“Except for measles and other childhood diseases, I have never been seriously ill! ” is how patients often report when asked as a physician about the history of their current ailment. The fact that in the European industrialized countries with their high population density almost everyone survives measles as a child makes this disease appear in the memory of the individual as a harmless episode with interruption of kindergarten or school attendance. Later, of course, the adult is not able to recall the worries and the trouble that our mothers had with their children suffering from measles.
Causes and transmission of measles
On the mucous membrane of the cheeks, on the second or third day of fever, one recognizes punctiform spots of white color, which look like milk residues, but cannot be wiped away, overnight, usually under renewed steep rise of fever, the rash breaks through. Measles as an acute infectious disease could not be avoided so far despite exemplary personal hygiene and high standard of living of the population. Measles is so contagious that practically every child becomes infected after meeting a measles sufferer and falls ill eleven days later with fever and acute inflammatory symptoms of the eyes and nasopharynx. Another three days later, the large-spotted skin rash on the neck and behind the ears begins. The causative agent of this disease is the measles virus, which has been successfully cultivated for many years on tissue cultures, for example on human cancer cells or on incubated chicken eggs. The measles virus can be cultured from the pharyngeal rinsing water of the sick person, from his nasal secretions and conjunctival sac, and 48 hours before the onset of the rash also from the blood. The measles pathogen is extremely volatile and very soon loses its viability outside the human body because it is rapidly destroyed by sun and air. Its transmission therefore does not occur through dead objects, but exclusively through direct contact with a sick person or through droplet infection. There are no healthy carriers of measles. However, a draft of air can spread the measles pathogens over a distance of several meters through door gaps and open windows. Contagiousness is greatest at the beginning of the disease during the first days of fever, and the risk of infection ceases when the rash fades.
Measles in children
If a child has survived measles, he or she usually retains lifelong protection against this disease. When a child suffers measles for the second time, concerns about the accuracy of the diagnosis made earlier are well founded. Rubella can be similar to measles, especially if the rash is severe. Susceptibility to measles is about the same at any age. The only exception is the first quarter of life, but only if the mother herself has survived measles in her lifetime, so that she could give her child protective substances as an immunizing dowry. Beyond the fourth month of life, however, this maternal protection is extinguished. In our large cities, measles is a permanent occurrence. This fact, combined with the high propensity to contract the disease, means that measles is usually acquired during infancy and preschool. Measles is spread from the cities to the countryside – naturally by people – via transport routes and is capable of triggering downright epidemics in villages and smaller towns. The “outbreak period” of measles is extremely constant: parents must expect fever and signs of inflammation to appear exactly 11 days after their child is infected; the rash then appears on the 14th day.
Symptoms and course of the disease
The doctor is often able to recognize measles before the rash begins. For the siblings of the measles child, the medical diagnosis nevertheless usually comes too late, because the infection has already occurred, so that the siblings usually fall ill in the same way two weeks later. The signs of an incipient measles disease include photophobia (sensitivity to light) and conjunctivitis, severe rhinitis and a dry, irritating cough.On the mucous membrane of the cheeks, on the second or third day of fever, dot-like spots of white color are seen, which look like milk residues, but cannot be wiped away; overnight, usually under a renewed steep rise in fever, the rash breaks through. It appears on the face, behind the ears, on the neck and on the back between the two shoulder blades. In the course of the next few days, it spreads over the entire body, down the arms and legs to the fingers and toes. Between the reddened, mostly jagged or star-shaped bordered skin areas of first light red, later more violet-red color, some pale healthy skin can still be seen. After three days, the face again flakes off first. Over the next few days, the fever drops and with it the rash fades completely. The general condition of the child with measles is severely impaired in most cases. The light-shy children are tearful, have no appetite and cannot be satisfied by anything. Many children appear apathetic and doze off. The inflamed eyelids become sticky during the night, and the nose secretes a purulent mucus that makes the upper lip sore, sometimes even causing a trunk-shaped swelling of the upper lip. The tongue is often heavily coated, breathing is accelerated, as is the pulse, so that the parents – horrified by the severe clinical picture of their highly feverish, sometimes light-headed child – call the doctor several times and the doctor already considers admitting the child to a children’s hospital. At this stage of the disease, however, the child suffering from measles is highly contagious for all other children in the clinic; he or she must therefore be strictly isolated within the clinic or placed in an infection ward for measles patients. This compelling need only rarely allows a measles child to be referred for inpatient treatment. Rather, the physician is forced to constantly monitor the child’s condition through several home visits.
