Managing measles

Understanding the ways to prevent and manage the viral disease

Managing measles


easles is also called Rubeola, “10-day measles” or “Red measles.“ Pakistan stands fourth in line with Nigeria, India, Liberia and Ethiopia for the most reported measles cases between January 2022 and September 2022.

Measles is an acute viral illness caused by a virus in the paramyxovirus family that is normally passed through direct contact and the air. The virus infects the respiratory tract, and then spreads throughout the body. Measles is a human disease and is not known to occur in animals.

The symptoms appear 7 to 14 days after contact with the virus. Measles typically begins with a high fever (may spike to more than 104°F), cough, runny nose, coryza and red, watery eyes. Tiny white spots (Koplik spots) may appear inside the mouth two to three days after symptoms begin.

Three to five days after the symptoms begin, a rash breaks out. It usually starts 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. When the rash appears, a person’s fever may spike to more than 104° Fahrenheit.

Who are at risk of developing complications?

Young children (less than 5 years of age), adults aged above 20 years, immunocompromised people and pregnant ladies.

Common complications:

Ear infections occur in about one out of ten children with measles.

Diarrhoea is reported in less than one out of 10 people with measles.

Severe complications:

Pneumonia: As many as 1 out of every 20 children with measles gets pneumonia, the most common cause of death from measles in young children.

Encephalitis: About 1 child out of every 1,000 who get measles will develop encephalitis (swelling of the brain) that can lead to convulsions and leave the child deaf or with an intellectual disability.

Risks in pregnancy: Previously unvaccinated women exposed to measles may give birth prematurely or have a low-birth-weight baby. Measles in pregnancy can also lead to perinatal infections in the newborn, which can be associated with high mortality and neurological complications.

Management of measles:

Infected people should be isolated for four days after they develop a rash. Airborne precautions should be followed in healthcare settings (N95 respirator is useful). It can spread to others through coughing and sneezing. If other people breathe the contaminated air or touch the infected surface, then touch their eyes, noses or mouths, they can become infected. Hence, face mask and hand sanitiser must be used.

What to do if you suspect measles in a child or an adult?

Patients must be seen by a physician at the earliest for diagnosis and to address complications such as pus discharge from eyes and oral ulcers.

There is no specific antiviral therapy for measles. Symptomatic treatment helps. Paracetamol is effective for pain and fever.

Measles is an acute viral illness caused by a virus in the paramyxovirus family that is normally passed through direct contact and the air. The virus infects the respiratory tract, and then spreads throughout the body. Measles is a human disease and is not known to occur in animals.

Pus discharge from the eyes is treated with tetracycline eye ointment. It is to be applied on the inside of the lower eyelid four times a day. Hands should be properly washed before applying ointment. Use clean water and a cloth to wipe away pus from your eyes. Do not put anything else in the eyes without a physician’s advice.

Mouth ulcers should be treated with gentian violet solution (0.25 percent). Wash your hands properly and then wrap a clean cloth wet with salt water around your finger. Apply this solution inside the mouth. Continue this for 48 hours after ulcers have healed.

Vitamin A supplementation is a must. For a child aged 6 months to 12 months, oral Vitamin A 100,000 IU, two doses are recommended. For age 1 year and above, 200,000 IU, two doses are recommended.

What should a pregnant woman do if exposed to a patient suffering from measles?

A pregnant woman must see a physician at the earliest when there is exposure to measles at home, hospital or workplace. It is recommended that susceptible pregnant women exposed to measles receive 1 g of normal human immunoglobulin (Ig) within 72 hours and not more than six days of exposure to prevent or modify the course of the disease.

What should be done if a non-pregnant person is exposed to measles?

If not vaccinated earlier, either administer MMR vaccine within 72 hours of initial measles exposure or immunoglobulin (IG) within six days of exposure. Do not administer MMR vaccine and IG simultaneously, as this practice invalidates the vaccine.

Vaccine recommendations:

For children, WHO-approved expanded program of immunisation recommends two doses of measles vaccine (MMR). Dose 1 is to be administered at age 9 months and Dose 2 at age 15 months.

Students at post-high school educational institutions without evidence of measles immunity need two doses of MMR vaccine. The second dose should be administered no earlier than 28 days after the first dose.

People who are born during or after 1957 and do not have evidence of immunity against measles should get at least one dose of the MMR vaccine.

Adults who are going to be in a setting that poses a high risk for measles or mumps transmission should make sure they have had two doses separated by at least 28 days. These adults include students at post-high school education institutions, healthcare personnel and international travellers.

What are the side effects of an MMR shot?

Mild swelling and redness at the injection site can occur. Mild rash and fever may occur.

Does MMR shot cause autism?

Scientists in the United States and other countries have carefully studied the MMR shot. None has found a link between autism and the MMR shot. (CDC)

Is MMR safe in pregnancy and lactation?

It is contraindicated in pregnancy. However, lactating mothers can safely get vaccinated.

Dr Naureen Kazim [MBBS, DFM, MCPS] is a senior registrar at the Department of Family Medicine, Ziauddin Medical University, Karachi

Dr Naseem Amin Dhedhi [MBBS, FCPS, MRCGP(INT)] is a consultant in family medicine at Al-Khidmat Raazi Hospital, Islamabad

Managing measles