Measles 58911 225920468 2008-07-16T00:48:52Z Kevin Dufendach 2171589 Moved stray "German measles" paragraph to opening line {{Infobox Disease | Name = Measles | ICD10 = {{ICD10|B|05||b|00}}.- | ICD9 = {{ICD9|055}} | Image = H9991083.jpg | Image_width = 180 px | Caption = Skin of a patient after 3 days of measles infection. | DiseasesDB = 7890 | MedlinePlus = 001569 | eMedicineSubj = derm | eMedicineTopic = 259 | eMedicine_mult = {{eMedicine2|emerg|389}} | eMedicine_mult = {{eMedicine2|ped|1388}} }} {{Taxobox | color = violet | name = ''Measles virus'' | image = Measles virus.JPG | image_width = 180 px | image_caption = ''Measles virus'' | virus_group = v | ordo = ''[[Mononegavirales]]'' | familia = ''[[Paramyxoviridae]]'' | genus = ''[[Morbillivirus]]'' | type_species = '''''Measles virus''''' }} '''Measles''', also known as 'rougeole' in French, is a [[disease]] caused by a virus, specifically a [[paramyxovirus]] of the genus ''[[Morbillivirus]]''. '[[German measles]]' is an unrelated condition caused by the [[rubella virus]]. Measles is spread through respiration (contact with [[fluid]]s from an [[infection|infected]] person's nose and mouth, either directly or through [[Particulate|aerosol]] transmission), and is highly contagious&mdash;90% of people without [[immune system|immunity]] sharing a house with an infected person will catch it{{Fact|date=May 2008}}. ''Airborne precautions'' should be taken for all suspected cases of measles. The [[incubation period]] usually lasts for 4&ndash;12 days (during which there are no [[symptom]]s). Infected people remain contagious from the appearance of the first symptoms until 3&ndash;5 days after the [[rash]] appears. Reports of measles go as far back to at least 600 B.C. however, the first scientific description of the disease and its distinction from [[smallpox]] is attributed to the [[Persia]]n physician [[Ibn Razi]] (Rhazes) 860-932 who published a book entitled "The Book of Smallpox and Measles" (in Arabic: ''Kitab fi al-jadari wa-al-hasbah''). In roughly the last 150 years, measles has been estimated to have killed about 200 million people worldwide.<ref>Torrey EF and Yolken RH. 2005. Their bugs are worse than their bite. Washington Post, April 3, p. B01.</ref> In [[1954]], the virus causing the disease was isolated from an 11-year old boy from the [[US]], [[David Edmonston]], and adapted and propagated on [[chick embryo]] [[tissue culture]].<ref>Live attenuated measles vaccine. EPI Newsl. 1980 Feb;2(1):6.</ref> To date, 21 strains of the measles virus have been identified.<ref> Rima BK, Earle JA, Yeo RP, Herlihy L, Baczko K, ter Muelen V, Carabana J, Caballero M, Celma ML, Fernandez-Munoz R 1995 Temporal and geographical distribution of measles virus genotypes. J Gen Virol 76:11731180.</ref> Licensed [[vaccine]]s to prevent the disease became available in [[1963]]. ==Symptoms== The classical symptoms of measles include a fever for at least three days, the three ''C''s&mdash;[[cough]], [[coryza]] (runny nose) and [[conjunctivitis]] (red eyes). The fever may reach up to 40° [[Celsius]] (104° [[Fahrenheit]]). ''[[Koplik's spots]]'' seen inside the mouth are [[pathognomonic]] (diagnostic) for measles but are not often seen, even in real cases of measles, because they are transient and may disappear within a day of arising. The characteristic measles rash is classically described as a generalized, [[maculopapular]], [[erythematous]] rash that begins several days after the fever starts. It starts on the head before spreading to cover most of the body, often causing [[itch]]ing. The rash is said to "stain", changing colour from red to dark brown, before disappearing.{{Fact|date=February 2008}} ==Diagnosis and treatment== Clinical diagnosis of measles requires a history of fever of at least three days together with at least one of the three ''C''s. Observation of [[Koplik's spots]] is also diagnostic of measles. Alternatively, laboratory diagnosis of measles can be done with confirmation of positive measles [[IgM]] antibodies or isolation of measles virus RNA from respiratory specimens. In cases of measles infection following secondary vaccine failure IgM antibody may not be present. In these cases serological confirmation may be made by showing IgG antibody rises by Enzyme immunoasay or complement fixation. In children, where [[phlebotomy]] is inappropriate, saliva can be collected for salivary measles specific [[IgA]] test.