Measles epidemic

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By Fasiha Hasham

In this bitter winter season, an epidemic of Measles has occurred. From January 2015 to February 2015, 141 cases are reported in 17 states. According to the Center of Disease Control, United States is currently experiencing a large multi-state, Measles outbreak which is linked to an amusement park in California. Three other outbreaks are occurring in Illinois, Nevada and Washington respectively. In 2014, 644 cases from 27 states were also reported.

Measles is a highly infectious viral disease, it is an airborne illness that spread through cough, sneezes or contact with saliva and nasal secretions. Measles virus is very resistant and can survive up to 2 hours on a surface and in air. It usually infects children under 5 years of age, adults older than 20 years, pregnant women and immunocompromised individuals.

Measles is caused by a single stranded RNA enveloped virus which only infects the humans, no other animal reservoir is known.

Typical sign and symptoms include high grade fever up to 104 F for four days, cough, cold, coryza and conjunctivitis. Kopliks spots are seen inside the mouth; they usually develop before the rash and are temporary. Kopliks spot are diagnostic of measles. The rash that develops, is red maculopapular rash, it appears 14 days after the exposure to the virus. The incubation period is 7 to 21 days and the patient is contagious from 4 days before to 4 days after the rash appears. The rash may spread from the back of the ear to the head and neck, then to the trunk and the extremities. It may last for 8 days and causes itching. It changes its color from red to brown before disappearing.

Diagnosis is based on history of high grade fever for 3 days with cough, coryza and conjunctivitis. Kopliks spots can be seen inside the mouth. Any history of contact with an infected person can also help in the differential diagnosis. Detection of measles specific IgM antibodies and isolating the virus RNA, gives a confirmation of the disease. Blood, throat swabs and urine samples are taken for the tests.

There is no specific antiviral therapy for measles. Symptomatic treatment of the patient with proper hydration and rest helps in the recovery. Ibuprofen and paracetamol are given to reduce the fever. In case of measles, Aspirin is not recommended to reduce fever because studies have shown that children may develop Reye Syndrome if treated with Aspirin in measles. Bronchodilators are also used in case of severe cough.  Vitamin A is also given to decrease the risk of blindness.

Complications can occur like diarrhea, otitis media, viral or bacterial pneumonia, brain inflammation like sub-acute sclerosing pan encephalitis and corneal ulceration. These complications are more severe in adults, pregnant women and immunocompromised individuals than in children.

Vaccine for measles which is known as the MMR, it stands for measles, mumps and rubella, is given first at the age of 12 to 15 month. The second dose is given at the age of 4 to 6 years. Any child who does not respond to the first dose of MMR at the age of 12 months will respond to the second dose.

In adults without the evidence of measles immunity, that is if they do not have any documentation for immunization, no evidence of immunity from any lab tests or are born after 1957, should have two doses of MMR. People who are travelling internationally should also be vaccinated against this disease. Health care providers are also recommended to be vaccinated against it.

Sometimes a post exposure prophylaxis is also given to patients with no evidence of immunity against it. A dose of MMR within 72 hours after the initial exposure or a dose Ig immunoglobulins within 6 days of exposure may provide some protection or decrease the chances of complications and mortality from the disease. Adverse reaction to MMR are rare, sometimes fever, pain at the site of the injection may occur. Severe life threatening may develop in less than one per million vaccinations.

Infected people should be isolated for four days after the development of the rash. Respiratory protection to defend against the airborne infection should be used. N95 respirators should be used in the hospitals and other facilities to reduce the transmission of disease.

Majority of the patients survive through measles, some of the consequences of measles are bronchitis, sensorineural hearing loss and one in 100, 000 can develop pan encephalitis, which is deadly.

Editor’s Note: Dr. Fasiha Hasham obtained her medical degree from Sindh Medical College and completed a residency at Jinnah Post Graduate Medical Centre in Pakistan before moving to the United States. Her specialties include Internal Medicine and Gynecology and Obstetrics. She is married with four children and lives in Farmington Hills, Michigan. The views expressed here are her own.