Clinical Notes : Paediatrics
64. Measles
Notifiable disease
Measles is included in the Irish HSE list of Notifiable Diseases, but does not appear on the HSE list of Notifiable Diseases for Immediate preliminary Notification to a Medical Officer of Health.
The Notification form to be submitted to HSE, includes Laboratory Results and details of the Reporting GP.
In the OOH setting, it is therefore best to refer the patient back to the GP for immediate follow-up and notification.
List of Notifiable Diseases and their respective pathogens
List of Notifiable Diseases for Immediate Notification
to a Medical Officer of Health
Etiology
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Measles is caused by a morbillivirus of the paramyxovirus family
Presentation
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Spread by droplets
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15 minutes of face to face contact only required to transmit virus
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Incubation
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7-20 days (usual 10-12 days)
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Prodrome
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lasts approx. 4 days
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Includes:
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onset of fever
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malaise
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coryza
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Koplick spots (Small red spots with blue/white centre, likened to grains of sand) on red mucosa of the mouth
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Conjunctivitis
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Cough
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Rash then appears
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on face/ upper neck and spreads to reach hands and feet
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fading after approximately 5-6 days
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fever is often maximal at this stage 39-40C
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Treatment
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Conservative management with rest, oral fluids, analgesia and antipyretics as required
Infection control
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Stay away from immunocompromised, pregnant or unvaccinated individuals until 4 days after onset of rash
Recovery
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Rash resolves in approximately 1 week with complete resolution in 10 days
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Stay away from work/ school, pregnant, unvaccinated and immunocompromised people until 4 days after the rash appears
Complications
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The most common complications of measles include
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pneumonia
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ear infection
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diarrhoea/ dehydration
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Convulsions/ encephalitis are rare but can be fatal
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Differential diagnosis
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Other causes of rash are more likely in people who have previously had measles or have been fully immunized
Maculopapular childhood rashes
Measles (Morbillivirus)
Rash : Starts on face
Fades after 5-6 days
Non-pruritic
3Cs : Cough Coryza Conjunctivitis. Koplik spots in mouth
Worst Complications : Secondary bacterial infection. Encephalitis.
Rubella (Rubivirus)
Rash : Starts on face
Pink
Pruritic
Non-specific syndrome
Worst Complications : congenital rubella syndrome (1st four months gestation)
Roseola (Human Herpes Virus 6)
Rash : Starts on neck
Pink
Non-pruritic
High fever, cough, erythematous pharynx, tonsils and TMs
Worst Complications : febrile seizures (mostly in <5yrs)
5th Disease/Erythema Infectiosum (Parvovirus B19)
Rash : Slapped cheeks
May appear on extensor surfaces
Usually non-pruritic
flu like illness 3 days prior to rash
Worst Complications :
Child - aplastic crisis (reticulocytopenis)
Fetus - fetal hydrops/fetal loss
Chicken Pox (Varicelloa Zoster)
Rash : Everywhere
Vescicles on macules
Very pruritic
1-3 day prodrome of fever and respiratory symptoms
Worst Complications : congenital varicella syndrome (1st or 2nd trimester)
Measles
Health Services Executive, ROI
Measles (Rubeola)
Centres for Disease Control and Prevention
Measles
BMJ Best Practice
Last reviewed: February 2019
Last updated: August 2018
Measles: guidance, data and analysis
Public Health England
Published 31 July 2014
Last updated 9 January 2019
Robinson CL, Bernstein H, Romerso JR, Szilagyi P.
Advisory Committee on Immunization Practices recommended immunization schedule for children and adolescents aged 18 years or younger - United States, 2019.
MMWR Morb Mortal Wkly Rep. 2019 Feb 8;68(5):112-4
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