measles

Synonyms in a broader sense

Latin / medical: morbilli

English: measles

definition

Measles is an acute infectious disease caused by the measles virus that is spread around the world. Initially, patients experience flu-like symptoms followed by a rash. Measles is usually a childhood disease. This is due to the high risk of infection, so that the infection with the measles virus is very high even in childhood.

Symptoms / complaints

Typical of measles in the catarrhal stage are the colpic spots that can be seen on the oral mucosa, in connection with a high fever, conjunctivitis and severe malaise. This is followed by a rash, which in measles typically starts behind the ears and then spreads over the body. In addition, the measles infection can be recognized by the extreme photophobia, the infestation of the conjunctiva and the extremely strong symptoms of the disease.

The symptoms are divided into two phases. The first phase is called the prodromal stage, the second phase is called the exanthema stage.

In the first phase, the preliminary stage, patients have flu-like symptoms. It comes to:

• fever
• to cough
• Runny nose and
• Conjunctivitis.

The photophobia that occurs is due to the inflammation of the conjunctiva. Redness of the oral mucosa is typical.
White, lime-like spots appear on the cheek mucosa. These so-called Kolpik spots usually appear on the second to third day of the disease.
The following day there is reddening of the entire mouth and throat. During this time there is the first fever peak.
In general, tiredness and fatigue can also be observed. The prodromal stage lasts about three to four days. In the end, the body temperature will drop back to normal.

In the second phase the typical rash develops all over the body. Usually the beginning is behind the ears and then spreads further.
It is characterized by small red, point-like spots. If the rash breaks out, the fever will rise again. After about three days the fever begins to fall again. This stage lasts about three days.

The cervical lymph nodes are also usually swollen.

Read more on the topic: Symptoms of measles and measles rash

Measles rash

The rash in measles typically begins after the fever subsides. If the rash breaks out, however, the fever can rise again sharply. It usually starts behind the ears and from there spreads over the entire body. The rash in measles is accompanied by a strong feeling of illness. In addition, there may be swelling of all lymph nodes and pain in the lymph nodes. Diarrhea can occur in some patients. After four to five days, the rash will fade.

How is the disease progressing?

The disease begins with a so-called catharrale stage. This stage begins about eight to ten days after the infection and manifests itself as fever, feeling very sick, photophobia, conjunctivitis and a cold. There is a rash on the lining of the mouth with so-called Kolpik spots. After a brief decrease in the fever, the rash already described occurs, whereby the fever symptoms increase again. After four to five days, the rash subsides.

How contagious is measles?

Measles is one of the most contagious diseases ever and is caused by direct contact or through Droplet infection transfer.
This includes direct contact with infectious secretions from the nose and throat, but also the inhalation of infectious droplets that arise when speaking, sneezing and coughing.

The measles virus leads almost 100% to the outbreak of the disease, even with very brief contact. This is described by the contagion index. This describes the proportion of a population in which the disease breaks out after contact with the pathogen. In the case of measles, it is close to one. This means that anyone who has contact with the virus will get it.
The incubation period, the time between infection and the appearance of the first symptoms, is usually eight to ten days for measles until the onset of the preliminary stage and about 14 days until the onset of the typical rash (Rash).
There is a risk of infection three to five days before the outbreak of the rash up to four days afterwards. The greatest danger is just before the rash breaks out.
The conclusion that can be drawn from this is that measles is contagious before it is visible to the sick person and everyone else in their environment.

Can you get measles despite being vaccinated?

A disease caused by the Morbillivirus despite vaccination is very rare. Nevertheless, as with any vaccination, there are so-called Vaccination failure. However, this percentage is very low. If you have symptoms of measles infection despite vaccination, you should still consult a doctor. As a rule, however, the infection then proceeds a great deal milder than without vaccination.

