- Measles is on the rise – 2 cases have been reported in 2023 in Leeds – both amongst were un-immunised.
- Measles is highly infectious – (4 day prior to and after rash appears) suspected patients should be isolated within the ED
- Measles Immunisation – 1 dose 90% effective, 2 doses 95% effective
- Measles is a notifiable disease
Clinical
Incubation –typically 10-12days but could be 7-21day
Prodrome 3C’s – Coryza, Cough, Conjunctivitis, often symptoms peak on first day of rash
Fever – typically increases during the prodromal phase, peaks (generally >39°C) around the rash onset, as shown in Figure 1, and will gradually decrease after that.
Maculopapular rash – generally starts on the face and behind the ears. The number of lesions/spots generally increase in the first 2-3 days, and their distribution expands further to the face, trunk, and can sometimes be generalised. Lesions can become confluent, particularly on the face and the trunk. The rash is red, blotchy, maculopapular (That is non-vesicular), not itchy, and generally lasts for 3-7 days, fading gradually [6].
Koplik spots “grain of salt on a red background” – may appear around the time of the rash, sometimes one day before, and last for 2-3 days after the rash appears. These are small spots with white or bluish- white lesions, of about 2-3mm in diameter, on an erythematous base on the buccal mucosa. These can be confused with other lesions in the mouth and therefore their suspected presence is an unreliable marker for measles.
Treatment
- Supportive treatment and Isolation is effective for most
- Notify Public Health
Prognosis/Complications
- Most cases are uneventful and self limiting
- Most Frequent Complications
- Viral pneumonitis
- Otitis media
- Tracheobronchitis “measles croup”
- Rare Complication
- Encephalitis <0.1%
- Subacute Scleorsing Panencphalitis <0.01% and present years after infection
- At Risk Groups
- Pregnant women measles can lead to an increased risk of prematurity and fetal loss, although there is no evidence that it leads to congenital defects.
- Very young infants and adults, who are more likely to develop complications and require hospitalisation
- Immunocompromised patients, esp. patients who have recently undergone bone marrow transplantation, patients with primary T-cell dysfunction, AIDS patients and patients with acute lymphoblastic leukemia (ALL)
