What is Measles? Measles, also called rubeola, is a highly contagious respiratory infection that's caused by a virus.

It causes a total-body skin rash and flu-like symptoms, including a fever, cough, and runny nose. Though rare in the United States, 20 million cases occur worldwide every year. Since measles is caused by a virus, there is no specific medical treatment and the virus has to run its course. But a child who is sick should be sure to receive plenty of fluids and rest, and be kept from spreading the infection to others. Alternative Names Rubeola Signs and Symptoms While measles is probably best known for the full-body rash it causes, the first symptoms of the infection are usually a hacking cough, runny nose, high fever, and red eyes. A characteristic marker of measles are Koplik's spots, small red spots with blue-white centers that appear inside the mouth.

The measles rash typically has a red or reddish brown blotchy appearance, and first usually shows up on the forehead, then spreads downward over the face, neck, and body, then down to the arms and feet. Symptoms may include:

Bloodshot eyes

Cough Fever Light sensitivity (photophobia) Muscle pain Rash o Usually appears 3 - 5 days after the first signs of being sick o May last 4 - 7 days o Usually starts on the head and spreads to other areas, moving down the body o Rash may appear as flat, discolored areas (macules) and solid, red, raised areas (papules) that later join together o Itchy Redness and irritation of the eyes (conjunctivitis) Runny nose Sore throat Tiny white spots inside the mouth (Koplik's spots)

Who is at risk? Unvaccinated young children are at highest risk of measles and its complications, including death. Any non-immune person (who has not been vaccinated or previously recovered from the disease) can become infected. Measles is still common in many developing countries particularly in parts of Africa and Asia. More than 20 million people are affected by measles each year. The overwhelming majority (more than 95%) of measles deaths occur in countries with low per capita incomes and weak health infrastructures. Measles outbreaks can be particularly deadly in countries experiencing or recovering from a natural disaster or conflict. Damage to health infrastructure and health services interrupts routine immunization, and overcrowding in residential camps greatly increases the risk of infection. Transmission The highly contagious virus is spread by coughing and sneezing, close personal contact or direct contact with infected nasal or throat secretions. The virus remains active and contagious in the air or on infected surfaces for up to two hours. It can be transmitted by an infected person from four days prior to the onset of the rash to four days after the rash erupts. Measles outbreaks can result in epidemics that cause many deaths, especially among young, malnourished children.

In countries where measles has been largely eliminated, cases imported from other countries remain an important source of infection. Outlook (Prognosis) Those who do not have complications such as pneumonia do very well. Possible Complications Complications of measles infection may include:

Bronchitis Encephalitis (about 1 out of 1,000 measles cases) Ear infection (otitis media) Pneumonia

Is Measles Contagious? Measles is highly contagious 90% of people who haven't been vaccinated for measles will get it if they live in the same household as an infected person. Measles is spread when someone comes in direct contact with infected droplets or when someone with measles sneezes or coughs and spreads virus droplets through the air. A person with measles is contagious from 1 to 2 days before symptoms start until about 4 days after the rash appears. Measles is very rare in the United States. Due to widespread immunizations, the number of U.S. measles cases has declined in the last 50 years. Before measles vaccination became available in the 1960s, more than 500,000 cases of measles were reported every year. From 2000 to 2007, just an average of 63 cases per year was reported. However, in 2008 the United States saw an increase in measles cases and outbreaks (more than three or more linked cases), with 131 cases reported between January and July. More than 90% of those infected were not immunized or immunization status was unknown. The most important thing you can do to protect kids from measles is to have them vaccinated according to the schedule prescribed by your doctor. Prevention

Infants are generally protected from measles for 6 months after birth due to immunity passed on from their mothers. Older kids are usually immunized against measles according to state and school health regulations. For most kids, the measles vaccine is part of the measles-mumps-rubella immunizations (MMR) or measles-mumps-rubella-varicella immunization (MMRV) given at 12 to 15 months of age and again at 4 to 6 years of age. Measles vaccine is not usually given to infants younger than 12 months old. But if there's a measles outbreak, the vaccine may be given when a child is 6-11 months old, followed by the usual MMR immunization at 12-15 months and 4-6 years. As with all immunization schedules, there are important exceptions and special circumstances. Your child's doctor should have the most current information regarding recommendations about the measles immunization. Measles vaccine should not be given to pregnant women or to kids with untreated tuberculosis, leukemia or other cancers, or people whose immune systems are suppressed for any reason. Also, the vaccine shouldn't be given to kids who have a history of severe allergic reaction to gelatin or to the antibiotic neomycin, as they are at risk for serious reactions to the vaccine. During a measles outbreak, people who have not been immunized (especially those at risk of serious infection, such as pregnant women, infants, or kids with weakened immune systems) can be protected from measles infection with an injection of measles antibodies called immune globulin if it's given within 6 days of exposure. These antibodies can either prevent measles or make symptoms less severe. The measles vaccine also may offer some protection if given within 72 hours of measles exposure. Vaccine Side Effects Measles vaccine occasionally causes side effects in kids who don't have underlying health problems. The most common reactions are fever between 6-12 days after vaccination (in about 5%-15% of kids getting the vaccine) and a measles-like rash, which isn't contagious and fades on its own (in about about 5% of vaccinated kids). Treatment There is no specific medical treatment for measles. To help manage symptoms, which usually last for about 2 weeks, give your child plenty of fluids and encourage extra rest. If fever is making your child uncomfortable, you may want to give a non-aspirin fever medication such as acetaminophen or ibuprofen.

Remember, you should never give aspirin to a child who has a viral illness since the use of aspirin in such cases has been associated with the development of Reye syndrome. Kids with measles should be closely monitored. In some cases, measles can lead to other complications, such as otitis media, croup, diarrhea, pneumonia, and encephalitis (a serious brain infection), which may require antibiotics or hospitalization. In developing countries, vitamin A has been found to decrease complications and death associated with measles infections. In the U.S., vitamin A supplementation should be considered for children between 6 months and 2 years who are hospitalized with measles and its complications. Also, all kids older than 6 months with risk factors, such as vitamin A deficiency, weakened immune system, or malnutrition may benefit from vitamin A supplementation. Exams and Tests

Measles serology Viral culture (rarely done)

Treatment There is no specific treatment for the measles. The following may relieve symptoms:

Acetaminophen (Tylenol) Bed rest Humidified air

Some children may need vitamin A supplements. Vitamin A reduces the risk of death and complications in children in less developed countries, where children may not be getting enough vitamin A. People who don't get enough vitamin A are more likely to get infections, including measles. It is not clear whether children in more developed countries would benefit from supplements.

When to Call the Doctor Call the doctor immediately if you suspect that your child has measles. Also, it's important to get medical care following measles exposure, especially if your child:

is an infant is taking medicines that suppress the immune system has tuberculosis, cancer, or a disease that affects the immune system

Remember that measles, a once common childhood disease, is preventable through routine childhood immunization.