Frequency (epidemiology)

Occurrence in the population
Over a million children worldwide die of measles every year. Especially in poor countries where hygiene is poor and there are no vaccinations.
The measles virus is very contagious and breaks out in almost anyone who has it. Once acquired, the virus has lifelong immunity. So you can't get measles a second time.

Around 30 million people worldwide develop measles every year.

causes

The root cause resides in a virus made up of RNA.
RNA is a copy of DNA on which all genes are encoded. It usually takes eight to ten days for the disease to break out. The infection takes place via the so-called droplet infection, so z. E.g. through to cough, Sneezing, etc.
The viruses are absorbed through the mucous membrane of the mouth and nose. Also the Conjunctiva from eye can allow the virus to enter the body.

The contagious stage begins about two to four days before the rash appears. This stage lasts as long as the rash is present.

Due to the high risk of infection, almost everyone who is not vaccinated and comes into contact with an infectious person is infected. However, measles does not necessarily have to break out.

Pathogen / measles virus

The causative agent of measles is the so-called Morbilli virus from the group of paramyxoviruses. There is a vaccination against the virus. Month and the 15th - 23rd month should be administered. The measles virus is highly contagious and can be transmitted through the air by droplets. The infectiousness exists about four days before the rash breaks out to five days afterwards. Due to the serious illness and the serious complications, vaccination against measles is definitely recommended. There is no connection between measles vaccination and autism. There is no antiviral therapy for the measles virus.

incubation period

The incubation period is approximately eight to ten days. After that, symptoms such as fever, fatigue and conjunctivitis develop. The Rash occurs about three days after the onset of symptoms.

German Infection Protection Act

According to the Infection Protection Act every suspicion, illness or death of this illness must be reported to the health department.

diagnosis

In addition to the typical symptoms, blood tests (laboratory values) are also used for diagnosis. Often it is a visual diagnosis based on the typical rash. The bimodal fever also gives clues. Antibodies against the measles virus can be detected in the blood from the exanthema stage. These were created by the body's own defenses as a reaction to the invading viruses.

therapy

A specific therapy there is no such thing as measles. The sick person should keep bed rest and drink a lot.

Measles can be treated symptomatically. It does not fight the viruses, but alleviates the symptoms. For example, it can lower the fever.

In the event of complications, such as an additional bacterial infection (lung infection), antibiotics can be given.

Patients with measles must be isolated until the rash appears skin disappeared.

Complications

There are various complications caused by the measles virus, which incidentally only causes disease in humans.
The lungs, organs of the abdominal cavity, and even the brain can be affected.

If the lungs are affected, bronchitis or pneumonia usually occurs.
In developing countries, this is the cause of death in around a quarter of patients with measles. The lymph nodes in the abdominal cavity can swell a lot and cause severe pain.
The appendix can also become infected from the measles infection.

The most feared complication of measles is inflammation of the brain (encephalitis). It breaks out in about 0.1% of cases. It occurs three to ten days after the rash occurs and manifests itself as convulsions, epileptic fits and impaired consciousness.
In a few cases, permanent damage remains. These can occur in the form of paralysis as well as mental disabilities.
The mortality rate from measles encephalitis is relatively high at 25 percent.
Subacute sclerosing panencephalitis, on the other hand, is a complication that only occurs 2-10 years after the measles disease. It is an inflammation of the entire brain and is fatal in 100% of cases.

Furthermore, bacterial superinfections, i.e. additional infections with bacteria, can lead to complications. In most cases, the gums, eye, and ear are affected. If the eye is affected, in the worst case scenario, blindness can occur, and an otitis media can occur in the ear. However, with antibiotic treatment, these complications can be quickly brought under control.

An indication of an additional bacterial infection is a third rise in fever after the exanthema stage.

