measles(redirected from and rubella (MMR) vaccine)
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rubeola(ro͞obē`ələ), highly contagious disease of young children, caused by a filterable virus and spread by droplet spray from the nose, mouth, and throat of individuals in the infective stage. This period begins 2 to 4 days before the appearance of the rash and lasts from 2 to 5 days thereafter. The first symptoms of measles, after an incubation period of 7 to 14 days, are fever, nasal discharge, and redness of the eyes. Characteristic white spots appear in the mouth, followed by a rash on the face that spreads to the rest of the body. The symptoms disappear in 4 to 7 days.
One attack of measles confers lifelong immunity. However, it renders the patient susceptible to other more serious infections such as bronchial pneumonia and encephalitis. The measles virus has also been associated with subacute sclerosing panencephalitis (SSPE), which causes chronic brain disease in children and adolescents. After the attack of measles, it can cause intellectual deterioration, convulsive seizures, and motor abnormalities and is usually fatal. Common measles in pregnant women can be a threat to the unborn child, and vaccination of women well before pregnancy is recommended (see also rubellarubella
or German measles,
acute infectious disease of children and young adults. It is caused by a filterable virus that is spread by droplet spray from the respiratory tract of an infected individual.
..... Click the link for more information. , or German measles).
Immunization by injection of live measles-virus vaccine, first marketed in 1963, has proven effective. Given at first with gamma globulin, the vaccine was further developed by 1965 so that one shot alone gives long-term, probably lifetime, immunity; a nationwide program was established in the United States for the vaccination of all children over the age of nine months. Measles has been eliminated in the Americas, but epidemics still occur in regions where vaccination rates are low and health care is poor, and outbreaks can occur in the Americas when infected persons travel there from other regions.
An acute, highly infectious viral disease with cough, fever, and maculopapular rash. It is of worldwide endemicity.
The virus enters the body via the respiratory system, multiplies there, and circulates in the blood. Cough, sneezing, conjunctivitis, photophobia, and fever occur, with Koplik's spots (small red spots containing a bluish-white speck in the center) in the mouth.
A rash appears after 14 days' incubation and persists 5–10 days. Serious complications may occur in 1 out of 15 persons; these are mostly respiratory (bronchitis, pneumonia), but neurological complications are also found. Encephalomyelitis occurs rarely. Permanent disabilities may ensue for a significant number of persons. Measles is one of the leading causes of death among children in the world, particularly in the developing countries.
In unvaccinated populations, immunizing infections occur in early childhood during epidemics which recur after 2–3 years' accumulation of susceptible children. Transmission is by coughing or sneezing. Measles is infectious from the onset of symptoms until a few days after the rash has appeared. Second attacks of measles are very rare. Treatment is symptomatic.
Killed virus vaccine should not be used, as certain vaccinees become sensitized and develop local reactions when revaccinated with live attenuated virus, or develop a severe illness upon contracting natural measles. Live attenuated virus vaccine effectively prevents measles; vaccine-induced antibodies persist for years. See Biologicals, Hypersensitivity, Skin test
an acute infectious disease accompanied by elevated temperature, intoxication, catarrh of the mucous membranes of the upper respiratory tract and the eyes, and a maculopapular rash. The most common infectious disease in the world, measles occurs in every country. Persons of any age may contract the disease, but most patients are children age one to four years. Measles rarely strikes infants less than six months old, and, as a rule, infants up to three months old never contract the disease.
The causative agent is a virus that is very unstable in the external environment. It perishes quickly under the action of sunlight and ultraviolet rays. An infected individual is the only source of the infection, which is spread by air droplets. When a patient coughs or sneezes, the virus is discharged into the environment in droplets of mucus from the upper respiratory tract. The danger of contagion is greatest during the initial period and the first days after the rash appears, but after the fourth day after the eruption of the rash the patient is considered noninfectious.
The disease usually goes through four stages. The incubation period (that is, the period from the moment of infection to the appearance of the first symptoms) lasts for an average of eight to ten days (maximum, 17 days). In children who have been given gamma globulin as a preventive measure, the incubation period is longer (up to 21 or sometimes even 28 days). The onset of the disease is acute. The body temperature rises, the patient develops catarrh, a dry, persistent cough, and photophobia, the eyelids redden, and there is a purulent discharge from the eyes. The child becomes languid and capricious and eats and sleeps poorly.
The initial (prodromal or catarrhal) period lasts for three to four days (sometimes five to seven). Typically, changes occur in the mucous membranes of the mouth—specifically, grayish white dots the size of poppy seeds, surrounded by red areolae, appear on the mucous membranes of the lips. This is the BePskiil’ilatov-Koplik symptom, which is named after the Russian scientists A. P. Bel’skii (1890) and N. F. Filatov (1895) and the Czech physician H. Koplik (1896), who described it independently of each other. Because it does not appear with any other disease, the Bel’skii-Filatov-Koplik symptom is the absolute sign of a case of measles, and it makes it possible to diagnose the disease two to three days before the rash appears.
The rash period is characterized by a new, higher elevation of body temperature and by the appearance of a pinkish maculopapular rash on the skin, whose color remains unchanged. The first elements of the rash appear behind the ears and on the ridge of the nose in the form of small pink spots, which increase very rapidly in number and size. By the end of the first day the rash covers the entire face and neck, and a few isolated spots appear on the chest and upper back. On the second day the rash covers the entire torso and on the third, the extremities.
Unless complications develop, the recovery period begins on the third or fourth day after the appearance of the rash. The temperature becomes normal, the child’s condition improves, and the catarrhal symptoms gradually disappear. The rash darkens, turning reddish brown and then cinnamon brown (that is, it becomes pigmented). Fine scaling of the skin also occurs.
The most frequent complications of measles are laryngitis, laryngotracheobronchitis, pneumonia, and inflammation of the middle ear. Children who have been given gamma globulin may contract a milder form of measles.
The disease is usually treated at home. Only children with severe cases or complications or those who cannot receive appropriate care at home are hospitalized. The patient’s room must be kept clean and should be aired out regularly. It should not be kept dark. During the entire fever period and for the first two to three days after the temperature goes down, the patient must stay in bed. Hygienic baths may be given regularly during any period of the disease. The eyes should be washed several times a day with warm boiled water or a 2 percent soda solution. During the fever period a dairy and vegetarian diet is prescribed for children. When the temperature returns to normal, a complete diet supplemented with vitamins is prescribed, depending on the patient’s age. Medicines and antibiotics are given only if a physician prescribes them. Children age three months to four years who have not had measles and have not been vaccinated against it but who have been exposed to a patient are usually given an intramuscular injection of gamma globulin, whose effects last for three to four weeks. The most effective method of preventing measles is immunization with a vaccine that contains live, attenuated measles virus. Children age ten months to eight years are vaccinated. Immunity lasts for several years after vaccination.
REFERENCESVolynskaia, V. A., and M. A. Dadash’ian. Kor’. Moscow, 1957.
Dobrokhotova, A. I. Kor’ i bor’ba s nei. Moscow, 1959.
Problema likvidatsii kori. [A collection of articles.] Leningrad, 1968.
Libov, A. L. Sovremennoe sostoianie problemy kori. Moscow, 1969
N. I. NISEVICH