Measles: symptoms, complications and treatment
Measles is the most conspicuous of all childhood exanthematous diseases, as it is characterised by very high fever, cough, conjunctivitis, rash and mucous eruption (enanthema)
The causes of measles
Measles is caused by infection with a paramyxovirus, which has a very high contagious power, almost equal to that of chickenpox (a cohabitee of a child with measles, if not yet infected, is unlikely to escape contagion), exerted through prolonged direct contact and inhalation of the microscopic droplets of saliva emitted by the sick person during violent coughing fits.
Epidemiology
Measles vaccination was introduced in the United States in 1963. Since then, the disease has declined in incidence by 99%, although epidemics have still occurred (in 1971, 1976, 1986 and 1989).
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Before vaccination, virtually all children contracted measles at pre-school age, and this situation still occurs in developing countries and in countries that have not implemented such a strict health policy as the USA.
The benefits of the vaccine are unquestionable, first and foremost the reduction in deaths by around 75%, despite the fact that around 20 million cases of measles still occur worldwide every year.
To clarify the importance of vaccination, one need only recall that in 1980 there were 2.6 million measles deaths; in 2013 only 96,000, almost all of them under the age of 5.
Measles mortality affects about 0.2% of those infected.
Signs and symptoms of measles
The incubation time is 11 days, after which the first symptoms appear: high fever, feeling unwell, headache.
Within a few hours the sufferer complains of photophobia and conjunctivitis, the latter mainly affecting the eyelids.
At the same time, the typical signs of a cold begin: sneezing, a productive cough and nasal hypersecretion.
At this stage of the disease, which lasts up to 4 days, a typical and exclusive measles enanthema appears: the presence of whitish spots on the mucous membrane of the cheek, at the level of the upper first molar.
This is the pathognomonic Köplik’s sign, which precedes the rash by a day and lasts up to 2 days after the appearance of the rash.
Rarely, Köplik’s spots can also be detected on the eyelid and vaginal mucosa.
The rash starts behind the ears or on the face and neck, at first as macular erythema, and then rapidly spreads to the trunk and limbs.
Hands and feet may be spared and the rash rapidly changes from macular to papular, with a tendency to confluence, taking on a more intense red colour.
Pressure on the spots with a spectacle glass does not cause them to turn pale, as happens in the allergic rash.
After an average of 5 days, the skin manifestation disappears in the same cranio-caudal order as the appearance, often leaving a very fine desquamation of the skin that never involves the hands and feet.
The fever is always very high (40°C – 41°C) and may last up to 6 days, accompanied by a moist cough and the typical listening sign of bronchitis: signs that may persist for days even after the end of the febrile stage.
Generalised lymphadenitis is common, as in many febrile infectious diseases, while nausea and vomiting may be present in adults.
Measles complications
They constitute a danger, sometimes serious, and are announced by the persistence of fever beyond the sixth day.
The two most frequent complications are otitis media and pneumonia, although the most dramatic eventuality is the onset of demyelinating encephalitis, which can occur up to 14 days after the start of the illness.
The symptoms are dramatic: the fever that had disappeared reappears, intense headache, vomiting and nuchal rigidity occur.
Convulsions and a soporific state soon appear.
In 10% of patients death is inevitable and over 50% of survivors have permanent neurological sequelae of varying severity.
Course of the disease
Measles, if complications do not occur, is a disease with spontaneous recovery.
Fatal cases are almost always the result of bacterial overinfection pneumonia in adults or children under one year of age.
In the elderly, one cause of death is congestive heart failure, while the prognosis is particularly bad in immunocompromised patients.
Fortunately, the use of antibiotics succeeds in drastically decreasing fatal cases, but it should be noted that the use of antibiotics has no preventive effect.
Measles treatment and therapy
There is no specific therapy and the mainstay of care is based on symptomatic therapy: bed rest, codeine against coughs and myalgia, antipyretics, copious fluid intake.
Intense light does not damage the visual apparatus, but can bring relief to patients with significant photophobia (this is why, at a popular level, red curtains were put on the windows: by reducing the brightness of the room with heavy curtains, the patient was undoubtedly relieved; whether the curtains were red or green or black was absolutely irrelevant).
Antibiotics, as mentioned, have no preventive effect, so their use in uncomplicated measles is absolutely to be avoided.
How to Prevent Measles
Apart from avoiding contact with sick people, the only possible form of prevention is the administration of the MPRV vaccine, based on the live attenuated virus, which produces immunity through infection.
The protective efficacy is 98-99%, and a second reinforcing dose is appropriate (before the second dose was recommended, cases of immunisation failure were much more frequent).
As with all vaccines, the onset and duration of the resulting immunisation may differ depending on numerous factors, including the age of administration, lack of booster, the presence of an immune deficiency, the use of drugs that hinder immunity, and the use of a killed vaccine rather than a live one.
Contraindications to vaccination are pregnancy, immune deficiency, leukaemia, systemic malignancies, tuberculosis in active phase, use of drugs that decrease immunity (cortisone, antimetabolites).
A final aspect concerning the vaccine: its safety.
Apart from the scaremongering created by ignorance or commercial interests, it should be pointed out that the live virus vaccine does, in fact, create the disease it is supposed to prevent, obviously in a very attenuated form.
However, the onset of fever and in some cases a skin rash after vaccination is common.
This phenomenon should not be interpreted as a ‘damage’ of the vaccine, but simply as a demonstration of its effectiveness in inducing antibody formation.
With regard to the danger to life that has been hypothesised by some pseudoscientists, it is sufficient to recall a numerical fact that puts an end to the problem: the vaccine can cause one death per 1,000,000 vaccinees; measles causes one death per 1,000-2,000 sufferers.
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