Complications can occur even if the immune system has been weakened before. In the developing countries, the patients are weakened mainly because of malnutrition and thus offer a suitable host for parasites or tuberculosis bacteria.

prophylaxis

To the measles there is one to prevent Vaccination to disposal. Toddlers are between the 12th and 15th month of life vaccinated against measles. Usually in combination with mumps and rubella. The vaccination is done in two parts. People who are vaccinated are in no way contagious, even if they develop a measles-like rash. The vaccine viruses are not transmitted.

Both live and dead vaccines are available. Usually the Live vaccine made active immunization. In addition to children, endangered persons (e.g. staff in children's clinics or practices) are protected in this way. Even if an unvaccinated person has come into contact with a sick person, the vaccination can be successfully made up within the next three days - provided that the person to be vaccinated is immune to healthy, i.e. strong enough defenses.
Of the Death vaccine is usually only used for people with a weakened immune system. Here, too, you can still successfully vaccinate up to three days after contact with the disease.

Even babies born to a mother who has either been vaccinated or has already received the measles suffered immunity through the first six months of life Breast milk.

The measles vaccination

The Vaccination against measles was introduced in the GDR in 1970 and in the FRG in 1973. She is from the STIKO (sthand I.mpfkCommission) as a combination vaccination Mumps-measles-rubella recommended in the first and second year of life. The measles vaccination is in principle also available as a single vaccine, but since the combination vaccination is just as tolerable as the single vaccination, it is almost exclusively used in combination with mumps and rubella.

You have to be vaccinated twice against measles. Ideally, children receive between the 11th and 14th month of life the first vaccination and between the 15th and 23rd month the second.While the first vaccination provides the basic immunization, the second vaccination is only used as a refresher, because after the first vaccination there is already 95% protection. However, the second vaccination is necessary to ensure lifelong, safe protection.
If the booster vaccination is missed, it should be made up as soon as possible.

The measles vaccination is a live vaccination, which means that live but weakened viruses are injected into the body. This creates an active immune response. This in turn means that the immune cells recognize the virus as foreign and actively form their own antibodies against it, which are available for defense against a potential attack by the virus.
The immune system creates memory cells that enable lifelong protection after the second vaccination. This is not possible or not recommended Vaccination for a weakened immune system. These include acute infections, HIV infections or medication-induced suppression of the immune system (Immunosuppression).
It is also not recommended to vaccinate during pregnancy because it is a live vaccination. Vaccination is no longer a problem when breastfeeding. (see also: Vaccinations during pregnancy)

If it happens that a person who has not been vaccinated becomes infected with measles, there is the option of passive immunization, a so-called immunization, for the first six days after the infection Exposure prophylaxis.
Here, antibodies against the virus are injected directly, which can prevent or at least reduce the outbreak of measles. However, since the antibodies were not produced by the body itself, there is only protection for three to four weeks, because no memory cells are formed with this type of vaccination.
It is also difficult to identify the disease in time. This type of vaccination is only given to people with weakened immune systems for whom a live vaccination is too dangerous. It is also advantageous to vaccinate as many people as possible, because the measles virus is purely human pathogenic. That is, it only affects humans. If a sufficient number of people are vaccinated, the virus could be eradicated. This should only 1 case per million people occur or, in other words, a vaccination rate of 95% should be available.

Measles in adults

Measles - a known childhood disease? Before developing a vaccine, anyone would answer “yes” to this question.
But over time, adults are more and more affected. Ten years ago, the proportion of those affected over 20 years was 8.5%, today it is almost 40%.
This development, which manifests itself not only in measles but also in, for example, whooping cough, is due to vaccination. Since measles is highly contagious, no one who is not already immune was spared before the vaccination. In that case it meant that you had already suffered from the disease in childhood.
Therefore, the disease mainly affected children.
Today the situation is different: the children are immunized by the vaccination and it is mainly the elderly who were not vaccinated as children and who have so-called “vaccination pickings” who are affected. Although there is a recommendation for all adults born after 1970 to get the vaccination, according to a study by the Federal Center for Health Education, the majority of this target group does not know about the recommendation.