Complications of measles
As a rule, he is able to reassure the parents after a few days, because after the exanthema subsides, the child tends to recover quickly. The widespread opinion that the sick children must be kept in darkened rooms is completely wrong. Staying in darkened rooms is never necessary. The described, normal course of measles is unfortunately often enough complicated by complications, concomitant and secondary diseases, especially when an additional infection with pus pathogens affects the child who has become unresistant. The most common in this context is inflammation of the smallest bronchial tubes, which eventually turns into pneumonia, usually bilateral. In this complication, the measles rash often becomes quite indistinct and fades away exceedingly quickly, so that it is popularly said that “the rash has turned inward.” Renewed fever as well as accelerated and groaning breathing, with the distended nostrils moving, allow even the layman to recognize the measles child’s pneumonia at an early stage. Measles patients with pneumonia recover best in the fresh air. With good reason, measles croup is the most feared, which is announced by a barking cough and a hoarse voice. Especially in children in the 2nd to 4th year of life, in addition to complete voicelessness, there is a sounding (whooping) inhalation accompanied by deep retractions of the chest as an expression of high degree of respiratory distress. Such conditions of severe respiratory distress as a result of swelling of the mucous membrane in the area of the glottis can lead to fatal asphyxia if medical help is not sought in time. Measles children with laryngeal croup must receive clinical treatment. Middle ear infection, usually bilateral, is another common complication of measles, usually occurring during the second week of illness. Today, however, this clinical picture can be well controlled with penicillin and other antibiotic drugs. If a measles child also develops cramps, if his consciousness becomes cloudy and drowsiness and paralysis occur, signs of a brain inflammation are present. Such a serious complication makes inpatient treatment absolutely necessary, because the entire armamentarium of modern pediatrics must be used to control the disease of the central nervous system and to prevent permanent disorders of the sensory organs.
Prevention
For several years, the outbreak of the disease in children who have already been infected can be prevented by injecting the children with antibodies during the first two days after infection. Because of the possibility of such complications, pediatricians today do not consider measles to be a harmless childhood disease. Children of nursery age not only very often contract measles, they may even fall victim to measles complications. Measles also plays a significant role in the continued use of our daycare centers and nurseries. In order to relieve working mothers from worrying about their children, everything possible must be done on the part of doctors and nurses, as well as parents, to help prevent measles as much as possible. For this reason, siblings of children with measles must not be taken to a weekday or daycare center, as they must already be considered infected and put the other children at risk. If an infected child is already in a daycare center or pediatric ward, it is imperative that the directors be notified so that all other children are spared from the outbreak of a measles epidemic as much as possible. Measles tends to be particularly complicated in children in the first three years of life. Therefore, children of this age should never be deliberately exposed to measles. For some mothers, the time that children with measles have to stay away from nurseries and schools seems too long. However, it is important for doctors to ensure that children stay away from nurseries and schools for 14 to 16 days after the rash has cleared up. It is also very important to make sure that children whose siblings or playmates have measles are not vaccinated under any circumstances, so that the measles outbreak and the vaccination reaction do not coincide. However, these measures are not yet sufficient for effective measles control. For this reason, Germany has introduced compulsory reporting of every measles outbreak. Only in this way is it possible for the responsible medical authorities to initiate measures in good time to contain the spread of the disease. For some years now, it has been possible to prevent the outbreak of the disease in children who have already been infected by injecting them with antibodies during the first two days after infection. This serum component is so rich in protective substances that, if injected at the right time, it can provide complete, if only temporary, protection. This measles prophylaxis is preferably used for sick children who have been infected with measles within a group; however, a measles infection chain can also be interrupted in this way in crèches and homes. The best way to get rid of measles, however, is with the help of a vaccination. Although the children get so-called “vaccine measles” after about eleven days following the vaccination, which are accompanied by fever and a slight rash, but do not cause any complications and, above all, are not contagious for the environment of the vaccinated person.
