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Diseases & Vaccines / Vaccine-Preventable Diseases in EPI-SA / Measles / Clinical Disease
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CLINICAL DISEASE: MEASLES
Measles is a highly infectious disease caused by the measles virus and is transmitted primarily from person-to-person by large respiratory droplets, but can also be spread by the airborne route in the form of aerosolised droplets. The incubation period is generally 8 to 12 days from exposure to onset of symptoms, with the disease being most infectious during the stage before the rash appears.
The prodromal period lasts for 4 to 5 days and is characterised by fever, malaise, coryza and a sneezy cough. Koplik’s spots - tiny white spots surrounded by a red ring found inside the mouth – appears two days before the onset of the rash and disappears 1-2 days after the onset of the rash. The rash is an erythematous maculopapular eruption lasting 5 to 6 days. The rash begins at the hairline, involves the face and upper neck and then proceeds outwards reaching the hands and feet by the third day, and starts to fade. Patients fully recover 7-10 days after the onset of illness.
Most people recover from measles without sequelae. However, complications from measles may occur, and these include otitis media, bronchopneumonia, diarrhoea, laryngotracheobronchitis (croup), blindness, and encephalitis. Malnourished children, especially those with vitamin A deficiency, and persons with severe immunological disorders such as advanced HIV infection are most vulnerable to severe measles infection. The most significant complication of measles is death. Case fatality rates vary depending on the age of the patient, the intensity of the exposure, the nutritional status of the infected persons and the availability of treatment. In developed countries case fatality rates are significantly lower than in the developing world. Another further complication of measles is the rare, fatal degenerative disease of the central nervous system, subacute sclerosing panencephalitis (SSPE), presenting years after the initial measles infection.
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