All about Measles

Measles is an extremely infectious disease which can spread very easily and can only be controlled within society by vaccination.

In 2018, there was a significant increase in the number of confirmed measles cases; there were 991 confirmed cases in England and Wales, compared with 284 cases in 2017. In 2018, there were more than 140,000 measles deaths globally, and the deaths were mostly among children under the age of five.

What is measles?

Measles is an acute viral respiratory illness. It is a childhood illness and although it was once quite common, measles can now almost always be prevented with a vaccine. Measles spreads easily and can be serious and even fatal for small children.

Death rates have been falling worldwide as more children receive the measles vaccine; however, the disease still kills more than 200,000 people each year, with most of these deaths being children. Humans are the only natural hosts of the measles virus as it is not seen in animals.

Measles usually begins with cold-like symptoms, which are followed by a rash a few days later. Some people may also get small spots in their mouth.

What causes measles?

Measles is an infectious respiratory infection caused by a virus in the paramyxovirus family. The virus enters the body through the mouth, nose or eyes. The virus can then enter the lungs where it infects immune cells; these cells travel to the lymph nodes, where the virus transfers to other cells. The cells then travel through the body, releasing virus particles into the blood which carries the virus to different organs in the body.

Anyone who has not been vaccinated against measles can become unwell if they come into contact with the virus.

How is measles spread?        

The virus is transmitted from person to person through respiratory droplets which are produced when people who have the virus cough and sneeze. Droplets containing the virus can remain in the air for several hours, and the virus remains infectious on contaminated surfaces for up to two hours.

The infection spreads through:

• Having physical contact with someone who is infected with measles.
• Being near a person who is infected with measles when they cough or sneeze.
• Touching a surface which has the virus on and then putting your fingers into your mouth, nose or eyes.

Who is at risk of measles?

People who are at risk of measles include:

• Unvaccinated young children are at the highest risk of measles as it can lead to health complications, including death.
• Unvaccinated pregnant women.
• People with weak immune systems.
• Anyone who has not been vaccinated or who has been vaccinated but has not developed immunity.

Severe measles is more likely to be seen among poorly nourished babies and young children, especially children with insufficient vitamin A, or those who have weaker immune systems due to HIV, AIDS or other diseases.

The majority of measles deaths are seen in countries where there are weak health infrastructures. Countries that are experiencing war or are recovering from natural disasters are also more at risk from outbreaks of measles due to their health infrastructure being weakened. This is because vaccination programmes are disrupted and there may be overcrowding in refugee camps.

What are the symptoms of measles?

Measles symptoms usually appear approximately 10-12 days after contact with the virus, and the measles infection can last for several weeks.

Symptoms typically include:

• A high temperature.
• A runny or blocked nose.
• Sneezing.
• A cough.
• A sore throat.
• Watery eyes.
• Conjunctivitis.

A few days after the initial symptoms have appeared, small white spots may appear inside the cheeks and on the back of the lips. These will usually last for a few days.

The measles rash usually appears a few days after the cold-like symptoms. The rash first appears on the face and behind the ears, before spreading to the rest of the body. The spots are sometimes raised and join together to make blotchy patches.

The rash is not usually itchy. On white skin, the rash will usually be red or brown. The rash may be more difficult to see on black or brown skin. The rash will usually last for approximately 5-6 days.

Complications of measles

Most of the deaths from measles are caused by other complications associated with the disease. Serious complications are more common in children under the age of 5 years old, or in adults over the age of 30.

Complications that can be caused by measles include:

• Pneumonia – This is an inflammation of the lungs, usually caused by an infection.
• Other respiratory infections.
• Meningitis – This is an infection of the protective membranes that surround the brain and spinal cord. For further reading about the different types of meningitis, please see our knowledge base.
• Blindness.
• Seizures.
• Ear infection.
• Croup.
• Diarrhoea.
• Dehydration.
• Encephalitis – this is an infection that causes brain swelling.

Babies and people with weakened immune systems are more likely to be at risk of these complications.

You should seek immediate medical treatment if your child has measles and has any of the following symptoms:

• They have a high temperature that does not come down after taking paracetamol or ibuprofen.
• They are confused.
• They have shortness of breath.
• They have a seizure.

If you contract measles while you are pregnant, it could harm your baby. If you are pregnant and have been in close contact with someone who has measles, you should seek medical advice.

Complications during pregnancy can include:

• Miscarriage or stillbirth.
• Premature birth.
• Your baby having a low birth weight.

Can measles be prevented?

Measles can be prevented with the measles vaccine. In some countries this is given as a single vaccine in two doses.

In the UK and many other countries the MMR combined vaccine is used. The vaccine is given in two doses which will provide the best protection.

