Measles is one of the most highly infectious diseases. Although it is often wrongly dismissed as a minor disease that everyone will get as a child and recover from easily, the effects of measles can be extremely serious and even sometimes fatal. In countries with poor vaccination programmes measles remains a very severe disease with over one million children dying world-wide each year.
Thanks to the childhood immunisation programme, the disease became rare in the UK. However, because of the drop in the uptake of immunisation, the numbers of confirmed cases of measles has increased since 2005, reaching 1370 in 2008, the highest number since monitoring was introduced in 1995. In May 2011 the Health Protection Agency reported 334 cases compared with 33 in the similar period in 2010.The outbreak was thought to be linked to an epidemic in France, where 7,000 cases were reported since the start of 2011; more than in the whole of 2010.
Anyone who has not been vaccinated against measles or who has never caught measles and so has not developed natural immunity, always remains at risk of catching the disease. The number of people susceptible to measles in the UK has risen to such an extent that there is now a real threat of a large measles epidemic returning to the UK.
Measles is caused by a virus, known as a morbillivirus of the paramyxovirus family. The measles virus is highly infectious and can spread quickly, particularly in close-confined communities such as schools if children are not immunised, or in the work place if people are not immune. The measles virus is spread through airborne transmission of droplets when someone infected with the virus coughs or sneezes without covering their mouth or nose. A person with measles is infectious from about 4 days before to 4 days after a rash appears, but is most infectious before the rash is visible. Consequently, someone can spread the disease before they realise they have measles.
Anyone that has not been immunised against measles, or who has not developed a natural immunity, is at risk of catching measles if they have been in contact with someone that has measles.
People that are malnourished, have vitamin A deficiency, whose immune system is not functioning properly, or who have chronic conditions such as cystic fibrosis, congenital heart or kidney disease and Down’s syndrome are particularly vulnerable.
The incubation period for measles, ie the time taken for symptoms to appear after someone first becomes infected, is about 10 days. The symptoms of measles start like a bad cold with a high temperature, cough, sore eyes and runny nose. A red, blotchy rash appears at the head and spreads to the body and limbs over 3 to 4 days. The rash lasts for about a week before fading. Small red spots with blue-white centres, called Koplik spots, may be seen in the mouth on the inside of the cheeks.
The most common complications of measles are ear infections (otitis media), croup, pneumonia, diarrhoea and eye infections, mostly caused by secondary bacterial infections.
Other rarer, but more serious infections involve the nervous system. Encephalitis (inflammation of the brain) occurs in about 1 in 1,000 cases of measles and can leave permanent brain damage. Subacute sclerosing pan-encephalomyelitis (SSPE), a slowly progressive brain infection, is the most severe complication of measles. SSPE usually occurs years after the initial illness, it starts with intellectual impairment, leads to seizures and eventually death. Thankfully, vaccination has caused almost the total disappearance of SSPE in the UK, but it remains a risk if people are not immunised.
During pregnancy, measles carries the risk of potentially fatal inflammation of the lungs (pneumonitis) of the mother, and is associated with increased risk of miscarriage, premature and low birth weight babies, but not congenital malformation.
The risk of death with measles is age-related. It is highest in children under 1 year, falls in children aged 1 to 9 years and rises again in teenagers and adults.
Measles can be prevented by a highly effective and safe vaccine. In the UK, most babies are routinely vaccinated between 12 months and 15 months of age against measles with a vaccine known as MMR, which also protects against mumps and rubella. Adults not vaccinated with MMR when a child can be given the MMR vaccine at any time. Even if there is uncertainty about a person’s history of measles, mumps or rubella infection or vaccination there are no ill effects from vaccination. A second dose can be given routinely at any time 1 to 3 months after the first dose.
Anyone that has not been immunised against measles who is travelling to countries where measles is still a problem should also be vaccinated with MMR.
The MMR vaccine provides protection against measles very quickly. It can be used to provide protection of someone not immunised who has been in contact with measles, provided it is given within 3 days of contact taking place. A different type of injection called human normal immunoglobulin (HNIG) can be used to provide post-exposure protection against measles when the MMR vaccine cannot be used. For example in pregnant women or people with a severely weak immune system who do not have immunity to measles. HNIG must be given within 6 days of contact taking place to be effective.