The dangerous thing about this development is that it creates two new risk groups: children under two and adults over 20 years of age.

• For small children there is an increased risk of getting sick because vaccinated mothers cannot transfer their immunity to their protégé, they no longer offer nest protection through the vaccination.
• For sick people over the age of 20 there is an increased risk - as for children under five - that the risk of a measles complication is increased. These include bronchitis and pneumonia (lung infection), which account for roughly a quarter of measles-related deaths in poorer countries.

Furthermore, encephalitis, brain inflammation, is a dreaded complication. 10 to 20% end fatally or fatally and about a third suffer permanent damage. A very rare but definitely fatal complication of measles infection is subacute sclerosing panencephalitis, which occurs about five to ten years after the disease. Since measles weakens the immune system, other bacteria also have an easier time settling in the affected person. These superinfections include inflammation of the gums, eye, and middle ear.
These infections can be treated well with antibiotics.

For more information on this subject read on: Measles in adults

Measles in pregnancy

The damage caused by measles infection in a pregnant woman to her child has not yet been adequately clarified.
However, there are no typical malformations as with rubella infection in the mother. Therefore, in the event of an infection, prenatal diagnostics such as An amniotic fluid test is recommended because these methods are invasive and increase the risk of miscarriage by 0.5%.
However, measles is dangerous during pregnancy, as around a quarter of children are born prematurely. In addition, the risk of miscarriage or stillbirth is increased. If the mother becomes infected towards the end of the pregnancy, the child can be born with measles. This is a life-threatening condition for the baby, because he does not yet have a sufficiently developed immune system to effectively fight the pathogen.
However, measles infection in the mother is not only dangerous for the baby, it is also dangerous for the mother herself. For her, the risk of a possible complication increases. Thereby are above all with high fever and one lung infection to be expected.

Much less dangerous than the disease, but still not recommended is vaccination against measles during or shortly before pregnancy. However, neither the vaccination nor the illness during pregnancy provide a reason for this Termination of pregnancy Sick pregnant women should be medically monitored.

Measles encephalitis

One of the most feared complications of measles is measles encephalitis. A distinction is made between acute encephalitis and subacute encephalitis. Acute encephalitis occurs within two weeks of being infected with measles. No viruses can be detected here, there is no therapy. It can only be treated symptomatically. This results in neurological sequelae in 20 to 40 percent and 10 to 20 percent of patients die.

Subacute sclerosing panencephalitis (SSPE) is the second form of encephalitis. This can occur two to ten years after infection and leads to the most severe neurological disorders. Consequential damage remains and there may be a decline in development. The disease leads to death in 100% of cases.

forecast

Contrary to popular belief, measles are not a harmless childhood disease.
Rather, it is a disease that affects the entire body. Complications can certainly arise. These complications include:

• Otitis media
• Pneumonia or
• in rare cases even an inflammation of the brain.

Even today people still die from measles.

Usually, however, measles is largely harmless.

Once you have measles, you enjoy lifelong immunity.

Summary

Measles is caused by a virus. This virus is transmitted from person to person through droplet infection - for example through coughing and sneezing.

Due to the high risk of infection, measles usually occurs as a childhood disease and is very common in kindergartens and schools, for example. Once the patient has measles, the virus leaves behind a lifelong immunity, which means that measles cannot be recovered.
It takes about 5 to 8 days for the disease to break out. A typical rash occurs after about 14 days.
There are two stages:

1. The first stage manifests itself in flu-like symptoms such as fever, cough and conjunctivitis.
2. Later, the entire oral mucosa becomes reddened, which was previously covered with whitish spots. This stage lasts about three to four days.

In the second stage, the typical rash develops, which typically begins behind the ears. Here, too, the fever rises again. This bimodal course of fever is typical.

A third increase can only be observed in the case of complications, such as additional bacterial infection.

Despite vaccinations, around 30 million people still get sick each year - mostly in developing countries.