Measles in children: contagion, symptoms, complications and vaccinations

Measles is a highly contagious exanthematous infectious disease caused by viruses of the Paramyxoviridae family , genus Morbillivirus.

It is the most serious exanthematous disease due to the modalities of manifestation and the complications it can bring.

Mode of transmission and contagiousness

Measles is easily transmitted through the upper respiratory tract. A contact with saliva due to a sneeze, a cough, drinking from the same glass, putting the same toy in the mouth, through hands with saliva residues is enough…

The person with measles is contagious even before the appearance of the typical measles spots (3-5 days before) and up to 4-5 days after the appearance of the rash.

First signs

Even before the appearance of the typical spots, measles manifests itself with some initial symptoms (called prodromes) which last about 3-5 days and are:

• Koplik’s spots (whitish patches on the inside of the cheeks at the level of the upper first and second molars) that disappear within 1-2 days
• Fever
• dry cough
• rhinoconjunctivitis
• photophobia (sensitivity to light)

The typical rash

Typical manifestation of measles is a bright red exanthema with spots that tend to reunite in larger patches. The appearance of the spots is usually preceded by a high fever and lasts about 4-6 days.

The spots appear initially on the head, then spread on the trunk without affecting the palms of the hands and the soles of the feet.

Incubation and healing

The incubation period that goes from the moment of infection to the manifestation of the disease can last 7-12 days.

Approximately 7-10 days pass from the onset of the disease to healing (which consists in the progressive disappearance of the spots).

Given the highly contagious nature of the disease, the child must remain isolated for up to 5 days after the appearance of the spots.

Treatment

There is no cure for measles, only symptom management. Therefore, paracetamol is used to lower the fever, syrups to calm the cough, eye drops, all treatments that are prescribed by the pediatrician once the disease has been diagnosed.

Complications of measles

Measles is a disease that can leave a child very distressed even in the absence of complications.

The possible complications (which occur in 30% of measles cases) are mainly due to bacterial superinfections which are found above all in children under 5 years of age, malnourished children, immunocompromised people and adults over the age of 20.

They are represented by:

• Plaster (7%)
• laryngitis
• diarrhea (8%)
• Bronchopneumonia (6%) can be bacterial or viral and is the most common cause of measles-related death.
• thrombocytopenia (decreased number of platelets)
• seizures
• encephalitis (inflammation of the brain) in 0.1% of cases
• death (0.2%)

Acute encephalitis usually occurs 6 days after cutaneous onset (and is characterized by fever, headache, vomiting, stiff neck, meningeal irritation, drowsiness, seizures, and coma. The cerebrospinal fluid shows pleocytosis and elevated protein. The case fatality rate is approximately 15%.Some form of residual neurological damage occurs in up to 25% of cases.Convulsions (with or without fever) are reported in 0.6%-0.7% of cases.

Death from measles was reported in about 0.2% of cases in the United States from 1985 to 1992. As with other complications of measles, the risk of death is highest among children and adults. Pneumonia accounts for about 60% of deaths.

Subacute sclerosing panencephalitis (SSPE) is a degenerative disease of the central nervous system due to persistent measles virus infection in the brain. Onset occurs on average 7 years after measles (range 1 month-27 years) and occurs in 5 to 10 cases per million measles cases reported. Onset is insidious, with progressive deterioration of behavior and intellect, followed by ataxia, myoclonic seizures, and finally death.

The measles vaccination

The measles vaccine is made from live but attenuated measles virus so that it is unable to cause disease but capable of stimulating the production of antibodies at the same time.

Vaccination against measles is recommended from the first year of life of the child.

The measles vaccine causes the appearance of antibodies in 95% of vaccinated children and this percentage increases after a second dose which is given around 6 years of age of the vaccinated child to one year.

Protection appears already 7-10 days after vaccination. For this reason, the measles vaccine can prevent the disease even after infection, provided that the administration takes place within the first 2-3 days of the child’s contact with the sick person.

The vaccine should be postponed when:

• the child has an acute illness with fever or other symptoms considered important
• the child has had a recent administration of immunoglobulins, blood or plasma, which can hinder a good immune response to the vaccine
• the child has recently had another live virus vaccine

The child cannot be vaccinated if

• has a serious defect of the immune system due to diseases or therapies (e.g. chemotherapy)
• have severe allergic reactions to constituents of the vaccine or to previous administrations of the same vaccine.

Vaccine Side Effects:

The measles vaccine, both single and combined with that for rubella and mumps (MMR vaccine), is generally well tolerated.

Local reactions (redness and swelling) at the injection site are possible.

7-14 days after vaccination, the child may show a modest and short-lived fever (1-2 days) which in 15% of vaccinated people can reach 39°C.

Sometimes you may experience symptoms similar to mild disease with reddish spots on the skin, cough, red eyes, short-lived and quickly resolved, NOT contagious and does not lead to complications.

More important adverse reactions such as thrombocytopenia are rare and have a favorable course.

Like any other substance foreign to the body, the vaccine can rarely cause specific allergic reactions.