What is measles?

Key Facts

• Measles is one of the leading causes of death among young children even though a safe and cost-effective vaccine is available.
• In 2015, there were 134 200 measles deaths globally – about 367 deaths every day or 15 deaths every hour.
• Measles vaccination resulted in a 79% drop in measles deaths between 2000 and 2015 worldwide.
• In 2015, about 85% of the world's children received one dose of measles vaccine by their first birthday through routine health services – up from 73% in 2000.
• During 2000-2015, measles vaccination prevented an estimated 20.3 million deaths making measles vaccine one of the best buys in public health.

Introduction

Measles is a highly contagious, serious disease caused by a virus. In 1980, before widespread vaccination, measles caused an estimated 2.6 million deaths globally each year.

The disease remains one of the leading causes of death among young children globally, despite the availability of a safe and effective vaccine. Approximately 134,200 people died from measles in 2015 – mostly children under the age of 5.

Measles is caused by a virus in the paramyxovirus family and it is normally passed through direct contact and through the air. The virus infects the respiratory tract, then spreads throughout the body. Measles is a human disease and is not known to occur in animals.

Accelerated immunization activities have had a major impact on reducing measles deaths. During 2000-2015, measles vaccination prevented an estimated 20.3 million deaths. Global measles deaths have decreased by 79% from an estimated 651 600 in 2000* to 134 200 in 2015.

Signs and Symptoms

These consist initially of:

• Fever. This is usually the first sign of measles. It begins about 10 to 12 days after exposure to the virus, and lasts 4 to 7 days
• Runny nose
• Cough
• Red and watery eyes
• Appearance of small white spots inside the cheeks (Koplik spots). This can develop in the initial stage.

After several days,

• A rash erupts, usually on the face and upper neck.
• Over about 3 days, the rash spreads, eventually reaching the hands and feet. The rash lasts for 5 to 6 days, and then fades. On average, the rash occurs 14 days after exposure to the virus (within a range of 7 to 18 days).

Child with measles rash

Complications

The most serious complications include:

• Blindness
• Encephalitis (an infection that causes brain swelling)
• Severe diarrhoea (passage of watery stool) with related dehydration
• Ear infections
• Severe respiratory infections such as pneumonia.

Complications are more common in children under the age of 5, or adults over the age of 20. Severe measles is more likely among poorly nourished young children, especially those with insufficient vitamin A, or whose immune systems have been weakened by HIV/AIDS or other diseases.

Most measles-related deaths are caused by complications associated with the disease

In populations with high levels of malnutrition and a lack of adequate health care, up to 10% of measles cases result in death. Women infected while pregnant are also at risk of severe complications and the pregnancy may end in miscarriage or preterm delivery. People who recover from measles are immune for the rest of their lives.

Who is at risk for measles?

• Unvaccinated young children are at highest risk of measles and its complications, including death.
• Unvaccinated pregnant women are also at risk.
• Any non-immune person (i.e., person who has not been vaccinated or was vaccinated but did not develop immunity) can become infected.

Measles is still common in many developing countries – particularly in parts of Africa and Asia.

The overwhelming majority (more than 95%) of measles deaths occur in countries with low per capita incomes and weak health infrastructures.

Measles outbreaks can be particularly deadly in countries experiencing or recovering from a natural disaster or conflict. In such situations, damage to health infrastructure and health services interrupts routine immunization, and overcrowding in residential camps greatly increases the risk of infection.

How is measles transmitted?

Measles can be transmitted by an infected person from 4 days prior to the onset of the rash to 4 days after the rash erupts.

The highly contagious virus is spread by:

• Coughing and sneezing
• Close personal contact or
• Direct contact with infected nasal or throat secretions.

The virus remains active and contagious in the air or on infected surfaces for up to 2 hours.

Measles outbreaks can result in epidemics that cause many deaths, especially among young, malnourished children.

In countries where measles has been largely eliminated, cases imported from other countries remain an important source of infection.

Treatment of measles

There is no specific antiviral treatment for measles virus.

Supportive care of severe complications from measles is the main stay of measles treatment.

The supportive care includes:

• Good nutrition
• Adequate fluid intake and rehydration therapy with WHO-recommended oral rehydration or intravenous solution depending on the severity of fluid loss.
• This solution replaces fluids and other essential elements that are lost through diarrhoea or vomiting.
• Antibiotics should be prescribed to treat eye and ear infections, and pneumonia.
• Vitamin A supplements.
• Children in low income countries diagnosed with measles should receive two doses of vitamin A supplements, given 24 hours apart. This treatment restores low vitamin A levels during measles that occur even in well-nourished children and can help prevent eye damage and blindness. Vitamin A supplements have been shown to reduce the number of deaths from measles by 50%.

Prevention

Routine measles vaccination for children, combined with mass immunization campaigns in countries with high case and death rates, are key public health strategies to reduce global measles deaths.

The measles vaccine has been in use for over 50 years. It is safe, effective and inexpensive.

In South Africa, the recommended routine immunization schedule for measles is for the first dose to be given at 9 months after birth and the second dose at 12 months. 

The measles vaccine is often incorporated with rubella and/or mumps vaccines in countries where these illnesses are problems. It is equally effective in the single or combined form.

In 2015, about 85% of the world's children received 1 dose of measles vaccine by their first birthday through routine health services – up from 73% in 2000. Two doses of the vaccine are recommended to ensure immunity and prevent outbreaks, as about 15% of vaccinated children fail to develop immunity from the first dose.

Takeaways

Measles is a highly contagious infection caused by the measles virus. It commonly afflicts non-immunied children but immuno-compromised or immune-suppressed adults may also be affected. Although the frequency of measles attack has been lowered considerably globally between 2005 - 2015 through immunisation, the condition still afflicts children especially in low income African and Asian countries. There is no specific treatrment for measles. it is cost-effectively prevented through routine immunisation.

Content adapted from: World Health Organisation – Measles 

Related:

• Measles in Africa: A travel advisory.
• Vaccine preventable disease outbreaks on the rise in Africa.
• Measles immunisation gaps in Africa.
• Measles outbreak is back with a vengeance; Is the antivax movement to blame?
• How measles detectives work to contain an outbreak
• Immunisation schedules - Africa 
• Africa contributes heavily to global measles deaths

Posted: May 10, 2020

Updated: November 17,, 2023

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