After immunisation it is common to develop a mild fever and rash and generally feel a little unwell. The symptoms soon pass. Paracetamol can be used to lower a raised temperature.
When to see your Pharmacist
You can obtain paracetamol from your local pharmacy without the need for a prescription to help reduce a raised temperature following immunisation. Always check the label of medicines to make sure that the dose of paracetamol is not being exceeded. Aspirin should not be used in children under 16 years of age to lower high temperatures or for pain relief.
If travelling abroad and you are concerned about the risks of measles, talk to your pharmacist. Your pharmacist has access to regularly updated information about countries where measles remains a problem and if vaccination is required.
After MMR vaccination, swelling might occur at the injection site but is not normally any larger than the size of a 10p coin. Any larger swelling should be checked by your doctor.
If you are pregnant and have been in contact with someone with measles, but you are not sure if you are susceptible to measles, contact your doctor. Your doctor may decide to test for measles immunity and give you HNIG if you are not immune.
If you think you or your child has the symptoms of measles you should see your doctor immediately, especially if you have recently returned from a country, or been in contact with someone from a country, where measles is still a problem.
If you are sure that you or your child has measles, notify your doctor so that cases may be reported to the local health authority to allow official figures about the disease to be recorded and coordinated.
Protecting your child, your family and others against measles
The most effective way of protecting your child and others against measles is to have your child vaccinated with the MMR vaccine. The childhood immunisation programme provides direct protection against mumps, measles, rubella, diphtheria, whopping cough and the risks of bacterial meningitis caused by pneumococcal bacteria, meningococcal type C and Hib. By providing immunity against mumps and measles, the immunisation programme also helps provide protection against viral meningitis. The risks of all of the diseases covered by the immunisation programme are far, far greater than any risks associated with the vaccines themselves. It is essential that all children are vaccinated at the appropriate times. Vaccination of children also helps reduce the spread of infection to adults.
Since 1998 there has been much publicity in the media wrongly linking the MMR vaccine with autism and bowel disease. This publicity led to many parents delaying their baby’s MMR vaccination or not giving the vaccine at all. Take up of the measles vaccine fell, plummeting to a low of just 80% in 2004; a level at which there is no ‘herd-immunity’, allowing the disease to spread rapidly. As a result, there has been an increase in outbreaks of measles and, tragically, some children and adults have died or been seriously brain damaged.
The reports linking MMR vaccine with autism have since been discredited. The conclusion of experts from all over the world, including the World Health Organization, is that there is no link between MMR vaccines and autism or bowel disease. The World Health Organization advises that the MMR has an exemplary safety record and anticipates that its widespread use will eventually see the eradication of measles, mumps and rubella world-wide. The World Health Organization also advises against using separate vaccines for the simple reason that doing so would leave children at risk and offer no benefits. No country in the world recommends giving MMR as three separate vaccines. Giving the vaccines separately may be harmful because it leaves children open to the risk of catching measles, mumps or rubella. By having them all at once, a child is protected against all three diseases soon after the MMR injection is given.
Consequently, parents are encouraged to have their babies vaccinated against all three diseases with the MMR vaccine at the appropriate time. Parents who decided not to vaccinate their babies are strongly advised to reconsider having their child vaccinated at the earliest opportunity.
If someone in your family does develop measles try to keep them apart from others for at least 5 days after the rash appears. This means keeping young children off from school for 5 days, or staying away for 5 days from work or other places where there is close contact with other people.
The practice of holding ‘measles parties’, deliberately to infect others to build their immunity without vaccination, is positively discouraged by the health authorities as it can pose a serious health risk.
To reduce the spread of the virus, encourage all members of the family to use disposable tissues when sneezing or coughing, and to wash their hands regularly throughout the day, not just after going to the toilet.
To ease symptoms, drink plenty of water and eat soft foods that are easy to swallow. A cold flannel applied to the forehead will help reduce a high temperature. Do not overdo things, but try and get as much sleep and rest as possible to help the body recover.
- If you or your child develops a fever after MMR, sponging with cool water can help get their temperature down
- Drink lots of fluids
- Stay away from school or work for 5 days after the onset of rash
Reviewed on 27 May 2011