Measles

Measles Cases on the Rise

          During the first quarter of 2014, 129 cases of measles were reported in the United States, 58 of which were from California.  Almost all of the cases (95%) were either imported from foreign counties or acquired while traveling to a foreign country.  This increase in the cases of measles highlights the importance of adhering to recommended immunization schedules.  Children should receive their first dose of the MMR (measles, mumps, rubella) vaccine at 12 through 15 months and their second dose at 4 through 6 years of age.  Measles is still endemic in some countries, such as the Philippines, where recently there have been 20,000 cases and 69 deaths.  For this reason, children and infants traveling out of the country should be evaluated by their pediatrician to determine whether they should receive an accelerated dosing schedule of MMR vaccine. 

Signs and Symptoms of Measles

          Many physicians practicing in the United States, not to mention parents, have never seen a case of measles, thanks to the highly effective vaccination programs in our country.  Because of the increase in international travel and the current uncontrolled influx of aliens into the United States it is important to be aware of the signs and symptoms of measles or rubeola.  This highly contagious viral infection is characterized by high fever and a maculopapular rash that starts on the face and upper neck and spreads to the extremities.  The rash changes from red to dark brown before disappearing after about 8 days.  In addition, measles is characterized by ‘the three Cs’, cough, coryza (runny nose) and conjunctivitis (inflammation and redness of the white part of the eyes).  The fever can be as high as 104 degrees and precedes the appearance of the rash by several days.  Clinching the diagnosis of measles are the white spots on the inside of the cheek opposite the upper molars, known Koplik spots, which appear transiently before the rash.  These are often missed even by experienced physicians. 

Treatment and Complications

          Treatment is supportive and most patients recover within two weeks.  Minor complications such as diarrhea are common, but pneumonia and encephalitis can lead to serious sequelae and even death.  Immunocompromised individuals are at particular risk.  Patients suspected of having measles should be isolated immediately.  For non-immune, at risk patients exposed to measles, immune globulin may reduce the risk of infection if administered within six days of exposure.  Your personal physician or nurse practitioner can provide you with more information about measles and review your records to make sure you and your children are up to date on all your immunizations.