Measles in baby and child

Measles is a highly contagious viral disease that is spread worldwide. Characteristic symptoms of measles are skin rash, high fever and upper respiratory symptoms. In addition, the occurrence of severe complications such as pneumonia or encephalitis is possible. Once the infection has been overcome, those affected usually have lifelong immunity against renewed measles outbreaks.

Contrary to the widespread belief that measles is a harmless childhood disease, it is in fact a serious, complication-laden disease that claims high numbers of victims, particularly in economically disadvantaged regions such as Africa and Asia. According to estimates, approximately one million children die of measles each year in developing countries - these lives could easily be saved through measles vaccination.

In the industrialized nations, the number of measles cases has been greatly reduced by the introduction of vaccination. However, local measles epidemics occur regularly because vaccination protection is often neglected nowadays.

Measles is a notifiable disease in Austria. This means that any suspicion of the disease, as well as illness and death from measles, must already be reported to the competent district administrative authority.

Measles is caused by an infection with the measles virus. The virus is usually transmitted through direct contact or as a droplet infection. The pathogens are transmitted from person to person through the air when coughing, sneezing or talking.

Measles is an extremely contagious disease. Therefore, almost everyone who comes into contact with someone who has the disease becomes infected. However, the disease almost always leads to lifelong immunity from the virus. This protection can also be created artificially by a measles vaccination. Newborns are protected from measles until about the fifth month of life by antibodies of the mother, which were transferred to the child via the placenta during pregnancy (provided that the mother is protected).

The incubation period (time from infection to the appearance of symptoms) is usually between eight and ten days for measles. The disease is contagious from five days before the rash appears until about four days after it appears. After the rash has subsided, there is no longer any risk of infection.

Initial stage / catarrhal phase

The incubation period is usually followed by the catarrhal phase (also called the prodromal or initial stage) for three to five days. During this phase, children suffering from measles show typical symptoms of a severe cold, such as a cold, sore throat, dry cough, fever up to 41°C and nausea. In addition, conjunctivitis often occurs, leading to red, watery eyes and hypersensitivity to light. The face of affected children appears "blubbery and puffy". In some cases, there may be the appearance of Koplik's spots (white, chalky spots on a reddened background) on the oral mucosa in the area opposite the front molars.

Exanthem stage

About four days after the onset of the catarrhal phase, the red, blotchy skin rash (called exanthem) characteristic of measles disease develops. Typically, the skin behind the ears is affected first, from where the rash spreads over the whole body within 24 hours. In addition, there is a renewed rise in fever up to 40°C. Swelling of the lymph nodes in the neck and sore throat may also occur.

Recovery stage

After about four to five days, the rash usually recedes. For a short time, a bran-like desquamation of the skin may remain. If the course is uncomplicated, the sick child recovers quickly and from then on has lifelong immunity to the measles virus.

Due to the relatively characteristic clinical picture, the suspicion of measles can often be confirmed by a visual diagnosis by the attending physician. To confirm the diagnosis, a blood sample can be tested in the laboratory for the presence of antibodies against the virus.

If measles causes encephalitis (inflammation of the brain), a lumbar puncture must be performed. This involves using a needle to remove cerebrospinal fluid in the area of the lumbar vertebrae and then examining it.

For children with measles disease, it is important that they get enough rest in a cool, darkened room. A specific therapy against measles does not exist.

Since the body has an increased need for fluids in the case of illness and especially in the case of fever, care should be taken that the sick child drinks enough. The administration of antipyretics and antitussives may be advisable, but should be discussed with the doctor beforehand. If the child develops complications (for example, an unusually severe course or meningitis), hospitalization should be sought immediately.

The following advice will alleviate the symptoms and help with the healing process:

• From a body temperature of 38.5°C, cold calf compresses or fever suppositories can help to reduce the fever. However, calf compresses should only be used if the child has warm legs, feet, arms and hands.
• The child should drink a lot and eat only easily digestible food.
• As there is a painful hypersensitivity to light from inflammation of the eyes, the patient's room should be darkened.
• If the throat is congested, cough syrups and cough teas may be helpful in loosening the mucus so that it can be coughed up more easily. However, cough-irritating medicines should not be taken, as this would prevent the sick child from coughing up the mucus. This would increase the risk of contracting pneumonia caused by bacteria in the course of the disease. Furthermore, no drugs containing codeine should be administered.
• Even after the fever and rash have subsided, the child should continue to take it easy for a few days, as the immune system is still quite weakened after measles. Only one to two weeks after the illness should the child attend kindergarten or school again.

In an uncomplicated course, the rash disappears after four to five days and the measles disease heals. However, the severe complications with serious consequences are feared. Especially in babies, adults and people with a weakened immune system, middle ear and lung infections occur relatively frequently during measles. If a child's condition suddenly changes or the high fever persists, a doctor should be consulted immediately.

The following complications may occur:

• During the course of the disease, additional bacterial infections such as pneumonia or otitis media may occur. Signs of a possible middle ear infection are ear pain. Shortness of breath or shortness of breath may be an indication of pneumonia.
• In some cases, severe inflammation occurs in the cornea of the eyes, which can present with visual field loss and vision loss.
• Meningoencephalitis occurs in about one in a thousand cases. Meningoencephalitis is an inflammation of the meninges and the brain, which is fatal in up to 20% of cases and causes permanent damage to the brain in 20-40% of cases. This can lead to paralysis, speech disorders, hearing loss or mental retardation. Signs of meningitis can include severe headaches, a stiff neck, vomiting or a high sensitivity to touch.
• The most feared late complication of measles is subacute sclerosing panencephalitis, which has a 1 in 100,000 chance of occurring. This is a slowly progressing inflammation of the brain in which the nerves are increasingly damaged. The first symptoms usually appear about seven years after contracting measles. The disease is incurable and progresses through increasing mental deterioration (mental disorders, dementia, muscle cramps, epileptic seizures) within up to three years, always fatal.
• Rarely, toxic measles can also occur, which is accompanied by a bleeding rash, mucosal bleeding, prolonged high fever and convulsions and is often fatal. Primarily immunocompromised individuals are affected.
• Very rarely, black measles also occurs, causing bleeding from the nose, mouth and intestines.

Through an infection with the measles virus, but also with the help of a measles vaccination, a lifelong immunity is built up, which prevents renewed illnesses.

A measles vaccination offers lifelong, safe protection against the disease. The doctor administers an attenuated live vaccine. Antibodies against the measles virus are then produced in the body, creating immunity without any previous illness.

It is recommended that all children be vaccinated twice between the ages of 11 and 14 months and 15 and 23 months, resulting in lifelong immunity in 99% of cases. Whether there is still sufficient vaccination protection against measles disease can be clarified at the doctor's by a blood test.