Brief overview
- What is measles? Highly contagious viral infection that is spread worldwide. It is considered a “childhood disease”, although young people and adults are increasingly contracting it.
- Infection: Droplet infection, direct contact with infectious nasal or throat secretions from patients (e.g. by sharing cutlery)
- Symptoms: In the first stage, flu-like symptoms, a first episode of fever and whitish spots on the oral mucosa (Koplik’s spots). In the second stage, the typical measles rash (red, merging spots, starting from the ears) and a second episode of fever.
- Treatment: bed rest, rest, possibly fever-reducing measures (such as fever-reducing medication, calf compresses), cough medicine, antibiotics (in case of additional bacterial infection)
- Possible complications: e.g. middle ear infection, pneumonia, bronchitis, diarrhea, pseudo-croup (croup syndrome), brain inflammation (encephalitis); late complications: chronic brain inflammation (subacute sclerosing panencephalitis, SSPE)
- Prognosis: Measles usually heals without any problems. Complications occur in ten to 20 percent of patients in this country. Approximately one in 1,000 patients can die.
Measles: Infection
Secondly, measles can also be contracted through direct contact with infectious secretions from the nose and throat of an infected person. This happens, for example, when you use a patient’s cutlery or drinking glass.
Measles viruses are extremely contagious! Out of 100 people who have not had measles and have not been vaccinated against it, 95 will fall ill after coming into contact with measles viruses.
How long are measles patients contagious?
Anyone infected with measles is contagious for three to five days before the typical measles rash appears and up to four days afterwards. The greatest contagiousness is immediately before the outbreak of the rash.
Measles: Incubation period
The time between infection with a pathogen and the appearance of the first symptoms is called the incubation period. In the case of measles, this is normally eight to ten days. The typical measles rash (second stage of the disease) usually appears two weeks after infection.
Measles: Symptoms
Measles progresses in two stages with two bouts of fever and other symptoms:
Preliminary stage (prodromal stage)
The preliminary stage lasts about three to four days. Towards the end, the fever initially falls again.
Main stage (exanthema stage)
In this phase of the disease, the fever rises sharply again. The typical measles rash develops: irregular, three to six millimeter large, initially bright red spots that flow into each other. They first form behind the ears and then spread over the whole body. Only the palms of the hands and soles of the feet are spared. Within days, the spots become darker, brownish-purple.
After four to seven days, the masen spots fade again, in the same order in which they appeared (starting from the ears). This fading is often associated with scaling of the skin. At the same time, the other symptoms also subside.
It takes about two weeks for the patient to recover. However, the immune system is weakened for even longer: there is an increased susceptibility to other infections for around six weeks.
Mitigated measles
Measles: Complications
Occasionally a measles infection leads to complications. Because the immune system is weakened for several weeks, other pathogens such as bacteria have an easy time of it. The most common complications associated with measles are middle ear infections (otitis media), bronchitis, pneumonia and diarrhea.
Severe inflammation of the laryngeal mucosa is also possible. Doctors also speak of croup syndrome or pseudocroup. Sufferers have attacks of dry, barking coughs and breathing difficulties (including shortness of breath), particularly at night.
Foudroyant (toxic) measles are rare: Among other things, the affected patients develop a high fever and bleeding of the skin and mucous membranes. The mortality rate for this measles complication is high!
Another rare but dreaded complication is encephalitis. It manifests itself around four to seven days after the start of the measles outbreak with headaches, fever and impaired consciousness (up to and including coma). Around 10 to 20 percent of patients die. In a further 20 to 30 percent, measles-related encephalitis causes permanent damage to the central nervous system.
For every 100,000 measles patients, four to eleven will develop SSPE. Children under the age of five are particularly susceptible to this fatal late consequence of measles. In this age group, there are an estimated 20 to 60 cases of SSPE per 100,000 measles patients.
In people whose immune system is suppressed by medication or another illness (immunosuppression) or who have a congenital defect, measles can be quite weak on the outside. The measles rash may be absent or look atypical. However, there is a risk of serious organ complications. These include a progressive form of pneumonia (giant cell pneumonia). Sometimes a special type of brain inflammation also develops (measles inclusion body encephalitis, MIBE): it leads to death in around three out of ten patients.
