Measles is caused by an extremely contagious virus called paramyxovirus that replicates in your throat and nose. It's spread through respiratory droplets when an infected individual sneezes, coughs, or even talks. The virus can live in the air and on surfaces for up to two hours after a person with measles symptoms has left the area. It invades your respiratory system, causing fever and flu-like symptoms, and then spreads throughout your body. As your antibodies attack the virus, damage to the walls of tiny blood vessels occurs, leading to the measles rash.
An infected person is contagious for around eight days—four days before through four days after the measles rash appears. Measles is so contagious that one infected person who is exposed to 10 people who aren't immune to measles will infect 9 of the 10.
About 7 to 14 days after exposure to someone with measles, people without immunity to measles can develop measles symptoms, some of which are similar to the flu, including:
▪️Fever
▪️Dry cough
▪️Runny nose, sneezing, and congestion
▪️Red, watery eyes from conjunctivitis
▪️Sensitivity to light
▪️Poor appetite
▪️Swollen glands
▪️Koplik spots, small, bright red spots with a bluish-white central dot that are often found inside the mouth, on the inside of cheeks, and on the soft palate.
The classic measles rash is 3-5 days after the other symptoms appear. Unlike many other viral rashes, such as roseola and chickenpox, which typically start on the trunk, the measles rash starts on the face and head. Other things to watch for regarding the measles rash:
▪️This red, blotchy rash will spread down your or your child's body over the next three days, eventually reaching your hands and feet after starting around your hairline.
▪️It usually lasts about five to six days.
▪️After three to four days, the rash may no longer turn white when you push on it.
▪️Areas, where the measles rash was most severe, may start to peel.
▪️Once the rash begins to go away, it will fade in the same order that it started.
Measles is a serious, HIGHLY infectious disease that causes serious complications.
Although some people continue to claim that measles is a mild infection, it can have severe complications. In fact, one or more complications occur in around 30% of cases.
People who are at the highest risk for developing complications include: children under age 5, adults over age 20, pregnant women, and people with compromised immune systems.
Common complications include:
▪️Ear infections
▪️Diarrhea
More severe complications from measles include:
▪️Pneumonia: This lung infection is the main cause of measles death in children. Approximately 1 in 20 kids with measles develop pneumonia.
▪️Encephalitis: This is an inflammation of the brain that occurs in about 1 in 1,000 people. It involves more severe symptoms, such as fever, headache, vomiting, stiff neck, meningeal irritation, drowsiness, convulsions, and coma. This complication of measles usually begins about six days after the start of the measles rash and can lead to death, deafness, or permanent brain damage.
▪️Pregnancy issues: Measles can lead to preterm labor, low birth weight, and even pregnancy loss.
▪️Subacute sclerosing panencephalitis (SSPE): This is a deadly, but rare complication caused by defective measles virus. About seven to 10 years after having measles, children and young adults with SSPE develop progressive neurological symptoms, including memory loss, behavior changes, uncontrollable movements, and even seizures. As symptoms progress, they may become blind, develop stiff muscles, become unable to walk, and eventually deteriorate to a persistent vegetative state. Children who had measles before age 2 seem to be more at risk of developing this complication. People with SSPE usually die within one to three years of first developing symptoms. Fortunately, as the number of measles cases has been dropping in the post-vaccine era, so have the number of SSPE deaths.
▪️Seizures: In 0.6 percent to 0.7 percent of people, seizures with or without fever can occur as a complication of measles.
▪️Death: In the United States, measles is fatal in about 0.2 percent of cases.
Measles has a devastating impact on the body's immune system that could make it harder to fight infections for years.
The virus can cause "immune amnesia" - meaning the body forgets how to fight bugs it once knew how to beat.
Measles also resets the immune system to a "baby-like" state, compromising its ability to devise ways of tackling new infections.
"Measles is like the first 10 years of an untreated HIV infection compressed into a few weeks - that's the kind of immunological memory damage," said Dr. Michael Mina.
This is a serious problem because the measles are making a comeback due to a decrease in vaccinations.
Measles appeared in print as early as 0910 when a Persian physician published an account of measles and smallpox being two distinct and unique diseases.
In 1757, Scottish physician Francis Home transmitted measles from infected patients to healthy individuals via blood, demonstrating that the disease was caused by an infectious agent.
The Faroe Islands was experiencing a measles epidemic in 1846 so Danish physician Peter Panum traveled there and spent 5 months studying the disease. His observations were that measles was not just a childhood disease but affected people of all ages, the isolation of the Faroe Islands served to protect them from illness but also when illness hit the islands the mortality rate was high, the measles rash appeared 14 days after a person was exposed to the disease, and surviving the infection resulted in lifelong immunity against the disease.
Figuring out a cure for measles was proving to be difficult and very slow-going. Finally in 1916 French researchers Charles Nicolle, MD, and Ernest Conseil, MD showed that measles patients have specific protective antibodies in their blood. The researchers then demonstrated that serum from measles patients could be used to protect against the disease.
But it wasn't until 1954 that the measles virus was finally isolated and captured by Thomas Peebles, MD. The successful isolation of the virus was used to create a series of vaccines. In 1958 the first vaccine was tested on 11 children. All 11 vaccinated children developed measles antibodies, but nine also developed a mild rash—the vaccine didn’t cause full-blown measles, but it did cause symptoms. The researchers realized the virus used for the vaccine had to be weakened even more.
By 1960 there still wasn't a vaccine researchers felt good about mass producing. However, when an outbreak happened in February of 1960 and the 23 children who had been vaccinated with the most recent effort were exposed, they didn't fall ill. The vaccine still caused too many side effects but since it did its job and protected the children from the disease vaccine production went forward.
Successfully demonstrating its safety and efficacy, first in monkeys and then humans, John Enders and colleagues declared their measles vaccine capable of preventing infection in 1963.
Their Edmonston-B strain of measles virus was transformed into a vaccine licensed in the United States in 1963, and nearly 19 million doses would be administered over the next 12 years. In 1968 this vaccine was weakened (attenuated) enough to administer it without human blood proteins to lessen the side effects. Called the Moraten strain (More Attenuated Enders), it has been the only measles vaccine used in the United States since licensure.
In 1971 the MMR was licensed for use. It is a combination measles, mumps, and rubella vaccine. That combination will be discussed in a different post.
In 1978, the CDC declared a goal of eliminating measles from the United States by 1982. Although this goal would not be met, widespread vaccination drastically reduced the incidence of the disease, and it would be declared eliminated in the country by 2000. That was reversed in 2011 when the United States had 220 reported cases and since then the measles continue to have pockets of outbreaks every year. In 2020 the United States had 13 reported cases, in 2019 it was 31 cases which was the highest since 1992. That there continue to be outbreaks is concerning.
{You can find all the sources I used by clicking here.}
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