{{Fact|date=March 2008}} Positive contact with other patients known to have measles adds strong [[epidemiology|epidemiological]] evidence to the diagnosis. There is no specific treatment or antiviral therapy for uncomplicated measles. Most patients with uncomplicated measles will recover with rest and supportive treatment. Some patients will develop [[pneumonia]] as a sequela to the measles. Histologically, a unique cell can be found in the paracortical region of hyperplastic lymph nodes in patients affected with this condition. This cell, known as the [[Warthin-Finkeldey cell]], is a multinucleated giant with eosinophilic cytoplasmic and nuclear [[Inclusion bodies|inclusions]].{{Fact|date=March 2008}} ==Transmission== The measles is a highly contagious airborne pathogen which spreads primarily via the respiratory system. The virus is transmitted in respiratory secretions, and can be passed from person to person via aerosol droplets containing virus particles, such as those produced by a coughing patient. Once transmission occurs, the virus infects and replicates in the [[lymphatic system]], [[urinary tract]], [[conjunctiva]]e, [[blood vessel]]s and [[central nervous system]] of its new host.<ref name="principlesofvirology">{{cite book | author = Flint SJ, Enquist LW, Racaniello VR, and AM Skalka | title = Principles of Virology, 2nd edition: Molecular Biology, Pathogenesis, and Control of Animal Viruses | 2004}}</ref> The role of [[epithelial cell]]s is uncertain, but the virus must infect them to spread to a new individual.<ref>{{cite journal | title=Measles virus blind to its epithelial cell receptor remains virulent in rhesus monkeys but cannot cross the airway epithelium and is not shed| author=Leonard VHJ, Sinn PL ''et al''| journal=J. Clin. Invest.| year=2008| doi=10.1172/JCI35454 |url=http://www.jci.org/articles/view/35454}}</ref> Patients with the measles should be placed on ''droplet precautions.'' Humans are the only known natural hosts of measles, although the virus can infect some non-human primate species. ==Complications== Complications with measles are relatively common, ranging from relatively mild and less serious [[diarrhea]], to [[pneumonia]] and [[encephalitis]] ([[subacute sclerosing panencephalitis]]), [[corneal ulcer]]ation leading to [[Corneal abrasion|corneal scarring]]<ref>http://www.iceh.org.uk/files/tsno4/resources/no04.doc</ref> Complications are usually more severe amongst adults who catch the virus. The [[fatality rate]] from measles for otherwise healthy people in developed countries is low: approximately 1 death per thousand cases. In [[underdeveloped nation]]s with high rates of [[malnutrition]] and poor [[healthcare]], fatality rates of 10 percent are common. In [[immunocompromised]] patients, the fatality rate is approximately 30 percent. ==Public health== [[Image:Polkadotpuss3.jpg|thumb|250px|right|A scene from the [[1949]] [[Tom and Jerry]] cartoon ''[[Polka-Dot Puss]]'', where Tom and Jerry are put in [[quarantine]] after getting the measles. The disease was common during the time when the cartoon was made.]] Measles is a significant infectious disease because, while the rate of complications is not high, the disease itself is so infectious that the sheer number of people who would suffer complications in an outbreak amongst non-immune people would quickly overwhelm available hospital resources. If vaccination rates fall, the number of non-immune persons in the community rises, and the risk of an outbreak of measles consequently rises. In developed countries, most children are immunized against measles by the age of 18 months, generally as part of a three-part [[MMR vaccine]] (measles, [[mumps]], and [[rubella]]). The vaccination is generally not given earlier than this because children younger than 18 months usually retain anti-measles [[immunoglobulins]] (antibodies) transmitted from the mother during pregnancy. A "booster" vaccine is then given between the ages of four and five. Vaccination rates have been high enough to make measles relatively uncommon. Even a single case in a college dormitory or similar setting is often met with a local vaccination program, in case any of the people exposed are not already immune. In developing countries, measles remains common. Unvaccinated populations are at risk for the disease. After vaccination rates dropped in northern [[Nigeria]] in the early 2000s due to religious and political objections, the number of cases rose significantly, and hundreds of children died.<ref>{{cite news |title= Measles kills more than 500 children so far in 2005 |publisher=IRIN |date=[[2005-03-21]] |url=http://www.irinnews.org/Report.aspx?ReportId=53506 |accessdate=2007-08-13}}</ref> A 2005 measles outbreak in [[Indiana]] was attributed to children whose parents refused vaccination.