Measles

Generality

Measles is a highly contagious infectious disease caused by a virus belonging to the genus morbillivirus. The course of the infection is characterized by different symptoms: initially it resembles a cold, then, within a few days, it gives rise to very characteristic red-brownish spots.

Precisely the typicality of these macules means that for the diagnosis of measles the only objective examination (which consists in the simple analysis of the symptoms and signs manifested by the patient) is very often sufficient.
Currently, there is no specific therapy. The only things that can be done are: wait for the spontaneous resolution of the infection and relieve, with some effective remedies, the most annoying symptoms.
In countries where vaccination is widespread, death from measles is, today, a rather rare case, which requires certain conditions to occur.

What is measles?

Measles is an infectious disease of viral origin, highly contagious and characterized by the appearance of small brownish-red skin spots.
Measles only affects humans and is widespread throughout the world, although it has become somewhat less common since vaccination has existed.

WHO HITS?

All individuals who are not vaccinated and who have never contracted the disease in their lifetime are potentially at risk of getting measles.

Figure: the measles virus

A second infection is indeed possible, but very unlikely; this is because the immune response, which the human organism realizes when it contracts measles, is effective and lasting.

EPIDEMIOLOGY

Measles is considered a childhood infectious disease, such as rubella, chicken pox, whooping cough and mumps, as it mainly affects children between 12 months and 4 years (NB: we are obviously talking about subjects at risk, that is unvaccinated and who have never gotten sick with measles in their life).
Today, its diffusion (especially in industrialized countries, including Italy) has dropped considerably thanks to the creation of an effective vaccine.
Nevertheless, fatal cases still occur: some authoritative sources, in fact, report that death due to the complications of measles involves 30 to 100 individuals for every 100,000 people sick.

Measles in Italy

For many decades now, in our country, every case of measles has been compulsorily reported to the health authorities present in the area.
Furthermore, following the epidemic that broke out between 2002 and 2003, the special measles surveillance system was established: according to this protocol, the doctor must report every suspected case to the nearest local health authority, which, having received the reporting, has the task of carrying out all the most appropriate laboratory investigations and communicating the results to the Ministry of Health and the National Center for Epidemiology, Surveillance and Health Promotion (Cnesps).

Causes

Table. The cases of measles in Italy, from 2001 to 2009.

Year

M.

F.

Total

2001

464

358

826

2002

9362

8644

18.020

2003

6363

5.608

11.978

2004

380

305

686

2005

115

100

215

2006

302

269

571

2007

340

253

595

2008

2875

2426

5312

2009

423

336

759

Measles is caused by a virus belonging to the genus morbillivirus, which is part, in turn, of the mononegavirales order and of the paramyxoviridae family.
THE morbillivirus they are endowed with capsid (an external envelope that protects the virus from the dangers of the external environment) and possess, for genetic material, only one filament of RNA.

SPECIES OF MORBILLIVIRUS

There are various species of morbillivirus; these species, which can infect not only humans but also other mammals, are:

• The canine distemper virus
• The morbillivirus of cetaceans
• The measles virus
• The virus of the plague of small ruminants
• The distemper virus of seals
• The rinderpest virus

HOW IS THE MEASLE VIRUS TRANSMITTED?

With coughing and sneezing, people excrete millions of small, volatile droplets. If the person is infected with the virus, these droplets contain the virus; therefore, their inhalation, by those in the vicinity, involves the transmission of the infection.
Once inhaled, in fact, measles nestles in the mouth and lungs, where it multiplies until it reaches a numerical level that can spread to the rest of the body.
Transmission of the virus via volatile droplets is a direct mode of contagion.

The indirect transmission of measles

Volatile droplets containing the virus can settle on objects and make them a means of contagion. In fact, anyone who touches such objects can become infected, especially if after handling them he puts his hands in his mouth or brings them near the nose.
The transmission of measles in the aforementioned ways is an indirect transmission.
PLEASE NOTE: Viral particles survive on the surface of objects for only a few hours, after which they die.

Symptoms

For further information: Measles Symptoms

Ways of transmission of measles:

Direct:

• Volatile droplets expelled with sneezing, coughing, breathing (rare)

Indirect:

• Touch objects contaminated with volatile droplets

Measles begins with a series of symptoms reminiscent of a cold or flu; subsequently, it is characterized by a later sign: the skin rash which is the hallmark of the disease.

INITIAL SYMPTOMS

The first symptoms appear about ten days after the infection (incubation period). Such symptoms consist of:

• Typical manifestations of colds, namely: runny nose, watery eye, swollen eyelids, sneezing, etc.
• Red eyes and sensitivity to light
• High fever, even at 40 ° C
• Tiredness, irritability and a sense of lack of strength
• Pain and discomfort
• Dry cough
• Formation of small whitish-gray spots in the mouth and throat (Köplik's sign)
• Loss of appetite

The duration of this symptomatology is about 7-10 days.

THE CHARACTERISTIC SIGN OF THE MEASLE: THE SKIN RASH

The hallmark of measles is the skin rash (or rash), which causes the appearance, all over the body, of reddish spots, slightly raised and of varying size.

The spread on the rest of the body takes one or two days, while, for the complete disappearance, it is generally necessary to wait from 4 to 7 days.

Timing of measles

Demonstration When does it happen?

Appearance of the initial symptoms

10 days after infection (incubation period)

Appearance of skin rash (or rash)

2-4 days after the onset of initial symptoms

Resolution of initial symptoms

7-10 days after their appearance

Resolution of the skin rash (or rash)

4-7 days after its appearance

WHEN AND HOW TO CONTACT THE DOCTOR?

