Everything you need to know about Measles

Morbillivirus, the virus responsible for Measles, can pass from a diseased person to another through close contact or via breath, a cough, or a sneeze in 9 out of 10 cases. The contagious fluid particle discharged by a person with Measles retains its capability to infect for up to two hours. A single Measles case is capable of infecting 12–18 others, according to the World Health Organisation (WHO). That makes Measles, an illness that affects the cells lining the human throat and lungs, one of the most rapidly transmissible diseases.

Measles (also known as “khasra” in parts of India), is often mentioned in the same breath as rubella. The two diseases have some symptoms in common, but the two are spread by different viruses, so they are not the same. Thankfully, rubella isn’t as contagious or life-threatening as Measles, but it is still known to cause hearing defects, eye and heart problems, as well as mental retardation in children who got the virus from their mothers in the fetal stage (10–40th week of pregnancy). The chance of an infected mother transmitting the virus to her fetus is as high as 90%.

Measles outbreak

Measles can be serious and even fatal for small children less than 2 years of age. Three fatal cases involving children aged 1–5 years were reported from Mumbai’s Govandi locality in November 2022. The same month, Measles outbreaks were reported from Ranchi (Jharkhand), Ahmedabad (Gujarat), and Malappuram (Kerala). During a Measles outbreak, the percent of fatalities could reach up to 5–10% of the infected (child) population. Importantly, Measles is an exclusively human disease; animals are not known to get or transmit it.

Measles is easily and entirely preventable by vaccine. Any child who is fully vaccinated is unlikely to get the disease. But, there’s a catch; to prevent Measles outbreaks, a 95% vaccination coverage of children is vital and in resource-poor countries, the share of people vaccinated (in the population eligible for vaccination) is invariably low.

In India, children aged 9 months to 15 years are inoculated with Measles Rubella vaccine (MR vaccine) offered in two doses: at 9–12 months and 16–24 months. Two doses are necessary to cover immunity gaps, i.e., a period when the child is not protected from the virus. As of 2014, in India, nearly 90% of the eligible children received the first dose of the MR vaccine. The corresponding figure for the second dose was just 66%. Meanwhile, the government has set December 2023 as the target for Measles/Rubella elimination.

Disease transmission

Having entered the nose, throat, voice box, windpipe, and main air passageways, the Measles virus proceeds to infect the special immune cells of the lungs, thus tearing down the body’s defenses brick by brick. The irritants in the air passage trigger a dry cough that doesn’t produce any phlegm or mucus. The immune cells in the neck, armpit, chest, belly, and groin are also compromised and these infected cells, in turn, course through the body discharging the contagion further into the blood.

The small blood vessels in the skin are also infected. Usually little bluish-white spots, often on a reddened background, occur in the lining of the cheeks and back of the lips about 11–12 days after exposure to the virus. These Koplik’s spots (named after pediatrician Henry Koplik, widely believed to have described these spots for the first time in writing), disappear in three days.

To get rid of the invading pathogen, the immune cells release chemicals (e.g., histamine, nitric oxide). However, in the process, these chemical compounds also cause some swelling and damage to the cells hosting the foreign organism. This translates to small irregular and itchy red spots (“rashes”), the tell-tale signs historically associated with Measles. Such rashes break out on the face and behind the ears first. Typically, these rashes appear around 14 days after the initial exposure to the virus and start to fan out from the face to the arms, chest and back, then the thighs, and finally the legs and feet. The rashes usually last about a week before gradually fading away from the face first and from the lower extremities of the body last.

Symptoms

People start showing symptoms only 10–14 days after contracting Measles. The classic triad of symptoms are the three “C’s” — dry Cough, Coryza (runny nose), and Conjunctivitis (inflammation of the thin conjunctiva tissue that lines the white of the eye and the inside of the eyelids). Other key symptoms include a sore throat, as well as Koplik’s spots, itchy skin rashes, and high temperature previously discussed.

Diagnosis and treatment

Skin rashes often result from other medical conditions as well, so a blood test, urine test, throat swab, or nasal swab might be required to confirm the presence of Measles.

There is no cure, as such, for Measles. The medical care for people with Measles aims to relieve them from fever and related bacterial infections (of the ear and air tubes in the lungs), as well as boost immunity even as the virus runs its 10–14-day course. Preventing complications such as hearing loss resulting from ear inflammation and mild to severe inflammation of the large air passages (bronchi), voice box, and windpipe is the focus of present-day Measles treatment. Acute inflammation of the functional tissues of the brain (acute encephalitis) culminating in convulsions, loss of hearing, and of intellectual disabilities affects 1 out of every 1,000 Measles cases, and medications must take care of such problems that arise during treatment.

At the Adult Immunization Clinic at PD Hinduja Hospital and Medical Research Centre, Khar, our response to Measles and rubella includes post-Measles vaccination within 72 hours of the infection, antibody injections, antibiotics, and vitamin A supplementation. Our Measles and rubella therapeutics help relieve the severity of the symptoms and prevent serious complications, especially in infants, pregnant women, and people with compromised immune systems.

An ounce of prevention

Children who are not vaccinated are at a high risk of contracting Measles, and, at least in some instances this could cause significant morbidity or be fatal. So, make sure your child gets two full doses of the MR vaccine if you haven’t already. The vaccine is part of the government’s Universal Immunization Programme and is provided free of cost by the authorities. The vaccine is also administered by private hospitals at a cost.

Contact us at (022–4510 8989 / 6154 8989 ) PD Hinduja Hospital and Medical Research Centre, Khar, for treatment or more details.