<ref>{{cite journal |author=Parker A, Staggs W, Dayan G ''et al.'' |title= Implications of a 2005 measles outbreak in Indiana for sustained elimination of measles in the United States |journal= N Engl J Med |volume=355 |issue=5 |pages=447–55 |year=2006 |pmid=16885548 | doi = 10.1056/NEJMoa060775}}</ref> In the early 2000s the [[MMR vaccine controversy]] in the [[United Kingdom]] regarding a potential link between the combined MMR vaccine (vaccinating children from mumps, measles and rubella) and [[autism]] prompted a comeback in the measles party, where parents deliberately infect the child with measles to build up the child's immunity without an injection. This practice poses many health risks to the child, and has been discouraged by the public health authorities.<ref>{{cite news |author= Dillner L |title= The return of the measles party |work= Guardian |date=[[2001-07-26]] |accessdate=2007-08-13|url=http://lifeandhealth.guardian.co.uk/health/story/0,,1610704,00.html}}</ref> [[Evidence-based medicine|Scientific evidence]] provides no support for the hypothesis that MMR plays a role in causing autism.<ref>{{cite journal |author= [[Michael Rutter|Rutter M]] |title= Incidence of autism spectrum disorders: changes over time and their meaning |journal= Acta Paediatr |volume=94 |issue=1 |date=2005 |pages=2–15 |pmid=15858952 |doi= 10.1080/08035250410023124}}</ref> However, the MMR scare in Britain caused uptake of the vaccine to plunge, and measles cases came back: 2007 saw 971 cases in England and Wales, the biggest rise in occurrence in measles cases since records began in 1995.<ref>{{cite journal |journal= Health Serv J |date=2008-04-17 |pages=22–4 |title= Disease: a warning from history |author= Torjesen I |pmid=18533314 |url=http://www.hsj.co.uk/insideknowledge/features/2008/03/ingrid_torjesen_on_the_diseases_we_thought_had_gone_away.html}}</ref> According to the [[World Health Organization]] (WHO), measles is a leading cause of vaccine preventable childhood mortality. Worldwide, the fatality rate has been significantly reduced by partners in the [[Measles Initiative]]: the [[American Red Cross]], the United States Centers for Disease Control and Prevention (CDC), the United Nations Foundation, UNICEF and the World Health Organization (WHO). Globally, measles deaths are down 60 percent, from an estimated 873,000 deaths in 1999 to 345,000 in 2005. Africa has seen the most success, with annual measles deaths falling by 75 percent in just 5 years, from an estimated 506,000 to 126,000.<ref name="UNICEF" /> The joint press release by members of the [[Measles Initiative]] brings to light another benefit of the fight against measles: "Measles vaccination campaigns are contributing to the reduction of child deaths from other causes. They have become a channel for the delivery of other life-saving interventions, such as bed nets to protect against malaria, de-worming medicine and vitamin A supplements. Combining measles immunization with other health interventions is a contribution to the achievement of Millennium Development Goal Number 4: a two-thirds reduction in child deaths between 1990 and 2015."<ref name="UNICEF">[http://www.unicef.org/media/media_38076.html UNICEF Joint Press Release]</ref> ==Recent Outbreaks== In 2007, a large measles outbreak in [[Japan]] caused a number of universities and other institutions to close in an attempt to contain the disease.<ref>{{cite web |url=http://www.phac-aspc.gc.ca/tmp-pmv/2007/measjap070601_e.html|title=The Public Health Agency of Canada Travel Advisory |accessdate=2008-05-02|format= |work=}}</ref><ref>{{cite news |first=Justin |last=Norrie |authorlink= |coauthors= |title=Japanese measles epidemic brings campuses to standstill |url=http://www.smh.com.au/news/world/japanese-measles-epidemic-brings-campuses-to-standstill/2007/05/27/1180205052602.html |work= |publisher=The Sydney Morning Herald |date=May 27, 2007 |accessdate=2008-07-10 }} </ref> Approximately 1000 cases of the disease were reported in [[Israel]] between August 2007 and May 2008 (in sharp contrast to just some dozen cases the year before).{{Fact|date=July 2008}} Many children in ultra-Orthodox Jewish communities were affected due to low vaccination coverage.