is an infection of the respiratory system
caused by a virus, specifically a paramyxovirus
of the genus Morbillivirus
. Morbilliviruses, like
other paramyxoviruses, are enveloped, single-stranded,
negative-sense RNA viruses. Symptoms include fever
, runny nose
, red eyes
and a generalized, maculopapular
Measles is spread through respiration (contact with fluids
from an infected
person's nose and mouth, either directly or through aerosol
transmission), and is highly
contagious—90% of people without immunity
sharing a house with an infected
person will catch it. The infection has an average incubation
period of 14 days (range 6–19 days) and infectivity lasts from 2–4
days prior, until 2–5 days following the onset of the rash (i.e.
4–9 days infectivity in total).
An alternative name for measles in English-speaking countries is
, which is sometimes confused with rubella
(German measles); the diseases are
unrelated. In some other European languages, rubella
are synonyms, and rubeola
is not an
alternative name for measles.
Signs and symptoms
This patient presented on the third
pre-eruptive day with “Koplik spots” indicative of the beginning
onset of measles.
The classical symptoms of measles include four day fevers, the
(runny nose) and conjunctivitis
(red eyes). The fever may
reach up to 40° Celsius
). Koplik's spots
seen inside the mouth are
(diagnostic) for measles
but are not often seen, even in real cases of measles, because they
are transient and may disappear within a day of arising.
The characteristic measles rash is classically described as a
rash that begins several days
after the fever starts. It starts on the head before spreading to
cover most of the body, often causing itching
The rash is said to "stain", changing colour from red to dark
brown, before disappearing.
Complications with measles are relatively common, ranging from
relatively mild and less serious diarrhea
leading to corneal
. Complications are usually more severe amongst adults
who catch the virus.
The fatality rate
from measles for
otherwise healthy people in developed countries is 3 deaths per
thousand cases, or .3%.In underdeveloped nation
with high rates of
and poor healthcare
, fatality rates have been as high as
28%. In immunocompromised
(e.g. people with AIDS
) the fatality rate is
approximately 30 percent.
The measles virus is a highly contagious
airborne pathogen which
spreads primarily via the respiratory system. The virus is
transmitted in respiratory secretions, and can be passed from
person to person via aerosol droplets containing virus particles,
such as those produced by a coughing patient. Once transmission
occurs, the virus infects and replicates in the lymphatic system
, urinary tract
and central nervous
of its new host. The role of epithelial cells
is uncertain, but the virus
must infect them to spread to a new individual.
Patients with the measles should be placed on droplet
Humans are the only known natural host of measles, although the
virus can infect some non-human primate species.
Clinical diagnosis of measles requires a history of fever of at
least three days together with at least one of the three
s (cough, coryza, conjunctivitis). Observation of
is also diagnostic of
Alternatively, laboratory diagnosis of measles can be done with
confirmation of positive measles IgM
or isolation of measles virus RNA from respiratory specimens. In
children, where phlebotomy
inappropriate, saliva can be collected for salivary measles
test.Positive contact with other
patients known to have measles adds strong epidemiological
evidence to the diagnosis. The
contact with any infected person in any way, including semen
through sex, saliva, or mucus can cause infection.
In developed countries, most children
are immunized against measles by the age of 18 months, generally as
part of a three-part MMR vaccine
, and rubella
). The vaccination is generally not given
earlier than this because children younger than 18 months usually
retain anti-measles immunoglobulins
(antibodies) transmitted from the mother during pregnancy. A second
dose is usually given to children between the ages of four and
five, in order to increase rates of immunity. Vaccination rates
have been high enough to make measles relatively uncommon. Even a
single case in a college dormitory or similar setting is often met
with a local vaccination program, in case any of the people exposed
are not already immune.
In developing countries where measles is highly endemic, the
recommend that two
doses of vaccine be given at six months and at nine months of age.
