause of blindness among children in Africa and other areas of the world with endemic measles. Children who recover from measles are immune for the rest of their lives.

What is the treatment for measles?

General nutritional support and the treatment of dehydration with oral rehydration solution are necessary. Antibiotics should only be prescribed for ear infections and severe respiratory tract infections. It is important to encourage children with measles to eat and drink.

All children in developing countries diagnosed with measles should receive two doses of vitamin A supplements given 24 hours apart. Giving vitamin A can help prevent eye damage and blindness. Vitamin A supplementation reduces the number of deaths from measles by 50%.

How is measles prevented?

Measles is prevented by immunization with measles vaccine. Measles is highly transmissible; almost all non-immune children contract measles if exposed to infection.

To reduce the risk of infection in hospitals, all children between the ages of six and nine months who have not received measles vaccine and who are admitted to a hospital should be immunized against measles. If the children’s parents do not know whether they have received measles vaccine, the child should still be immunized. If a child has received measles vaccine before nine months of age, a second dose should be administered at nine months or as soon as possible after nine months.

Global accelerated disease control issues

In May 2003, the World Health Assembly at its 56th session adopted a resolution to reduce measles deaths by 50% by 2005 compared to 1999 levels.

The strategies recommended for reducing measles deaths include the following:

• A dose of measles vaccine should be provided to all infants at nine months of age or shortly thereafter through routine immunization services. This is the foundation of the sustainable measles mortality reduction strategy.

• All children should be provided with a second opportunity for measles immunization.

• This will assure measles immunity in children who failed to receive a previous dose of measles vaccine, as well as in those who were vaccinated but failed to develop such immunity following vaccination. The second opportunity may be delivered either through routine immunization services or through periodic mass campaigns.

• Measles surveillance should be strengthened through the integration of epidemiological and laboratory information.

• The clinical management of measles should be improved.

Key points

• Measles is a highly infectious viral disease that kills more children than any other vaccine-preventable disease.

• The disease is spread from person to person through sneezing, coughing, and close personal contact.

• The first sign of infection is a high fever lasting one to seven days and a generalized rash develops after onset/ exposure to the virus.

• Pneumonia is the most common cause of death associated with measles.

• Severe complications can be avoided through proper case management, including vitamin A supplementation.

• Measles can be prevented by immunization. All children should have two opportunities for immunization.