Measles (also called “Standard Measles” or “Rubeola”) is a serious respiratory virus that causes fever, cough, sneezing, runny nose, conjunctivitis (red, watery eyes), sore throat, and white spots inside the cheeks called Koplik’s spots, followed by a non-painful, non-itchy rash of flat red spots that spread from head to toe. It is very contagious and easily spread from person to person in the air from coughing and sneezing, by direct contact with an infected person, or from contaminated surfaces. It can live on surfaces and in the air for up to two hours.
In South Africa, a significant measles outbreak has been reported in 2023. Measles can cause serious complications, and even death, especially in babies and children under 5 years old, adults over 20 years old, pregnant women, and people who have weakened immune systems due to medications or other health conditions such as human immunodeficiency virus (HIV) infection. Possible complications include otitis media (middle ear infection), pneumonia (a serious lung infection), bronchitis (infection/inflammation in the airways), diarrhoea and dehydration, blindness, encephalitis (inflammation/infection of the brain/nervous system), and pregnancy complications like premature birth and low birth weight. Deaths are usually related to serious complications such as dehydration, pneumonia, and encephalitis.
Treatment for measles is focused on managing symptoms, preventing and treating complications, and decreasing transmission. There are no antiviral medications that are proven to treat measles.
Rehydration is important to replace the loss of fluids/body water due to fever and/or diarrhoea in patients with measles. Oral rehydration solutions that contain electrolytes/salts (ex.-potassium, magnesium, sodium) are available. Water alone may not be the best method of rehydration, especially with diarrhoea, because it causes a loss of electrolytes, which are necessary for many body processes. Oral rehydration solutions are available in pre-mixed liquids or in powder form. It is important to use clean or bottled water and follow the instructions carefully when mixing powdered oral rehydration solutions. In severe cases of dehydration, intravenous (IV) fluids may be administered at a healthcare facility. These include 0.9% sodium chloride solution (normal saline/NS), 5% dextrose in water (D5W), and lactated ringers solution. Electrolytes may be added to these IV solutions.
Pain/Fever Reducers, also called “analgesics” or “antipyretics,” respectively, are used to help make patients with measles more comfortable, treating symptoms such as fever and sore throat. Examples include acetaminophen, aspirin, and ibuprofen. Acetaminophen works by stopping pain signals and working on the part of the brain that causes temperature regulation. Ibuprofen and aspirin are NSAIDs (non-steroidal anti-inflammatory drugs) that treat pain and fever by decreasing inflammation in the body. Aspirin should NOT be given to children under 16 years old due to a serious potential reaction called Reye’s Syndrome.
Antibacterial Medications, also called “antibiotics” are used to treat complications of measles such as ear infection, pneumonia/bronchitis, and encephalitis. It is important to note that antibiotics are only needed to treat secondary bacterial infections caused by measles and that they do not help treat the measles virus itself. These medications work by killing or slowing the growth of bacteria. Examples of antibacterials used to help treat bacterial complications of measles may include amoxicillin, penicillin, amoxicillin/clavulanate, cefdinir, ceftriaxone, and levofloxacin.
Vitamin A can be low in patients, especially children, with severe cases of measles. It is recommended that all children with measles are given a high dose of Vitamin A/retinol (50,000 – 200,000 international units/IU based on age) to decrease the severity of measles and prevent complications, particularly eye damage/blindness.
Measles Vaccine can be given to people who are not immune to measles (have not previously had the infection or the vaccine) to help prevent them from getting the virus if the vaccine is administered/injected within 72 hours (3 days) of known contact with someone infected with measles. The measles vaccine works by introducing a weakened strain of the measles virus to stimulate the immune system to recognize and fight it. Some people may still get measles, but if the vaccine is given, the symptoms are milder, and the illness is shorter.
Immune Globulin may also be given to help prevent measles in people who are not immune to it, within 6 days of exposure to the virus. Immunoglobulin/IG is given by injection and contains antibodies, which are proteins the body uses to help fight infection. This is recommended for people who are allergic to the measles vaccine, pregnant women, babies under 6 months old whose mothers are not immune to measles, people who have weakened immune systems due to medications, blood or bone marrow cancers such as leukaemia/lymphoma, and people born with immune deficiency syndromes.
Common side effects that you or your child may experience from these medications include:
There have been reports of the MMR (measles, mumps, rubella) vaccine causing autism. However, scientific studies have found these reports to be false, and there is no known link between autism and vaccines. Immune globulin may cause severe infusion-related reactions, but these symptoms can usually be eliminated by slowing down the infusion and/or treating the symptoms with other medications.
Because it is highly contagious, it is important to take steps to prevent measles infection. Measles is contagious for up to 4 days before the rash appears, and 4 days after it appears. You should avoid contact with others by staying at home if you and/or your child are sick. Frequent handwashing and cleaning/disinfecting frequently touched surfaces are important. A measles vaccine is available for routine childhood vaccination and is paid for by the government. This can significantly prevent measles infection, transmission, and outbreaks. You should speak to your healthcare provider about what vaccines you and/or your child should receive.