<ref>{{cite journal |last=Stein-Zamir |first=C. |coauthors=G. Zentner, N. Abramson, H. Shoob, Y. Aboudy, L. Shulman and E. Mendelson |year=2008 |month=February |title=Measles outbreaks affecting children in Jewish ultra-orthodox communities in Jerusalem. |journal=Epidemiology and Infection |volume=136 |issue=2 |pages=207-214 |pmid=17433131 |doi=10.1017/S095026880700845X |url= |accessdate= |quote= }}</ref><ref>{{cite news |first=Tamar |last=Rotem |coauthors= |title=Current measles outbreak hit ultra-Orthodox the hardest |url=http://www.haaretz.com/hasen/spages/921836.html |work= |publisher=Haaretz |date=August 11, 2007 |accessdate=2008-07-10 }}</ref> ===United States=== Indigenous measles were declared to have been eliminated in North, Central, and South America; the last endemic case in the region was reported on November 12, 2002. <ref name="title">{{cite web |url=http://www.paho.org/english/ad/fch/im/Measles.htm |title=paho.org |accessdate=2007-12-05 |format= |work=}}</ref> Outbreaks are still occurring, however, following importations of measles viruses from other [[World Health Organization #Regional Offices|world regions]]. In June 2006, an outbreak in [[Boston]] resulted after a resident became infected in [[India]],<ref name="titleMeasles outbreak shows a global threat - The Boston Globe">{{cite web |url=http://www.boston.com/yourlife/health/diseases/articles/2006/06/10/measles_outbreak_shows_a_global_threat/ |title=Measles outbreak shows a global threat - The Boston Globe |accessdate=2007-12-05 |format= |work=}}</ref> and in October 2007, a [[Michigan]] girl who had been vaccinated contracted the disease overseas.<ref>{{cite news |first=David |last=Jesse |authorlink= |coauthors= |title=Measles outbreak may have spread |url=http://blog.mlive.com/study_hall/2007/10/measles_outbreak_may_have_spre.html |work= |publisher=The Ann Arbor News |date=October 4, 2007 |accessdate=2008-07-10 }}</ref> Between January 1 and April 25, 2008, a total of 64 confirmed measles cases were preliminarily reported in the United States to the Centers for Disease Control and Prevention,<ref>{{cite web |url=http://www.cdc.gov/mmwr/preview/mmwrhtml/mm57e501a1.htm?s_cid=mm57e501a1_e |title=cdc.gov |accessdate=2008-05-02 |format= |work=}}</ref><ref>[http://www.jsonline.com/story/index.aspx?id=738120 JS Online: Measles outbreak brewing, city health officials say<!-- Bot generated title -->]</ref> the most reported by this date for any year since 2001. Of the 64 cases, 54 were associated with importation of measles from other countries into the United States, and 63 of the 64 patients were unvaccinated or had unknown or undocumented vaccination status.<ref>{{cite web |url=http://www.cdc.gov/Features/MeaslesUpdate/ |title=cdc.gov MeaslesUpdate |accessdate=2008-05-02 |format= |work=}}</ref> By July 9, 2008, a total of 127 cases were reported in 15 states (including 22 in [[Arizona]]<ref>{{cite news |first=Arthur |last=Rotstein |authorlink= |coauthors= |title=Response curtailed measles outbreak |url=http://www.tucsoncitizen.com/daily/local/90471.php |work= |publisher=The Associated Press |date=July 9, 2008 |accessdate=2008-07-10 }}</ref>), making it the largest US outbreak since 1997 (when 138 cases were reported).<ref>{{cite news |first=Will |last=Dunham |authorlink= |editors=Julie Steenhuysen and Peter Cooney |title=Measles outbreak hits 127 people in 15 states |url=http://www.reuters.com/article/newsOne/idUSN0943743120080709 |work= |publisher=Reuters |date=July 9, 2008 |accessdate=2008-07-10 }}</ref> Most of the cases were acquired outside of the United States and afflicted individuals who had not been vaccinated. ==See also== *[[Infectious disease]] *[[List of epidemics]] *[[MMR vaccine]] *[[Rubella|Rubella (German measles)]] *[[Roseola|Roseola ("baby measles")]] ==References== {{reflist|2}} ==External links== {{commonscat|Measles}} *[http://www.who.int/vaccine_research/diseases/measles/en/ WHO.int] - 'Initiative for Vaccine Research (IVR): Measles', [[World Health Organization]] (WHO) *[http://www.cdc.gov/nip/diseases/measles/faqs.htm Measles FAQ] from [[Centers for Disease Control and Prevention]] in the United States *[http://news.bbc.co.uk/1/hi/health/7385020.stm Case of an adult male with measles (facial photo)] {{Viral diseases}} {{Exanthema}} [[Category:Dutch loanwords]] [[Category:Viral diseases]] [[Category:Mononegavirales]] [[Category:Pediatrics]] {{link FA|te}} {{Link FA|de}} [[af:Masels]] [[ar:حصبة]] [[gn:Sarapĩu]] [[ay:Piyampiya usu]] [[ca:Xarampió]] [[cs:Spalničky]] [[da:Mæslinger]] [[de:Masern]] [[et:Leetrid]] [[es:Sarampión]] [[eo:Morbilo]] [[fa:سرخک]] [[fr:Rougeole]] [[gl:Sarampelo]] [[ko:홍역]] [[id:Demam Campak]] [[it:Morbillo]] [[he:חצבת]] [[ku:Sorik (nexweşî)]] [[la:Morbillus]] [[lb:Riedelen]] [[hu:Kanyaró]] [[nl:Mazelen]] [[ja:麻疹]] [[no:Meslinger]] [[pl:Odra (choroba)]] [[pt:Sarampo]] [[ro:Rujeolă]] [[ru:Корь]] [[sk:Ružienka]] [[sl:Ošpice]] [[fi:Tuhkarokko]] [[sv:Mässling]] [[te:తట్టు]] [[th:โรคหัด]] [[vi:Sởi]] [[uk:Кір]] [[zh:痲疹]]