Also known as measles or morbilli, rubeola is an acute, highly contagious paramyxovirus infection. It’s one of the most common and the most serious of all communicable childhood diseases.
In temperate zones, incidence is highest in late winter and early spring. Before the availability of measles vaccine, epidemics occurred every 2 to 5 years in large urban areas. Use of the vaccine has reduced the occurrence of measles during childhood; as a result, measles is becoming more prevalent in adolescents and adults. (See Administering measles vaccine.)
Measles remains a major cause of death in children in underdeveloped countries.
Measles is spread by direct contact or by contaminated airborne respiratory droplets. The portal of entry is the upper respiratory tract.
Incubation is from 10 to 14 days.
Initial symptoms begin and greatest communicability occurs during a prodromal phase beginning about 11 days after exposure to the virus. This phase lasts from 4 to 5 days; signs and symptoms include fever, photophobia, malaise, anorexia, conjunctivitis, coryza, hoarseness, and hacking cough.
At the end of the prodrome, Koplik’s spots, the hallmark of the disease, appear. These spots look like tiny, bluish gray specks surrounded by a red halo. They appear on the oral mucosa opposite the molars and occasionally bleed.
About 5 days after Koplik’s spots appear, temperature rises sharply, spots slough off, and a slightly pruritic rash appears. This characteristic rash starts as faint macules behind the ears and on the neck and cheeks.
These macules become papular and erythematous, rapidly spreading over the entire face, neck, eyelids, arms, chest, back, abdomen, and thighs. When the rash reaches the feet (2 to 3 days later), it begins to fade in the same sequence it appeared, leaving a brownish discoloration that disappears in 7 to 10 days.
The disease climax occurs 2 to 3 days after the rash appears and is marked by a temperature of 103° to 105° F (39.4° to 40.6° C), severe cough, rhinorrhea, and puffy, red eyes. About 5 days after the rash appears, other symptoms disappear and communicability ends.
Symptoms are usually mild in patients with partial immunity (conferred by administration of gamma globulin) or infants with transplacental antibodies. More severe symptoms and complications are more likely to develop in young infants, adolescents, adults, and immunocompromised patients than in young children.
Atypical measles may appear in patients who received the killed measles vaccine. These patients are acutely ill with a fever and a maculopapular rash that’s most obvious in the arms and legs, or with pulmonary involvement and no skin lesions.
Severe infection may lead to secondary bacterial infection and to autoimmune reaction or organ invasion by the virus, resulting in otitis media, pneumonia, or encephalitis. Subacute sclerosing panencephalitis (SSPE), a rare and invariably fatal complication, may develop several years after measles. SSPE is less common in patients who have received the measles vaccine.
Measles results in distinctive clinical features, especially the pathognomonic Koplik’s spots. Mild measles may resemble rubella, roseola infantum, enterovirus infection, toxoplasmosis, and drug eruptions; laboratory tests are required for a differential diagnosis.
If necessary, measles virus may be isolated from the blood, nasopharyngeal secretions, and urine during the febrile period. Serum antibodies appear within 3 days after onset of the rash and reach peak titers 2 to 4 weeks later.
Therapy consists of bed rest, relief of symptoms, and respiratory isolation throughout the communicable period. A vaporizer and a warm environment can reduce respiratory irritation, and an antipyretic can reduce fever; however, cough preparations and antibiotics are generally ineffective. Treatment must also combat complications.
❑ Teach parents the importance of immunizing their children against measles, and follow appropriate procedures when giving the vaccine.
❑ Teach parents supportive measures, and stress the need for isolation, plenty of rest, and increased fluid intake. Advise them to cope with photophobia by darkening the room or providing sunglasses and to reduce fever with an antipyretic and tepid sponge baths.
❑ Warn parents to watch for and report the early signs and symptoms of complications, such as encephalitis, otitis media, and pneumonia.
❑ Children at home should be kept out of school for at least 4 days after the rash appears.
Review other book chapters online related to Measles:
Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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Title: Handbook of Diseases Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2003 ISBN: 1-58255-266-5 
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