Measles

4 days after incubation period appearance of exanthema

Catarrhal prodromal stage:
- Reduced general condition, fever (up to 40°C), pharyngitis, tracheitis, dry cough, rhinitis, conjunctivitis and photophobia
- After 2-3 days, punctate white mucosal lesions (Koplik's spots) appear enorally in the region of the molars for 48 hours, which cannot be scraped off

Enanthema: From the 3rd day, there are red spots in the area of the oral mucosa with a simultaneous drop in fever

Exanthematic stage:
- Starting retroauricularly, spreading over neck and trunk, morbilliform, erythematous, partly confluent patches finally pass to extremities
- Simultaneously, the fever begins to rise again, after 3-4 days the body temperature is regressive
- Foudroyant, sometimes lethal cases occur, especially in adults who have not been vaccinated. These are characterised by somnolence, bloody stools, hyperpyrexia, convulsions and circulatory disorders

clinic
BB (leukopenia)
PCR from body fluids
When neurological symptoms are present, a neurological consult is essential
Liquor puncture in case of neurological abnormalities. Note: In acute sclerosing panencephlitis with poor prognosis, very high IgG titres are found in the CSF
To perform a chest X-ray in case of pulmonary symptoms (streaky drawing)
IgM antibodies can be detected by ELISA from day 3 of the exanthema stage. If there is a 4-fold increase (2 levels) in the titer after 2 weeks, measles infection can be assumed

Bed rest

Antipyretic measures, e.g.:

Calf compress

Paracetamol
- Application:
- > 12 y. (>40 kg): single dose (ED): 500-1000 mg, max. daily dose (TD): 4 g
- 9-12 y. (30-40 kg): ED: 500 mg, max. TD: 2 g
- 6-9 y. (22-30 kg): ED: 250-500 mg, max TD: 750 mg
- KI: Liver damage, renal insufficiency, acute hepatitis, Meulengracht's disease, pregnancy, lactation

Topical therapy

Lotio alba

vaccination against	category	Indication	Instructions for use
Measles	S	People born after 1970 ≥ 18 years with unclear vaccination status, without vaccination or with only one vaccination in childhood	Once vaccinated with an MMR vaccine
	I	If admission is imminent or if the child is attending a community facility (e.g. day care centre): Infants from the age of 9 months	Twice vaccination with an MMR/V-*vaccine If the first vaccination is given at the age of 9 - 10 months, the 2nd MMR/V vaccination should already be given at the beginning of the 2nd year of life
	I	Born after 1970 from the age of 9 months with unclear vaccination status, without vaccination or with only one vaccination in childhood exceptionally 6 - 8 month old infants after individual risk-benefit assessment (off-label-use)	Once-only MMR(V)-*vaccination Completion, if necessary, according to the recommendations applicable to the age group If the first vaccination is given at 9-10 months of age, the 2nd MMR/V vaccination should be given at the beginning of the 2nd year of life. If the first vaccination is given at 6 - 8 months of age, a 2nd and 3rd MMR/V* vaccination should be given at 11 - 14 and 15 - 23 months of age * MMR/V = MMRV or MMR in co-administration with VZV vaccine ** MMR(V) = MMR with or without co-administration of VZV vaccine
	B	Working in health services or in the care of immunodeficient or -suppressed persons or in community settings: born after 1970 with unclear vaccination status, without vaccination or with only one vaccination in childhood	Once vaccinated with an MMR vaccine

S: Standard vaccinations with general application

I: Indication vaccinations for risk groups with individually (not occupationally) increased risk of exposure, disease or complications as well as for the protection of third parties

B: Vaccinations due to an increased occupational risk, e.g. after risk assessment according to the Occupational Health and Safety Act/Biological Substances Ordinance/Ordinance on Occupational Medical Precautions (ArbMedVV) and/or for the protection of third parties in the context of occupational activities

Robert Koch Institute, Epidemiological Bulletin No. 34. (2015). Rki.de. Retrieved 10 May 2016, from https://www.rki.de/DE/Content/Infekt/EpidBull/Archiv/2015/Ausgaben/34_15.pdf?__blob=publicationFile