Measles: Causes and risk factors
Measles is caused by the highly contagious measles virus. The pathogen belongs to the paromyxovirus family and is spread worldwide.
The disease is of particular importance in developing countries in Africa and Asia: Measles is one of the ten most common infectious diseases here and is often fatal.
Measles: Examinations and diagnosis
The symptoms of the disease, especially the rash, give the doctor important clues about measles. However, there are some diseases with similar symptoms, namely rubella, ringworm and scarlet fever. To avoid confusion, a laboratory test must therefore confirm the suspicion of measles. Various tests are possible, the most common being the detection of antibodies against measles viruses:
- Detection of specific antibodies against the measles virus: the fastest and most reliable diagnostic method. The patient’s blood is used as sample material (if cerebral inflammation is suspected, cerebrospinal fluid may be used). The test is usually positive as soon as the typical measles rash appears. However, the antibodies are sometimes not detectable before this.
- Detection of the viral genetic material (measles virus RNA): A urine sample, saliva sample, tooth pocket fluid or throat swab is taken for this purpose. The traces of viral genetic material found in these samples are amplified using the polymerase chain reaction (PCR) and can thus be clearly identified.
Measles must be reported!
Measles is a notifiable disease. As soon as the first symptoms indicate measles, a doctor should be consulted. Suspicion, actual illness and death from measles must be reported by the doctor to the responsible health authority (with the patient’s name).
If measles is suspected or an infection has been confirmed, those affected must stay away from communal facilities (schools, day care centers, etc.). This also applies to employees of such facilities. Patients may not be readmitted until five days after the outbreak of measles at the earliest.
Measles: Treatment
There is no specific treatment for measles. However, you can alleviate the symptoms and support the healing process. This includes bed rest in the acute phase of the disease and physical rest. If the patient’s eyes are sensitive to light, the patient’s room should be somewhat darkened – direct light on the patient should be avoided. Also make sure that the room is well ventilated and not stuffy.
Experts recommend that measles patients drink enough – especially if they have a fever and are sweating. Instead of a few large portions, several small meals should be eaten throughout the day.
The fever and painkiller acetylsalicylic acid (ASA) is not suitable for children. Otherwise, the rare but life-threatening Reye’s syndrome can develop in conjunction with febrile infections!
In the case of an additional infection with bacteria (for example in the form of middle ear or pneumonia), the doctor will usually prescribe antibiotics.
If measles causes croup syndrome or encephalitis, treatment in hospital is necessary!
Measles: Course of the disease and prognosis
Most patients recover from measles without any problems. However, complications occur in 10 to 20 percent of cases. Children under the age of five and adults over the age of 20 are particularly affected. Such measles complications can also be fatal under certain circumstances. This is particularly true of encephalitis, which develops either shortly after infection or as late complications years later.
According to the World Health Organization (WHO), the overall mortality rate for measles in developed countries such as Germany is up to 0.1 percent (1 death per 1,000 measles patients). In developing countries, it can be significantly higher, for example due to malnutrition.
Lifelong immunity
Pregnant women who have antibodies against measles also transmit these to their unborn child via the umbilical cord. The maternal antibodies remain in the child’s body until a few months after birth and thus prevent infection. This so-called nest protection lasts until around the sixth month of life.
Measles vaccination
A measles infection can cause permanent damage to the nervous system and even lead to death – in 2018, around 140,000 people worldwide died from measles, most of them children under the age of five. This is why the measles vaccination is so important:
It is generally recommended for all infants and young children: they should be vaccinated against measles twice within the first two years of life. If the offspring is to attend a community facility such as a daycare center, the measles vaccination has even been mandatory since March 1, 2020 (unless a medical certificate can prove that the child has had measles).
The measles vaccination is also either recommended or even mandatory for other groups of people. You can read more about this as well as about the implementation and possible side effects of the vaccination in the article Measles vaccination.
Further information
RKI guide “Measles” from the Robert Koch Institute (2014)