The vaccine should be given whether the child is HIV-infected or
not. The vaccine is less effective in HIV-infected infants, but the
risk of adverse reactions is low.
Unvaccinated populations are at risk for the disease. After vaccination
rates dropped in northern Nigeria in the early
2000s due to religious and political objections, the number of
cases rose significantly, and hundreds of children died.
measles outbreak in Indiana was
attributed to children whose parents refused vaccination.
the MMR vaccine controversy
in the United
Kingdom regarding a potential link between the combined MMR
vaccine (vaccinating children from mumps, measles and rubella) and
autism prompted a reemergence of the
"measles party", where parents
deliberately expose their child to measles in the hope of building
up the child's immunity without an injection.
poses many health risks to the child, and has been discouraged by
the public health authorities. Scientific evidence
support for the hypothesis that MMR plays a role in causing autism.
However, the MMR scare in Britain caused uptake of the vaccine to
plunge, and measles cases came back: 2007 saw 971 cases in England
and Wales, the biggest rise in occurrence in measles cases since
records began in 1995.
The joint press release by members of the Measles Initiative
brings to light
another benefit of the fight against measles: "Measles vaccination
campaigns are contributing to the reduction of child deaths from
other causes. They have become a channel for the delivery of other
life-saving interventions, such as bed nets to protect against
malaria, de-worming medicine and vitamin A supplements. Combining
measles immunization with other health interventions is a
contribution to the achievement of Millennium Development Goal
Number 4: a two-thirds reduction in child deaths between 1990 and
There is no cure for measles. Most patients with uncomplicated
measles will recover with rest and supportive treatment.
Some patients will develop pneumonia
sequel to the measles.
[[Image:Measles world map - DALY - WHO2002.svg|thumb|Disability-adjusted life year
for measles per 100,000 inhabitants.
According to the World Health
(WHO), measles is a leading cause of
vaccine-preventable childhood mortality. Worldwide, the fatality
rate has been significantly reduced by a vaccination campaign led
by partners in the Measles
: the American Red
, the United States Centers for Disease Control and
Prevention (CDC), the United Nations Foundation, UNICEF and the
World Health Organization (WHO). Globally, measles fell 60% from an
estimated 873,000 deaths in 1999 to 345,000 in 2005. Estimates for
2007 indicate deaths have fallen further to 197,000 globally, with
most of the global decline seen in the Eastern Mediterranean and
African regions (90% and 89% reduction from 2000
History and culture
The Antonine Plague
, 165-180 AD,
also known as the Plague of Galen
described it, was probably smallpox
measles. Disease killed as much as one-third of the population in
some areas, and decimated the Roman
army. The first scientific description of measles and its
distinction from smallpox and chickenpox
is credited to the Persian
ibn Zakariya ar-Razi
(860-932), known to the West as "Rhazes",
who published a book entitled The Book of Smallpox and
fi al-jadari wa-al-hasbah
Measles is an endemic disease
meaning that it has been continually present in a community, and
many people develop resistance. In populations that have not been
exposed to measles, exposure to a new disease can be devastating.
In 1529, a
measles outbreak in Cuba killed
two-thirds of the natives who had previously survived
smallpox. Two years later measles was responsible for
the deaths of half the population of Honduras, and had
ravaged Mexico, Central America, and the Inca civilization.
In roughly the last 150 years, measles has been estimated to have
killed about 200 million people worldwide. During the 1850s,
measles killed a fifth of Hawaii's
people. In 1875, measles killed over 40,000 Fijians,
approximately one-third of the population.
In the 19th
century, the disease decimated the Andamanese
population. In 1954, the virus
causing the disease was isolated from an 11-year old boy from the
States, David Edmonston,
and adapted and propagated on chick embryo tissue
To date, 21 strains of the measles virus have
been identified. Licensed vaccines
prevent the disease became available in 1963.
beginning of September, 2009, Johannesburg, a town in Gauteng, South Africa reported about 48 cases of
Soon after the outbreak, the Government ordered
that all children be vaccinated. Vaccination programs were then
initiated in all schools and parents of young children were advised
to have them vaccinated. Many people were not willing to have the
vaccination done, as it is believed to be unsafe and ineffective.
