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 June 15, 2003
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Measles (Rubeola) is a highly communicable disease characterized by fever, general malaise, sneezing, nasal congestion, brassy cough, conjunctivitis, and a maculopapular eruption over the entire body caused by the rubeola virus.


While measles is usually a benign infection, encephalitis is a grave complication. Of those who develop encephalitis, about one in eight will die. Bronchopneumonia is a serious complication of measles. Otitis media, followed by mastoiditis, brain abscesses, or even meningitis, is not rare.


Measles is most common in school-age children with outbreaks occurring in the winter and spring. The occurrence of measles before the age of 6 months is relatively uncommon because of passively acquired maternal antibodies from the immune mother.


The onset is gradual with rhinitis, drowsiness, loss of appetite, gradual elevation of temperature for the first two days, when the fever may rise to 101 to 103 degrees (F). Koplik's spots usually appear on the buccal (inner cheek) mucosa opposite the molars on the second or third day. About the fourth day, fever usually reaches a higher elevation than previously, at times as high as 104 to 106 degrees (F). With this recurrence the rash appears. The measles rash first appears on the face, being seen early as small maculopapular lesions that increase rapidly in size and coalesce in places, often causing a swollen, mottled appearance. The rash extends to the body and extremities, and in some areas may resemble the rash of scarlet fever. A cough, present at this time, is due to bronchitis produced by the inflammatory condition of the mucous membranes, which undoubtedly corresponds to the rash seen on the skin. Ordinarily, the rash lasts from 4 to 5 days; and as it subsides, the temperature declines. Consequently, five days after the appearance of the rash, the temperature should be normal or approximately normal in uncomplicated cases.


Maintain bedrest and provide quiet activities for the child. If there is sensitivity to light, keep room darkly lit. Remove eye secretions with warm saline or water. Encourage the child not to rub the eyes. Administer antipruritic medication and tepid sponge baths as ordered. A cool mist vaporizer can be used to relieve cough. Apply antipruritic medication to prevent itching. Isolate child until fifth day of rash.


Generally two doses of live measles vaccine are recommended, one shot at 15 months of age, and the second shot before entering either kindergarten or first grade (or at some other age as required by law in your state). Measles re-vaccination guidelines are as follows: Persons vaccinated with live measle vaccine before their first birthday should be considered unvaccinated, and should receive at least one dose of measles vaccine. Immunization is recommended one time for all persons born after 1956 who lack evidence of immunity to measles (receipt of live vaccine on or after the first birthday, laboratory evidence of immunity, or a history of physician-documented measles). A second dose of measles vaccine is recommended for young adults in settings where individuals congregate (colleges, residential settings, etc.).


What are the usual symptoms of measles? What can be done at home to help with the discomforts of measles? What are the complications of measles? Do you recommend the measles vaccine? When is re-vaccination necessary?

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