	Adverse reactions after MMR vaccination per 1 million vaccinated	Complications of measles disease per 1 million measles vaccinated
Immune deficiency	Very rare	All sufferers
Ear infection	0	70000-90000
Pneumonia	0	10000-60000
Hospitalisation	20-50	10000-25000
Febrile convulsions	30-300	5000-7000
Brain inflammation	0.6-1.6	200-2000
Decrease in platelets	30	330
Subacute sclerosing Spanencephalitis (SSPE)*	0	1-10
Allergic shock reaction (Anaphylaxis)	1-10	0
Autism	0	0
Deaths	< 1**	300 to 1000
Cost	1 million vaccinations cost 140 million Swiss francs.	1 million sick people cost between 3.6 and 5 billion Swiss francs.

* SSPE is a late consequence of a measles infection. Years after the infection, an insidious brain inflammation develops that cannot be cured and is always fatal.

** No death is expected, and to date no death has been reported due to the vaccine; however, the risk cannot be completely ruled out.

Source:Federal Office of Public Health - Measles. (2016). Bag.admin.ch. Retrieved 10 May 2016, from http://www.bag.admin.ch/themen/medizin/00682/00684/01087/index.html?lang=de

If a measles infection is suspected, a report must be made
Kindergarten and school ban (unvaccinated children who have had contact with contagious persons must stay at home for max. 3 weeks). In case of suspicion, contact with non-immune persons must be avoided until 5 days after the appearance of the exanthema
For the first few months, newborns are protected by the mother's antibodies

MMR vaccination:
- MMRV vaccination should be given between 11 and 14 months of age. A booster vaccination is recommended 1 ½- 3 months later to detect vaccination failure. For children in childcare facilities, immunisation can be given as early as 9 months of age. The 2nd vaccine should then be given between 12-15 months of age. This is done to immunise the approx. up to 10% vaccination failures (thereafter there are only approx. 5% vaccination failures).
- The live vaccine can prevent the outbreak in immunocompetent children from 7 months of age onwards - provided it has been used within the first 3 days of exposure
Passive immunisation:
- If in immunodeficient patients or children before 7-13 months of age at exposure using
  - Intravenous immunoglobulins i.v. 250-400 mg/kg bw daily for 3-5 days every 3-4 weeks
    - Initial dose: 0.4-0.8 g/kg bw
    - In the course: 0.2 g/kg bw every 3 to 4 weeks
    - Determination of the IgG serum level always immediately before the next infusion!
    - An IgG valley level of at least 5 to 6 g/l should be reached before a new infusion

indicated and should be given within 6 days of first exposure. In this case, there is no increased risk for the child, but the risk that the existing maternal antibodies neutralise the vaccine. In this case, the second vaccination should be given between the 12th and 15th month of life, as usual
If a patient was born in 1964 or earlier and has not had measles, vaccination is recommended only in case of exposure
A contraindication to vaccination is pregnancy. If vaccination is nevertheless given, this is not a reason to terminate the pregnancy
Possible side effects: Local reaction, pain, swelling, redness. In rare cases, flu-like symptoms, thrombocytopenia and meningitis
Unlike Dr Wakefield postulated at times, the current data is very clear that there is no link between autism and MMR vaccination
Costs of MMR vaccination are covered by health insurance (except for the deductible)

Topical therapy:
- Drying out shaking concoctions

Cutts FT, Henao-Restrepo AM, Olivé JM. Measles elimination: progress and challenges. Vaccine 1999;17:S47-S52.
Davidkin I, Valle M, Peltola H, et al. Etiology of Measles‐ and Rubella‐like Illnesses in Measles, Mumps, and Rubella–Vaccinated Children. The Journal of Infectious Diseases 1998;178:1567-70.
Velangi, Tidman. Gianotti-Crosti syndrome after measles, mumps and rubella vaccination. British Journal of Dermatology 1998;139:1122-3.
Bundesamt für Gesundheit - Masern. (2016). Bag.admin.ch. Retrieved 10 May 2016, from http://www.bag.admin.ch/themen/medizin/00682/00684/01087/index.html?lang=de

Measles

Differential diagnoses

Synonym (s)

Definition

Epidemiology

Etiopathogenesis

Clinical features

Diagnosis

Complications

Prognosis

Therapy

References Informational link