Measles

Measles is a highly contagious systemic viral infection caused by measles virus. Transmission is airborne and the virus can remain infectious in air or on surfaces for up to approximately 2 hours. Infectiousness begins several days before rash onset and continues for several days afterward.

Severe disease is more likely in young children, malnourished children and those with immunodeficiency.

The prodrome typically includes:

• High fever
• Cough
• Coryza
• Conjunctivitis

Koplik spots may appear on the buccal mucosa before the rash.

The rash:

• Begins on the face and hairline
• Spreads downward to trunk and limbs
• Becomes confluent in severe disease
• Fades in the same general order

Complications include:

• Pneumonia
• Otitis media
• Diarrhoea and dehydration
• Keratitis and corneal ulceration
• Encephalitis
• Severe malnutrition
• Subacute sclerosing panencephalitis years later

Diagnosis is clinical during outbreaks but should be laboratory confirmed according to surveillance requirements.

Testing may include:

• Measles IgM
• PCR from respiratory or urine specimens

Assess carefully for pneumonia, dehydration, malnutrition and eye disease.

There is no routine specific antiviral treatment.

Give supportive care:

• Fluids
• Nutrition
• Oxygen where required
• Treatment of dehydration
• Antibiotics only for secondary bacterial infection

Give vitamin A to children with measles:

Under 6 months: 50,000 IU PO once daily for 2 days

6 to 11 months: 100,000 IU PO once daily for 2 days

12 months and older: 200,000 IU PO once daily for 2 days

A further dose 4 to 6 weeks later is appropriate when clinical vitamin A deficiency or ocular complications are present.

Use airborne infection control precautions.