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Disease Categories > Infectious Disease > Viruses

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Measles - Rubeola

Measles is a highly contagious disease caused by the measles virus.

Epidemiology

Prevalence – minimal number of cases yearly in U.S. due to the high rate of vaccination
- >750,000 deaths worldwide
Transmission
- Via droplets
- Highly contagious; >90% transmission among non-immune individuals

Organism

A single-stranded RNA virus and the only member of genus Morbillivirus (Paramyxoviridae family)
Humans are the only natural reservoirs

Clinical Presentation

Diagnosis based on clinical exam may be difficult
Highly contagious, acute, exanthematous respiratory disease with pathognomonic Koplik spots on the buccal mucosa
- Rash starts centrally and spreads to the periphery
In atypical measles, rash begins peripherally and moves centrally
- Atypical measles has occurred in patients who received killed vaccines and later came in contact with wild virus strain
Complications
- Pulmonary – primary giant cell pneumonia (Hecht pneumonia)
- Neurological – coma, seizures, encephalitis (subacute sclerosing panencephalitis [SSPE] is a rare, progressive encephalitis which may result in dementia and death caused by measles
- Gastrointestinal – disease mimicking appendicitis
- Cardiovascular – myocarditis, pericarditis
- Occular – corneal ulceration and scaring
- Pregnancy – increased incidence of pneumonia, spontaneous abortion, premature delivery and low birth weight babies

Diagnosis

Indications for testing
- Suspicious rash and clinical syndrome
- Known exposure to measles in an unvaccinated person
- Confirmation of immunity to measles after vaccination

Laboratory testing
- Serum testing for antibodies
  - Confirm acute infection with measles using IgM and IgG serial testing
  - Confirm seroconversion after vaccination using IgG testing
  - IgM, IgG CSF testing to identify SSPE (which may occur years after original infection using IgG testing)

Differential Diagnosis

Treatment

Prevention

Prevention includes MMR vaccine administered to 12-15 month old children, with revaccination between 4-12 years of age
- High fever and pulmonary infiltrates can occur in patients vaccinated with Measles, Mumps and Rubella (MMR) 1964-67 and exposed to measles
  - Symptoms believed to be hypersensitivity reactions to the vaccine
- Mass U.S. immunization has greatly reduced measles infections
  - However, some individuals may be susceptible to measles due to vaccine failure or non-immunization
Since vaccine is live attenuated virus, do not use in pregnant patients or those with significant immunosuppression

Test Name and Number	Recommended Use	Limitations	Follow Up
Measles (Rubeola) Antibodies, IgG & IgM 0050375 Method: Enzyme-Linked Immunosorbent Assay	Diagnose measles	Low IgM antibody levels occasionally persist >12 months post-infection or immunization	Residual IgM response may be distinguished from early IgM response by testing patient sera 2-3 weeks later for changes in specific IgM antibody levels
Measles (Rubeola) Virus Culture 0065055 Method: Cell Culture/Immunofluorescence	Gold standard test for nasopharyngeal aspirate/washing, throat swab, lung tissue, CSF or urine samples
Measles (Rubeola) Antibody, IgG 0050380 Method: Enzyme-Linked Immunosorbent Assay	Screen for vaccination
Measles (Rubeola) Antibody, IgM, CSF 0054441 Method: Enzyme-Linked Immunosorbent Assay	Diagnose rare but fatal subacute sclerosing panencephalitis (SSPE) in CSF samples	Rubeola CSF antibody detection may indicate central nervous system infection; however, consider possible contamination by blood or transfer of serum antibodies across blood-brain barrier
Measles (Rubeola) Antibody, IgG, CSF 0054440 Method: Enzyme-Linked Immunosorbent Assay	Diagnose rare but fatal subacute sclerosing panencephalitis (SSPE) in CSF samples	Rubeola CSF antibody detection may indicate central nervous system infection However, consider possible contamination by blood or transfer of serum antibodies across blood-brain barrier

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