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What is Measles (Rubeola)?


Measles Rubeola
Image source: CDC PHIL

Measles (Rubeola) is a respiratory disease caused by a paramyxovirus, genus Morbillivirus with a core of single-stranded RNA.1 Measles is highly contagious and causes a systemic infection that begins in the nasopharynx (upper area of the throat behind the nose). The virus is highly contagious but it can easily be destroyed by light, high temperatures, UV radiation or disinfectants. 2 Measles viruses are divided into eight clades (A to H) and while 24 genotypes have been confirmed, only 19 have been detected since 1990. 3

Measles causes a systemic infection that begins in the nasopharynx. The virus is transmitted through respiratory secretions (nasal discharge, coughing sneezing) and an infected person is contagious for four days prior to the onset of symptoms up until three to four days after rash onset.4

Measles is unique to humans.5 Before the first measles vaccine was licensed for use in the U.S. in 1963, measles cases and outbreaks were seen generally in late winter and spring 6 usually every two to three years.7

Measles symptoms begin 10-14 days after close contact with someone infected with measles. Symptoms start with a fever, cough, runny nose, conjunctivitis, and white spots in the mouth, and progresses to a rash that starts on the face, spreads to the rest of the body, and lasts for about a week.8 Prior to the appearance of the measles rash (on the fourth or fifth day after fever begins), measles can be mistaken for several illness including influenza, bronchiolitis, croup, or pneumonia.9

Other symptoms of measles include:10

  • Light sensitivity
  • Watery eyes
  • Sneezing
  • Body aches
  • Swollen eyelids

Illnesses that may also develop along with measles are ear infections, diarrhea, croup, bronchiolitis and pneumonia.

Complications include very high fever, diarrhea, otitis media, seizures, pneumonia, encephalitis (0.1% reported), and very rarely, subacute sclerosing panencephalitis (SSPE - a progressive, debilitating and deadly brain disorder), and death. 11 12 Measles during pregnancy may result in a premature birth or a low birth-weight infant.13 Recovery from measles will create antibodies that confer long-lasting immunity.14

In the past, when measles infections were common, doctors diagnosed measles from the presence of tiny white specks surrounded by a red halo inside the cheeks of an infected person’s mouth.15  However, as measles is no longer common, the measles rash has been frequently misdiagnosed by physicians as scarlet fever, Kawasaki Disease, and dengue. 16 The Centers for Disease Control (CDC) urges healthcare providers to consider measles when a patient presents with a febrile rash, and to notify the local health department of any suspected cases within 24 hours. 17  

Confirmation of measles must be made by laboratory diagnosis (blood, throat swab)18 as physician reports of measles cases based on symptoms are no longer accepted by the CDC as confirmation of the disease.19 Additionally, measles genotyping should be completed as this is the only way to determine whether a person has wild-type measles or a rash as a result of a recent measles vaccination (vaccine-strain measles).20

“Modified” measles can also occur in persons with some degree of immunity, as well as in previously vaccinated persons, who get a milder form of measles. “Atypical” measles can occur in a person, who was previously vaccinated with a killed-virus vaccine used from 1963 to 1967, and who is exposed to wild-type measles. 21 The course of atypical measles is generally longer than natural measles.22 

IMPORTANT NOTE: NVIC encourages you to become fully informed about Measles and the Measles vaccine by reading all sections in the Table of Contents , which contain many links and resources such as the manufacturer product information inserts, and to speak with one or more trusted health care professionals before making a vaccination decision for yourself or your child. This information is for educational purposes only and is not intended as medical advice.

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References

1 CDC Measles – Measles Virus. Epidemiology and Prevention of Vaccine-Preventable Diseases (The Pink Book). 13th ed. 2015.

2 Ibid

3 CDC Measles (Rubeola) Genetic Analysis of Measles Viruses Jun. 5, 2018

4 CDC Measles (Rubeola) For Healthcare Professionals – Clinical Features. May 8, 2018

5 CDC Transmission of Measles Feb. 5, 2018

6 CDC Measles – Epidemiology Epidemiology and Prevention of Vaccine-Preventable Diseases (The Pink Book). 13th ed. 2015.

7 World Health Organization Measles. May 9, 2019

8 Mayo Clinic Measles May 24, 2019

9 Koenig KL, Alassaf W, Burns MJ Identify-Isolate-Inform: A Tool for Initial Detection and Management of Measles Patients in the Emergency Department West J Emerg Med. 2015 Mar; 16(2): 212–219.

10 Nordqvist, C Understanding the causes of measles MedicalNewsToday May 15, 2017

11 CDC Measles – Complications Epidemiology and Prevention of Vaccine-Preventable Diseases (The Pink Book). 13th ed. 2015.

12 Perry RT, Halsey NA. The Clinical Significance of Measles: A Review. J Infect Dis. 2004 May 1;189 Suppl 1:S4-16.

13 CDC Measles (Rubeola) Complications of Measles. Jun. 13, 2019

14 CDC Measles Epidemiology and Prevention of Vaccine-Preventable Diseases (The Pink Book). 13th ed. 2015.

15 Mayo Clinic Measles – Diagnosis May 24, 2019

16 Seward J Suspect Measles and Act Fast. Medscape. Updated Feb. 11, 2015

17 CDC Measles (Rubeola) For Healthcare Professionals – Diagnosis and Laboratory Testing Feb. 5, 2018

18 Ibid

19 CDC Prevention of Measles, Rubella, Congenital Rubella Syndrome, and Mumps, 2013: Summary Recommendations of the Advisory Committee on Immunization Practices (ACIP) MMWR June 14, 2013; 62(RR04);1-34

20 CDC Measles (Rubeola) Genetic Analysis of Measles Viruses Jun. 5, 2018

21 CDC Measles - Complications Epidemiology and Prevention of Vaccine-Preventable Diseases (The Pink Book). 13th ed. 2015.

22 Sabella C. Measles: Not just a childhood rash Cleve Clin J Med 2010 Mar. 77(3):207-213


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