Other names :
Morbilli, rubeola, ordinary measles.

Introduction :
Generalised viral infection causing fever, rash, debilitation and occasionally, serious complications.

Cause :
Measles is due to a viral infection that is spread from person to person by a cough or sneeze.

Incidence :
Measles traditionally occurs in epidemics every three years or so, but since vaccination has become widespread, epidemics are less common. Unfortunately, not everyone is being vaccinated, so an epidemic (with some deaths) occurred as recently as 1994 in Australia. The World Health organisation hopes to eliminate measles completely by the year 2000, and in Europe and North America it has already been eradicated. Even some African countries are doing better than Australia by eradicating the disease.

Prevention :
Measles can be prevented by vaccination. If everyone is vaccinated, then the disease ceases to exist. Because vaccination against measles is voluntary, and not compulsory, some parents neglect to have their children vaccinated, and that is why outbreaks are still occurring. Not until over 90% of the population has been vaccinated or developed natural immunity by catching measles, will the disease die out. The ideal time to start vaccination a child for measles is at 12 months of age, but older children and adults can be vaccinated at any age. The vaccination is normally combined with the mumps and rubella vaccine and is given at 12 months and 12 years of age to give life long protection.

Investigations :
The diagnosis is usually obvious, but if necessary, a blood test can confirm that a rash is due to measles.

Course :
Measles usually starts with the cold-like symptoms of a snuffly nose, cough and conjunctivitis. Not until the rash develops a few days later can the diagnosis be made. The rash starts in the mouth, where tiny white spots may appear on the lining of the cheeks. The skin rash usually starts on the face about four days after the cold symptoms, and gradually spreads as dark red blotches across the body. The rash remains for a week or more before gradually fading. The patient often starts to feel better once the rash has reached its maximum spread, but the patient is contagious from five days before the rash appears, until it disappears.

Treatment :
As with all other viral infections, there is no specific treatment for measles. All doctors can do is ease the symptoms of the disease by prescribing rest, pain killers and medicine to relieve the cold symptoms. Vitamin A supplements appear to reduce the severity of an attack. If the child worsens, immediately seek further medical help.

Complications :
Serious complications may occur with measles, and are more common in more primitive countries where there is no natural immunity. Complications include encephalitis (a serious brain infection) that may result in permanent brain damage, pneumonia, ear infections and damage, and the increased risk of developing multiple sclerosis later in life. Death, although rare, can occur, even in Australia.

Outcome :
Most patients recover without complications.

Medical curiosity :
In the past, measles epidemics have been devastating in primitive countries. Up to 80% of the population of several Pacific islands died after a visit by the first explorers from a disease to which they had no natural resistance, as they had never previously been exposed to measles.

Related conditions :
Immunisation, Rubella.