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Measles: An Overview
Introduction
Measles is a highly contagious viral disease that has been recognized for centuries. Although a safe and effective vaccine has significantly reduced its global prevalence, measles remains a public health concern in areas with low vaccination coverage. The disease can lead to severe complications, especially in children, pregnant women, and individuals with weakened immune systems.
Causative Agent
Measles is caused by the measles virus, a single-stranded, enveloped RNA virus belonging to the Paramyxoviridae family and Morbillivirus genus. The virus is extremely sensitive to environmental conditions such as heat and light, but it spreads very efficiently from person to person.
Mode of Transmission
The measles virus spreads primarily through respiratory droplets produced when an infected person coughs or sneezes. The virus can also remain active and contagious in the air or on surfaces for up to two hours. This high transmissibility means that even short-term contact with an infected person can result in infection if the individual is not immune.
Epidemiology
Before widespread vaccination, measles was almost universal in childhood. Today, thanks to the measles vaccine (introduced in the 1960s), global cases have dropped dramatically. However, outbreaks still occur, particularly in areas with:
- Low immunization rates
- Disrupted healthcare systems
- Vaccine hesitancy
The World Health Organization (WHO) considers measles one of the leading causes of death among young children, despite the availability of the vaccine.
Pathophysiology
Once inhaled, the virus infects the respiratory tract and spreads to local lymph nodes. It then enters the bloodstream (viremia), reaching multiple organs and tissues. The characteristic measles rash results from the immune system’s response to infected capillary endothelial cells.
Signs and Symptoms
The incubation period for measles is usually 10–14 days. Symptoms appear in two phases:
1. Prodromal (Pre-rash) Phase
- High fever (often ≥40°C / 104°F)
- Cough
- Runny nose (coryza)
- Red, watery eyes (conjunctivitis)
- Koplik spots: tiny white lesions inside the cheeks, appearing 2–3 days before the rash
2. Rash Phase
- Starts as red, flat spots on the face and behind the ears
- Spreads downward to the trunk and limbs
- May merge into larger blotches
- Lasts 5–6 days before fading in the same order it appeared
Complications
Measles can lead to serious complications, especially in malnourished children or those with compromised immunity. These include:
- Ear infections (otitis media)
- Pneumonia – the leading cause of measles-related deaths
- Encephalitis – inflammation of the brain, potentially leading to permanent damage or death
- Diarrhea and dehydration
- Subacute sclerosing panencephalitis (SSPE) – a rare, fatal neurological disorder occurring years after infection
Diagnosis
Diagnosis is based on:
- Clinical features: Rash, fever, Koplik spots, and history of exposure
- Laboratory tests:
- Detection of measles-specific IgM antibodies
- Reverse transcription polymerase chain reaction (RT-PCR) to detect viral RNA
Treatment
There is no specific antiviral treatment for measles. Management is mainly supportive:
- Adequate hydration
- Nutritional support
- Fever management (paracetamol/acetaminophen)
- Vitamin A supplementation (WHO recommends two doses for all measles cases to reduce severity and complications)
- Monitoring and treatment of complications
Prevention
The most effective prevention is vaccination:
- MMR vaccine (measles, mumps, rubella) or MR vaccine (measles, rubella)
- Two doses are recommended:
- First dose: 9–12 months of age
- Second dose: 15–18 months or at school entry
Additional preventive measures include:
- Maintaining high community vaccination coverage (herd immunity)
- Isolating infected individuals for at least 4 days after rash onset
- Rapid outbreak response through mass immunization campaigns
Prognosis
In healthy, well-nourished individuals with access to healthcare, measles usually resolves without long-term effects. However, in vulnerable populations, it can cause severe disease and death. The global case-fatality rate ranges from 0.1% to over 5%, depending on healthcare access and nutritional status.
Global Public Health Importance
Measles outbreaks serve as indicators of gaps in healthcare systems. Achieving and maintaining high vaccination coverage (≥95%) is essential for measles elimination. The WHO has set a target for global eradication, but challenges such as misinformation, vaccine hesitancy, and conflicts that disrupt health services remain major barriers.
Conclusion
Measles is a preventable yet potentially deadly disease. While remarkable progress has been made in reducing its burden, recent outbreaks highlight the importance of sustained vaccination efforts, public health awareness, and rapid outbreak response. Eradication is achievable, but it requires global cooperation and unwavering commitment to immunization.
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