Page 138 - JSOM Summer 2020

An Ongoing Series

Measles (Rubeola)

An Update

Elena M. Crecelius, MD *; Mark W. Burnett, MD 2
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ABSTRACT
Prevention
Measles is a significant concern with approximately 10 million
people infected annually causing over 100,000 deaths world- Measles usually occurs in people who have not been fully vac-
wide. In the US before use of the measles vaccine, there were cinated or in those without a personal history of infection. If
estimated to be 3 to 4 million people infected with measles unvaccinated, roughly 9 in 10 susceptible people exposed to

annually, causing 400 to 500 deaths.Complications of measles measles will become infected. The measles vaccine needs to
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include otitis media, diarrhea, pneumonia, and acute enceph- be kept in a cold environment (between –58° F and +5° F).
alitis. Measles is a leading cause of blindness in the develop- Even brief periods of breakage of this ‘cold chain’ from stor-
ing world, especially in those who are vitamin A deficient. age to administration can significantly decrease the efficacy
Malnourished children with measles are also at higher risk of of the vaccine. The first dose of measles vaccine results in
developing noma (or cancrum oris), a rapidly progressive gan- protection for approximately 95% of recipients older than 1
grenous infection of the mouth and face. Most deaths due to year. Completion of the two-dose measles vaccine series re-
measles are caused by pneumonia, diarrhea, or neurological sults in immunity in 99% of recipients. Less than 5% of those
complications in young children, severely malnourished or im- properly vaccinated may have waning immunity after several
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munocompromised individuals, and pregnant women. A rare years. Anyone older than 6 months of age, including those
sequela of measles is subacute sclerosing panencephalitis. with HIV infection, can receive the measles vaccine during an
outbreak with the exception of pregnant women or those who
Keywords: Paramyxoviridae; measles; vaccinations are severely immunocompromised.

Clinical Presentation
Introduction
Symptoms of measles begin with a high fever, cough, runny
Background: Measles is a highly infectious disease to those nose and conjunctivitis 7 to 14 days after exposure. White or
susceptible. It is caused by a virus from the Paramyxoviridae grayish spots with a red base, known as Koplik spots, may
family that is spread from person to person via the air or con- appear in the mouth 2 to 3 days later. If present, Koplik spots
tact with respiratory secretions. Measles is a significant con- are helpful in the diagnosis of measles, but they are relatively
cern with approximately 10 million people infected annually transient and their absence does not exclude measles. The
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causing over 100,000 deaths worldwide. In the US before use distinctive rash of measles starts 3 to 5 days after symptom
of the measles vaccine there were estimated to be 3 to 4 mil- onset with flat red spots on the upper forehead. The rash will
lion people infected with measles annually, causing 400 to 500 progress in a descending manner, will blanch with pressure,
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deaths. Since the turn of the 21st century, all cases of measles and may develop overlying small red bumps, become conflu-
in the US have been attributed to international exposure or un- ent and have an associated spike in fever. The rash recedes in
der-vaccination. In 2019 there were 1,282 cases of measles in the same manner that it developed. People with measles are
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the US, more than any other year since 1992. In other regions infectious for four days prior to development of the rash and
of the world measles is endemic. Warfare, social disruption, remain infectious for four days after onset of the rash.
and natural disasters that displace large groups of people, and
disrupt routine vaccinations even for a short time, increase the Complications of measles include otitis media, diarrhea, pneu-
risk of measles outbreak. monia, and acute encephalitis. Measles is a leading cause of

*Correspondence to elena.m.crecelius.mil@mail.mil
1 CPT Crecelius is a resident physician in pediatrics at Tripler Army Medical Center in Hawaii. She is a graduate of the Indiana University School
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of Medicine. COL Burnett is currently chief of pediatrics at Tripler Army Medical Center in Hawaii and is the pediatric subspecialties consultant
to the US Army surgeon general. He is board certified in pediatrics and pediatric infectious diseases and has served overseas in Korea, Germany,
Kosovo, Iraq, Afghanistan, and Kuwait and as the JSOTF-P surgeon in the Philippines. He is a graduate of the University of Wisconsin-Madison
and the Medical College of Wisconsin.
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