Definition

Measles, often known as morbilli or rubeola, is a viral infection. The disease typically originates in the respiratory system and spreads throughout the body. Measles or MR/MMR vaccine can effectively prevent this infection. Despite the widespread availability of this vaccine, this disease has an annual mortality rate of approximately 200,000 cases, primarily affecting children who have not received the vaccine.

Causes

The virus that causes measles is considered Paramyxovirus. Viruses are microorganisms that exclusively thrive on living organisms. Measles could occur when the virus infiltrates the host cells and utilizes components of the cells to replicate themselves.

Measles virus is highly contagious and easily spread through the respiratory tract. The transmission can occur as soon as roughly four days before the onset of a rash and up to four days after the rash becomes visible. When the infected individual coughs, sneezes or speaks, tiny droplets containing the virus will disperse in the air. Other people could catch the virus if they are near the infected people. The droplets could remain suspended in the air for up to an hour. The droplets might also drop on the surface of things and remain there for a few hours. Measles can be contracted by touching contaminated objects and touching one's mouth, nose, or eyes. Once the virus enters the respiratory tract, it could spread to the bloodstream and infect the whole body.

Risk factor

 Risk factors associated with measles:

• No vaccination against measles. If you have not received the measles vaccination, your likelihood of contracting the disease increases significantly.
• Travel overseas. Visiting a country with a high prevalence of measles significantly increases your risk of contracting the virus.
• Vitamin A deficiency. Insufficient vitamin A intake in a regular diet might increase the severity of measles symptoms, and complications could arise from the infection. 

Symptoms

The onset of symptoms of measles typically occurs approximately 10-12 days following the virus exposure. The symptoms that occur might involve the following:

• Cough 
• Fever 
• Cold
• Sore throat
• Redness of the eyes
• Koplik spots, also known as white spots in the oral cavity

The symptoms usually appear before the skin rash develops. A full-body rash is a key indicator of measles. This rash typically emerges within 14 days after exposure to the virus and can last up to 7 days. It starts behind the ears and then spreads across the entire body.

The onset of this infection typically happens during a period of 2-3 weeks, progressing through the following stages:

• Infection and incubation period. During the initial 10-14 days following introduction to the virus, the virus spreads throughout the body. During this period, the infected people could still be asymptomatic.
• The signs and symptoms are not specific. The onset of measles typically involves a mild or moderate increase in body temperature, along with symptoms such as a cough, runny nose, inflamed eyes, and sore throat. The symptoms could last for 2 to 3 days.
• Acute diseases and skin rashes. The rash associated with measles is characterized by small, slightly elevated reddish lesions. Typically, this rash manifests behind the ears and on the face and then spreads to the arms, chest, back, and legs. During this period, high fever could occur. 
• Recovery phase. The rash could be visible for 7 days. The sequence of the rash's disappearance corresponds to its appearance, commencing with the face, then arms, chest, back, and finally, the legs. Subsequently up to 10 days, individuals may experience coughing, a shift in the rash's color to a darker shade, and skin peeling.

Diagnosis

Doctors can diagnose measles by looking at the rash and other symptoms characteristic of measles, such as white spots in the mouth, fever, cough, and sore throat. Doctors can also do lab tests to look for the measles virus in your or your child's body.

Management

There are no specific treatments for measles. Administering antibiotics is ineffective in treating this infection, as measles is caused by a virus, whereas antibiotics only target bacterial infections. The symptoms often resolve after 2 to 3 weeks.

If you or your child have recently come into contact with the virus from infected people, there are numerous actions you can take to avoid measles or lessen the severity of the symptoms, such as:

• Getting vaccinated within 72 hours of coming into contact with the virus
• Immunoglobulin (immune protein) within 6 days following virus exposure

The doctor can also offer some recommendations to help manage measles, including:

• Administering paracetamol or ibuprofen to lower body temperature
• Take a rest to enhance your immune system
• Ensure adequate or increased water intake
• Cough medication helps alleviate coughing and sore throat
• Vitamin A supplements 

Complications

Measles complications can include:

• Diarrhea and vomiting. Diarrhea and vomiting can cause the patient to be dehydrated because of fluid loss.
• Ear infections. One of the most common complications of measles is a bacterial ear infection.
• Bronchitis, laryngitis, and croup. Measles can cause croup, where the airways become irritated and swollen (airway inflammation). This irritation and swelling can also occur in the branches of the throat, leading to the left and right lungs (bronchi), known as bronchitis. Measles can also cause irritation and swelling of the vocal cords, known as laryngitis.
• Pneumonia. Measles often causes lung infections (pneumonia). People with compromised immune systems can experience severe pneumonia that could be fatal.
• Encephalitis. About 1 in 1,000 people who experience measles can experience encephalitis, or irritation and swelling of the brain. This condition can be dangerous in people with compromised immune systems. Encephalitis may occur right after the appearance of skin rashes or several months later. This disease can also cause permanent brain damage.
• Pregnancy complications. If you are pregnant, you need to avoid measles because this disease can cause preterm birth, low birth weight, and fetal death.

Prevention

Several ways can be done to prevent measles transmission, such as:

• Wash your hands regularly with running water and soap.
• Use tissues to cover your mouth when you sneeze or cough.
• Throw away used tissues in the trash.
• Do not share eating utensils, glasses, towels, clothes and sheets with measles patients.
• People with measles should not go to work or school until 4 days after the rash disappears.
• Keep people who have not got vaccinated with measles (usually babies under 9 months of age) away from people who are infected with measles.
• Measles immunization. In Indonesia, measles immunization can be given in MR (measles and rubella) and MMR (measles, mumps and rubella) vaccines. MR immunization can be given to 9-month-old babies and booster to 18-month-old babies. Meanwhile, MMR immunization can be started at the age of 12 months and boosted at the age of 18 months. Furthermore, immunization can be repeated at the age of 7 years (following School Immunization Month in grade 1 of elementary school). Please remember that MMR immunization does not cause autism.

When to see a doctor?

You or your child should see a doctor if you have recently been exposed to the measles virus or if your child develops reddish rashes that resemble measles. Getting vaccinated before starting school, college, a job, getting married, having children, or traveling abroad is important.

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