The MMR vaccine is a safe and effective combined vaccine which protects against three diseases:

• Measles.
• Mumps – This is a contagious viral infection which usually affects the glands on each side of the face.
• Rubella – This is a rare illness that also causes a spotty rash and has similar symptoms to measles. It is a contagious viral infection which may cause mild or no symptoms in most people. However, it can cause serious problems for unborn babies whose mothers become infected during pregnancy. Rubella is not as infectious or severe as measles.

The MMR vaccine is considered to be safe and very effective. After two doses, 99% of people will be protected against measles and rubella and 88% of people will be protected against mumps. Protection against measles, mumps and rubella begins to develop approximately two weeks after having the vaccine.

The MMR vaccine is given to babies and young children. The first dose is recommended at one year of age and the second dose is recommended at 3 years and 4 months of age. Newborn babies will have antibodies passed on from their mother which helps protect them against measles, mumps and rubella.

When a child is one year old, the antibodies from their mother will almost have gone, and therefore the MMR vaccine will be most effective at this age. The second dose of the vaccine is given at around 3 years and 4 months of age, before a child starts school. Receiving both doses will give long-lasting protection against measles, mumps and rubella.

If your child has missed any of the two doses, you can still ask your GP surgery for the MMR vaccine. Additionally, any adult who has not had two doses of the MMR vaccine can ask their GP surgery for an appointment.

It is important to check whether you are fully vaccinated if you:

• Are planning to travel abroad.
• Are planning to get pregnant.
• Are going to college or university.
• Are a health or social care worker.
• Were born between 1970 and 1979, as you may have only been vaccinated against measles.
• Were born between 1980 and 1990, as you may not be protected against mumps.

If you are unsure whether you have been vaccinated, the NHS offers guidance on how you can access your health records.

Before the introduction of the measles vaccine in 1963, major epidemics occurred approximately every 2–3 years and measles caused an estimated 2.6 million deaths each year, globally.

The UK achieved measles elimination status from the World Health Organization in 2017; however, in 2018, there was a significant increase in the number of confirmed measles cases and the same strain of measles virus was detected for more than 12 months in 2017 and 2018, therefore the World Health Organization declared that the UK could no longer have an eliminated status and that the transmission of measles had been re-established.

Elimination is defined as the absence of endemic measles virus transmission in a region or a country for a period of 12 months or more.

In countries where measles has been largely eliminated, cases are still imported from other countries and this is usually the main source of infection.

The World Health Organization is the United Nations agency that connects nations in order to promote health so that the highest level of health can be attained throughout the world. They are responsible for international public health.

Measles remains a concern in many countries around the world and there have been outbreaks in countries across Europe usually where the MMR vaccine uptake has been low.

Unless measles elimination is achieved around the world, we will continue to see the measles virus in the UK. Measles vaccination resulted in a 73% decrease in measles deaths between 2000 and 2018 worldwide and this is estimated to have prevented 23.2 million deaths.

Routine measles vaccinations for children and mass immunisation campaigns in countries with high measles and death rates is the most effective way to reduce measles deaths globally. In 2018, approximately 86% of children, globally, received the first dose of the measles vaccine by their first birthday, and 69% of children received the second dose of the measles vaccine in the same year.

In order to limit the spread within the UK, it is important to maintain a high uptake of both doses of the MMR vaccine. Measles is a highly infectious disease and therefore even small declines in children receiving both doses of the MMR vaccine can have an impact on the spread of measles. When a large percentage of the population is protected against a disease through vaccination, it is harder for the disease to spread between people who are not vaccinated.

How is measles treated?

There is no specific treatment for measles as it is a virus which needs to run its course.

If there are no complications, your healthcare provider will recommend rest and plenty of fluids in order to avoid dehydration. You can give paracetamol or ibuprofen for a high temperature. You should never give aspirin to a child who has a viral illness as this can be dangerous.

If there are complications and hospital treatment is required, two doses of vitamin A will be given 24 hours apart. This will restore low vitamin A levels which can occur when a person has measles. It can also help to prevent eye damage and blindness. Vitamin A supplements have also been shown to reduce the number of deaths due to measles.

Severe complications from measles can usually be reduced through good nutrition, adequate fluid intake and prompt treatment of dehydration. The World Health Organization also recommend oral rehydration solution. The solution replaces fluids and other essential elements that can be lost through diarrhoea or vomiting. Antibiotics should also be prescribed to treat eye and ear infections. Antibiotics can also be useful in treating pneumonia.

Someone who is infected with measles should stay at home in order to prevent spreading the infection. If you have measles, you are infectious from 4 days before the rash starts until about 4 days after. You are most contagious while you have a temperature, runny nose and cough.

An injection of measles antibodies can be given to at-risk people who have been exposed to measles. It is most effective when given within 6 days of being in contact with measles. These antibodies can either prevent measles or make the symptoms of measles less severe.

You should contact your GP or ring 111 if you suspect you or your child might have measles or if you have been in close contact with someone who has measles and you have not been fully vaccinated against the virus.