The Health Department assured the public that their program was
indeed safe. Speculation arose as to whether or not new needles
were being used. By mid-October there were at least 940 recorded
cases, and 4 deaths.
February 19, 2009, 505 measles cases were reported in twelve
provinces in the North of Vietnam, with Hanoi accounting
for 160 cases.
A high rate of complications including
has worried health workers and the
U.S. CDC recommended that all travelers be immune to measles.
On The 1st April 2009, an outbreak has happened in two schools in
North Wales. Ysgol John Bright and Ysgol Ffordd
Dyffryn in Wales have had the
outbreak and are making sure every pupil has had the MMR vaccine.
a large measles outbreak in Japan caused a
number of universities and other institutions to close in an
attempt to contain the disease.
Approximately 1000 cases of the disease were
reported in Israel between
August 2007 and May 2008 (in sharp contrast to just some dozen
cases the year before).
Many children in ultra-Orthodox
Jewish communities were affected due to low vaccination coverage.
2008 the disease is endemic
in the United
Kingdom with 1,217 cases diagnosed in 2008
epidemics have been reported in Austria, Italy and Switzerland.
Low vaccination rates are
Indigenous measles were declared to have
been eliminated in North, Central, and South America; the last
endemic case in the region was reported on November 12, 2002, with
only Northern Argentina and rural Canada,
particularly in the provinces of Ontario, Quebec, and Alberta
having minor endemic status.
Outbreaks are still occurring,
however, following importations of measles viruses from other
. In June 2006, an outbreak in Boston resulted
after a resident became infected in India, and in
October 2007, a Michigan girl who had been vaccinated contracted the disease
Between January 1 and April 25, 2008, a total of 64 confirmed
measles cases were preliminarily reported in the United States to
the Centers for Disease Control and Prevention, the most reported
by this date for any year since 2001. Of the 64 cases, 54 were
associated with importation of measles from other countries into
the United States, and 63 of the 64 patients were unvaccinated or
had unknown or undocumented vaccination status.
9, 2008, a total of 127 cases were reported in 15 states (including
22 in Arizona), making it the largest U.S. outbreak since 1997
(when 138 cases were reported).
Most of the cases were
acquired outside of the United States and afflicted individuals who
had not been vaccinated.
By July 30, 2008, the number of cases had grown to 131. Of these,
about half involved children whose parents rejected vaccination.
The 131 cases occurred in 7 different outbreaks. There were no
deaths, and 15 hospitalizations. 11 of the cases had received at
least one dose of the measles vaccine. 122 of the cases involved
children who were unvaccinated or whose vaccination status was
unknown. Some of these were under the age of one year old and below
the age when vaccination is recommended, but in 63 cases the
vaccinations had been refused for religious or philosophical
Image:Measles enanthema.jpg|Intra oral rash of measles
Image:Measles in African Child 3.JPG|Measles in African Child
Image:RougeoleDP.jpg|This child shows a classic day-4 rash with measles.
Image:Morbillo.jpg|Histopathology of measles pneumonia. Giant cell
immune enhancement (with echinacea, for example) can assist the
body in working through this viral infection. Homeopathic support
also can be effective throughout the course of the illness. Some
specific alternative treatments to soothe patients with measles
include the Chinese herbs bupleurum (Bupleurum chinense) and
peppermint (Mentha piperita), as well as a preparation made from
empty cicada (Cryptotympana atrata) shells. The itchiness of the
rash can be relieved with witch hazel (Hamamelis virginiana),
chickweed (Stellaria media), or oatmeal baths. The eyes can be
soothed with an eyewash made from the herb eyebright (Euphrasia
officinalis). Practitioners of ayurvedic medicine recommend ginger
or clove tea.