Dr Thapelo Motshudi
2 March 2023
6 min read

What is measles?

Measles is a highly contagious disease caused by a RNA virus, and it is regarded as the most contagious disease known to humankind. It remains an important cause of death among young children globally, despite the availability of a safe and effective vaccine. More than 140,000 people died from measles in 2018. The overwhelming majority (more than 95%) of measles deaths occur in countries with low per capita incomes and weak health infrastructures. Humans are the only natural hosts of the measles virus.

Who can get measles?

Anyone who is not immune to measles can catch measles from an infected person. Once a person has had measles, they are immune to the virus. Vaccination is another way to become immune to measles. Vaccinated individuals are protected from severe symptoms of measles, mostly for the rest of their life. Communities become vulnerable to outbreaks of measles when more than 5% of persons are not vaccinated.

How is it spread?

Measles spreads through the air when an infected person coughs or sneezes. It is so contagious that if one person has it, up to 9 out of 10 people around him or her will also become infected if they are not protected. Your child can get measles just by being in a room where a person with measles has been, even up to two hours after that person has left.

An infected person can spread measles to others even before knowing he/she has the disease, from four days before developing the measles rash through four days afterward. Measles is spread by contact with saliva or mucus droplets from the mouth or nose of an infected person when they breathe, cough, or sneeze.

Recent outbreak in South Africa?

Currently there is an outbreak of measles in South Africa. An outbreak is defined as cases occurring in a specified area over a short period of time (three or more cases in a health district within four weeks). Measles infections are not localized to particular risk groups or geographical areas, and they occur anywhere in South Africa. Cases can be found in communities or in institutions like crèches or day care centers. Adult travelers who have not been vaccinated in childhood are also at risk of measles when visiting areas where measles cases have been reported, or where measles is relatively common.

As of 11 February 2023, the National Institute of Communicable Diseases (NICD) had tested 3694 samples for measles, of which 560 (15.1%) were confirmed positive. Provinces with declared outbreaks are Limpopo (which has the greatest number of cases), Mpumalanga, North West, Gauteng, and Free State.

What are its symptoms?

Initial symptoms, which usually appear 10-12 days after infection, include high fever, a runny nose, bloodshot or inflamed eyes (conjunctivitis), and tiny white spots on the inside of the mouth (also called Koplik's spots). Several days later, a rash develops, starting on the face and upper neck, and gradually spreading downwards.

Severe measles is more likely among poorly nourished young children, especially those with insufficient vitamin A, or whose immune systems have been weakened by HIV/AIDS or other diseases. The measles rash may last about seven days. The rash gradually fades first from the face, and last from the thighs and feet. As other symptoms of the illness go away, the cough and darkening or peeling of the skin where the rash was may stay for about 10 days.

Complications of measles can include diarrhea, dehydration, pneumonia, brain infection (encephalitis), blindness and death. Complications are more serious in those who catch measles as young infants (under 2 years of age), in children who are malnourished, and in pregnant women.

How is it diagnosed?

Measles is usually diagnosed based on the disease's characteristic rash as well as a Koplik's spot on the inside lining of the cheek. On seeing this a healthcare provider may ask about whether you or your child has received measles vaccines, whether you have recently traveled, and if you've had contact with anyone who has a rash or fever.

However, many providers have never seen measles, and the rash can be confused with many other illnesses too, like German measles. The diagnosis should always be confirmed by a blood test. A throat swab, collected within 5 days of the start of the rash, can also be sent to the laboratory together with the blood sample. Measles is a notifiable disease, and public health officials will respond to every measles case to prevent outbreaks. Blood should be taken from the patient and sent to the NICD Centre for Vaccines and Immunology, along with a completed ‘case investigation form’, which can be found on the NICD web page.

How is it prevented?

Routine measles vaccination for children, combined with mass immunization campaigns in countries with low routine coverage, are key public health strategies to reduce global measles deaths. The measles vaccine has been in use since the 1960s and has been found to be safe and effective. The WHO recommends immunization for all susceptible children and adults for whom measles vaccination is not contraindicated. Reaching all children with 2 doses of measles vaccine, either alone, or in a measles-rubella (MR), measles-mumps-rubella (MMR), or measles-mumps-rubella-varicella (MMRV) combination, should be the standard for all national immunization programs.

The measles vaccine is included in the expanded program on immunizations (EPI) schedule in South Africa. It is administered at 6 months and 12 months of age. The MMR vaccine is available in the private sector and in military health care facilities. MMR is usually administered at 12 months and 18 months. If a measles vaccine dose has been missed, it is never too late to catch up measles vaccination.

Does the measles vaccine cause autism?

There is overwhelming evidence that vaccines do not cause autism, yet this belief remains persistent among a fringe minority, a significant majority of whom have no basic training in medicine or immunology. People believe that thimerosal, a mercury-based preservative that used to be used in the measles vaccine, causes autism. Not only has no evidence has been shown to support this claim, but thimerosal has been completely removed from vaccines, yet rates of autism continue to rise.

How is it treated?

There's no specific treatment for measles. However, some measures can be taken to protect individuals who don't have immunity to measles after they've been exposed to the virus. These include medication to reduce fever, antibiotics if pneumonia develops, and Vitamin A in children with low levels, especially to prevent eye damage.

People without immunity to measles, including infants, may be given the measles vaccine within 72 hours of exposure to the measles virus to provide protection against it. If measles still develops, it usually has milder symptoms and lasts for a shorter time.

Immune serum globulin.

The content in this communication is for information purposes and is not intended to be detailed advice, you should seek the advice of your physician or a qualified healthcare provider with any questions you may have regarding a medical condition.


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