Measles is a highly infectious viral disease. It is transmitted through droplets from the nose, mouth or throat of an infected person.
Although deaths from measles has decreased globally by about 85% since 2000, it is still common in many developing countries.
And despite the availability of a safe and effective vaccine, it remains an important cause of death among young children globally.
The number of measles cases in Malaysia increased about 10 times from 195 cases in 2013 to 1,934 cases in 2018, with six deaths in 2018 – all of whom had not been vaccinated.
The number of measles patients who had no vaccination increased about 11.7 times from 125 in 2013 to 1,467 in 2018.
Measles infections have also spiked in many countries in recent years, e.g. in Singapore, Indonesia and Philippines in Asean, and many developed countries.
Spots and rashes
Measles starts with cold-like symptoms that develop about 10 days after becoming infected. This is followed a few days later by the measles rash.
The illness lasts seven to 10 days in most people.
The initial symptoms include a running or blocked nose; sneezing; watery eyes; red sore eyes; high fever, which may reach about 40ºC; greyish-white spots in the mouth; body aches; cough; loss of appetite; and tiredness.
Many of those infected have the greyish-white spots in the mouth a day or two before the measles rash appears.
The spots, which last a few days, do not appear in every infected person.
However, if the spots are present in those with the initial symptoms above or with a rash, the diagnosis of measles is very likely.
The measles rash comprises small red-brown, flat or slightly elevated raised spots that may join to form larger rashes.
The rash, which may be itchy in some people, usually appears on the head and neck initially, then spread to the rest of the body.
It appears about two to four days after the initial symptoms and disappears after about a week.
The infected person usually feels most sick on the first or second day of the rash appearing.
A similar rash can be found if a person has rubella. A rash is unlikely to be due to measles if the person has had measles before or had two doses of the MMR (measles, mumps, rubella) vaccine.
The common complications of measles are infections of the middle ear and eye; infections of the airway and lungs, like bronchitis and pneumonia; diarrhoea and vomiting, which can result in dehydration; inflammation of the voice box; and febrile (fever) fits.
The less common complications include infections of the liver, the membrane covering the brain and spinal cord, or the brain itself; and squinting of the eyes.
Rare complications include infection of the optic (eye) nerve; problems of the heart and nervous system; and a fatal brain condition called subacute sclerosing panencephalitis.
A pregnant woman who gets measles and is not immune to it, is at increased risk of having a miscarriage; stillbirth; premature delivery; and a baby with low birth weight.
Complications are more likely in those less than one year old; children who are malnourished or have impaired immunity; teenagers; and elderly adults.
No treatment, have vaccine
There is no specific treatment for measles. The supportive treatment includes medicines for fever, pain, and cold-like symptoms; drinking plenty of fluids; and treating sore eyes.
It is important to be on the look-out for the signs and symptoms of measles complications as mentioned above.
The measles vaccine has been used for about 60 years. It is safe, effective and cheap.
Global health authorities recommend vaccination for all children and adults for whom there is no medical reason not to vaccinate.
The measles vaccine is given alone or in combination with mumps and rubella (MMR), which is a part of many national immunisation programmes.
The Health Ministry replaced the measles vaccine with the MMR vaccine in 2002 because of the triple vaccination’s efficiency.
The MMR vaccine, which is produced from weakened types of live measles, mumps and rubella viruses, enables the body to immediately produce antibodies against all three viruses, should there be contact with any of them.
Two common misperceptions about the MMR vaccine are that it contains mercury and that it causes autism in children.
The fact is that the MMR vaccine does not contain mercury and does not cause autism or other neurological disorders in those it is given to.
The MMR vaccine is given at one year of age, followed by a second dose at seven years of age.
Anyone who has not been vaccinated before can be vaccinated at any time.
An MMR vaccine dose can be given to anyone above six months of age if they are at immediate risk of measles, e.g. in a local outbreak; have close contact with someone with measles; or are travelling to an area where there is widespread measles.
Anyone who had the MMR vaccine before one year of age should still have the two routine doses at one and seven years of age.
If one is unsure as to whether one has been vaccinated previously, having the vaccine again does not cause harm.
If the MMR vaccine is not suitable for a person, human normal immunoglobulin (HNIG), which is a concentration of antibodies, can be given to provide short-term immediate protection – usually within six days of exposure to measles.
HNIG is given to vulnerable persons exposed to someone with measles, e.g. babies below six months of age; pregnant women who have not had measles previously or not been vaccinated before; and those whose immunity is impaired, e.g. HIV patients or those on chemotherapy.
It is important to reduce the likelihood of spread to others if a person has measles.
This can be done by avoiding school or work for at least four days after the rash develops, and/or avoiding contact with those who are at increased risk of infection, e.g. young children and pregnant women.