Measles

Measles is a highly contagious viral infection that affects not only children, but also adults. Typical symptoms include a brown-red skin rash that starts on the face and spreads over the entire body.

Serious complications can arise from measles. Encephalitis results in death in 10 to 20 percent of such cases. A vaccination against the infection offers protection. As of March 2020, vaccination against measles is compulsory for those in community facilities.

Measles has a two-phase progression. The typical skin rash appears in the second phase of the illness.

Phase 1

Initial symptoms appear between approx. 8 to 10 days after infection with the virus. The infection starts with a fever, inflammation of the conjunctiva, sneezing, and coughing. White, chalky spots form on the inner oral mucosa of the cheek; spots in this form are symptoms only of measles. 

Phase 2

Approximately 3 to 7 days after the onset of the first symptoms, a typical skin rash with brown-red spots that come together to form one mass. The rash starts on the face and behind the ears and spreads over the entire body. The spots become enlarged 4 to 7 days later. Often, small scales appear. The fever lasts for approximately one week.

The measles pathogen is the measles virus (morbillivirus) and occurs only in humans. Therefore measles is always transmitted from human to human.

Measles cases can be found throughout the world. In some countries in Africa and Asia, only a small portion of the population is vaccinated and the number of deaths due to measles is very high.

In Germany, the prevalence of the measles infection has sharply declined because most children are vaccinated. Nevertheless, sometimes there are regional outbreaks, primarily in insufficiently vaccinated groups. The numbers range between 300 and 2,500 illnesses each year. The goal is to eradicate measles completely through consistent vaccination.

In some measles cases, two particularly serious complications can arise: acute encephalitis and encephalitis that occurs later on in the illness, which is always fatal. 

Other bacterial infections

The measles virus triggers an immune deficiency that lasts at least 6 weeks. Therefore, patients can also become infected by bacteria during this time.  

Typical secondary disorders that can result after a measles infection are: 

• pneumonia 
• middle ear infection 
• diarrhea 

Acute encephalitis occurs in one out of 1,000 measles cases. Ten to 20 percent of those die from it. In 20 to 30 percent, the encephalitis results in permanent, severe conditions, such as a mental disability or paralysis.  

Rare secondary disorders

In rare cases, slowly progressive encephalitis (subacute sclerosing panencephalitis – SSPE) occurs 6 to 8 years after a measles infection. It is always fatal. SSPE starts with psychological and intellectual changes and ends with a loss of all brain functions.

For every 100,000 people infected with measles, 4 to 11 are affected by these secondary disorders. Young children are at a much higher risk, with 20 to 60 out of every 100,000 measles cases affected by secondary disorders.

A vaccination against measles offers protection. As of March 2020, all children who attend community facilities and all adults who work in a community facility must be vaccinated. The German Standing Committee on Vaccination (STIKO) of the Robert Koch Institute recommends the following procedure:

Vaccination for children

Children should receive their first measles vaccination between the ages of 11 to 14 months. A second vaccination is required between the age of 15 and 23 months. The minimum amount of time between the first and second vaccination is 4 weeks. The second dose provides lifelong protection without the need for a booster.  

Children under 1 year of age who attend a community facility may receive their first vaccination at the age of 9 months.  

Vaccination for adults

Adults born after 1970 should receive a booster for measles if they were never vaccinated or vaccinated only once, or if the status of their inoculation protection is unclear. This is mandatory for employees of community facilities and for those who care for people with an immune deficiency.  

Typically, the vaccination is administered as part of a combined live virus vaccine (MMR) that also protects the person from mumps and rubella. Doctors can also administer a vaccination (MMRV) that offers additional immunity against chickenpox (varicella).

Reactions to the vaccination

Sometimes a person reacts to a vaccination and experiences redness, swelling, and pain at the vaccination site. General symptoms, such as fever, headaches, and aching limbs can occur, but subside after a few days. So-called vaccination measles occurs in approximately 5 to 15 percent of those vaccinated. It is mild and not contagious.

The website of the Robert Koch Institute provides answers to frequently asked questions about the measles vaccination.

Measles symptoms are not always distinct and differ very little from other viral illnesses accompanied by a skin rash. To confirm a diagnosis directly, doctors can take a swab of the mouth or throat, or they can diagnose measles indirectly by sending a blood sample to the lab to look for measles antibodies.

If a measles infection is confirmed, the type of treatment depends on who has been infected.  

Treating the acutely ill

There is no special treatment for the measles virus. For people with measles in its acute stage, bed rest is needed. Pain medication that lowers fever and has an anti-inflammatory effect can be taken to treat symptoms. If other bacterial infections occur, doctors will prescribe antibiotics. 

Treatment of contacts

Anyone born after 1970 without vaccination protection or with unknown inoculation protection should be vaccinated once against measles within 3 days of contact with an infected person. This helps to prevent an outbreak of the illness or at least a severe case. No action must be taken by people who have been sufficiently vaccinated.  

Attending or working at a community facility

Those who have come in contact may enter a community facility only if they have been sufficiently vaccinated prior to a possible infection. Alternatively, they can be vaccinated within 3 days of contact. Otherwise, they may not enter the community facility for 3 weeks.  

Treating high-risk patients

Patients with a weakened immune system, pregnant women, and children under the age of 6 months are at a greater risk of infection and of experiencing complications. They may be administered antibodies against the virus within 2 to 6 days of contact to protect them from the infection. However, treatment with antibodies can also have side effects.