If the skin rash and the symptoms that preceded it can be traced back to measles, it is good to contact your doctor immediately and describe the problems.

Attention: to contain the spread of the virus, it would be better if the first contact with the doctor took place by telephone.

Complications

Measles can lead to a variety of complications, some very serious and sometimes life-threatening.

The individuals most at risk of complications are:

• Children less than 12 months old
• Undernourished children
• Children with very weak immune systems. For example, AIDS patients and those suffering from leukemia who are undergoing chemotherapy
• Teenagers and adults

The least at risk, on the other hand, are healthy children over a year old.

COMPLICATIONS: FROM THE MOST COMMON TO THE MOST RARE

Complications related to measles can be distinguished based on frequency, as there are some more common than others.
The full picture of all possible complications is as follows:

• Most common complications. The most common complications of measles are: diarrhea, vomiting, middle ear infections (otitis), eye infections (conjunctivitis), laryngitis (inflammation of the larynx), airway infections (bronchitis, pneumonia and croup) and, finally , febrile convulsions.
  
• Uncommon complications. This category includes infections that damage the liver (hepatitis), strabismus (due to the involvement of the nerves and eye muscles), infections of the meninges (meningitis) and infections that damage the brain (encephalitis).
  
• Rare complications. On very rare occasions, measles can lead to serious eye diseases (such as optic neuritis), severe heart problems, severe nervous system disorders and, finally, the so-called subacute sclerosing panencephalitis (the latter affects one in every 25,000 measles patients).

Alarm bells, which signal the worsening of the situation

Symptoms that usually characterize the appearance of complications are: shortness of breath, chest pain when breathing, hemoptysis (bleeding when coughing), weakness, confusion and convulsions.

DANGERS FOR PREGNANT WOMEN

If measles infects an unvaccinated, non-immune pregnant woman, it can result in:

• The spontaneous abortion
• The death of the child at the time of delivery
• Premature birth of the fetus (premature birth)
• The low weight of the baby at the time of birth

Therefore, at the slightest suspicion of infection, a mother should immediately contact her doctor and undergo all necessary checks.

Diagnosis

To diagnose measles, a thorough physical examination is usually enough, through which the entire symptomatology manifested by the patient is analyzed.
If doubts remain, a saliva test, which is collected with a special absorbent pad, and a blood test can be used.

Treatment

There is currently no drug therapy for the specific treatment of measles.
The only things an infected individual can do are:

• Wait for the spontaneous resolution of the infection e
• Relieve symptoms with some particular remedies / treatments

SPONTANEOUS RESOLUTION

Spontaneous resolution of measles takes 7 to 10 days. In fact, this is the time it takes for the immune system of a healthy individual to fight and eliminate all traces of the virus from the organism.

What happens, after healing, inside the organism?

The immune system represents the defensive system against threats coming from the external environment (primarily, infectious agents of a viral or bacterial nature).
When it fights infectious agents such as viruses, it also prepares special defense cells, capable of recognizing the same threat in advance and preventing a second infection.
This prodigious mechanism is called immune memory and the cells that put it into practice (which are particular antibodies) are called memory cells.
Antiviral vaccines are built on the concept of immune memory.

TREATMENT OF SYMPTOMS

For further information: Medicines for the treatment of Measles

When the infection is particularly annoying, it is possible to alleviate the symptoms with some simple remedies, sometimes very effective.

To relieve fever, generalized pain and a sense of malaise: in these situations, it is a good idea to take some anti-inflammatory drugs and at the same time analgesics, such as paracetamol and "ibuprofen (which is an NSAID, or a non-steroidal anti-inflammatory drug). .
Attention: remember that aspirin, in individuals under the age of 16, can have very serious side effects, such as Reye's syndrome; therefore, it should not be administered until a certain age.

Figure: Steam inhalation to mitigate cold symptoms. You need a basin filled with hot water and a towel to put on your head.

To avoid dehydration: high fever causes intense sweating, therefore, to avoid excessive dehydration of the tissues, it is necessary to drink plenty of water.

To mitigate eye inflammation (swollen eyelids, red eyes, watery eyes, etc.) and light sensitivity discomfort: it is essential to keep your eyes clean with special cotton swabs and avoid touching them with unclean hands. Furthermore, it is good that the room in which the patient resides is poorly lit, so as not to tire the eyes too much.

To treat cold symptoms (runny nose, cough, etc.): the main remedies for these ailments are steam inhalations and hot drinks with lemon or honey.

To limit the spread of the infection: to avoid the transmission of the disease (especially among people potentially at risk of complications, such as infants and pregnant women) it is good practice to remain isolated at home (therefore not to go to work or school), until the end of the skin rash. In fact, in the period of time in which the rash disappears, also the infectious charge (ie the ability to infect other people) is exhausted.

Prevention

Measles is preventable with the MMR vaccine (where M stands for measles, P for mumps and R for rubella).
This vaccination should be performed during infancy, with two injections: one at about 12-13 months and another at 5-6 years (usually just before starting elementary school).

Special case: for unvaccinated adult individuals and children under one year of age, the vaccine is not essential / expected. It becomes so, however, if the risk of contagion were real. Two classic situations that require an extraordinary vaccination, so to speak, are: a trip to geographic areas where the virus is highly widespread or an infection occurred to a very close member of the family.