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.

 
 

Etiology

  • Measles is caused by a morbillivirus of the paramyxovirus family

 

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Presentation

  • Spread by droplets

    • 15 minutes of face to face contact only required to transmit virus

  • Incubation

    • 7-20 days (usual 10-12 days)

  • Prodrome

    • lasts approx. 4 days

    • Includes:

    • onset of fever

    • malaise

    • coryza

    • Koplick spots (Small red spots with blue/white centre, likened to grains of sand) on red mucosa of the mouth

    • Conjunctivitis

    • Cough

  • Rash then appears

    • on face/ upper neck and spreads to reach hands and feet

    • fading after approximately 5-6 days

    • fever is often maximal at this stage 39-40C

 
 

Treatment

  • Conservative management with rest, oral fluids, analgesia and antipyretics as required

 

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Infection control

  • Stay away from immunocompromised, pregnant or unvaccinated individuals until 4 days after onset of rash

 

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Recovery

  • Rash resolves in approximately 1 week with complete resolution in 10 days

  • Stay away from work/ school, pregnant, unvaccinated and immunocompromised people until 4 days after the rash appears

 

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Complications

  • The most common complications of measles include

    • pneumonia

    • ear infection

    • diarrhoea/ dehydration

    • Convulsions/ encephalitis are rare but can be fatal

 
 
 
 
 

Differential diagnosis

  • Other causes of rash are more likely in people who have previously had measles or have been fully immunized

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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

Access

 

Measles (Rubeola)

Centres for Disease Control and Prevention

Access

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Measles

BMJ Best Practice

Last reviewed: February 2019

Last updated: August  2018

Access

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Measles: guidance, data and analysis

Public Health England

Published 31 July 2014
Last updated 9 January 2019

Access

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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

Access

 

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