eMedicine Specialties > Pediatrics: General Medicine > Infectious Disease

Measles: Follow-up

Author: Selina SP Chen, MD, MPH, Assistant Professor of Pediatrics, Department of Internal Medicine, John A Burns School of Medicine, University of Hawaii; Internal Medicine and Pediatric Hospitalist, Kapiolani Medical Center for Women and Children; Internal Medicine Hospitalist, Straub Clinic and Hospital
Coauthor(s): Glenn J Fennelly, MD, MPH, Director, Division of Pediatric Infectious Diseases, Jacobi Medical Center; Associate Professor, Department of Pediatrics, Albert Einstein College of Medicine
Contributor Information and Disclosures

Updated: Jun 10, 2009

Follow-up

Further Inpatient Care

  • Hospitalization may be indicated for treatment of measles complications (eg, bacterial superinfection, pneumonia, dehydration, croup).

Inpatient & Outpatient Medications

  • Perform timely contact tracing and institute prophylaxis or immunization, if indicated

Deterrence/Prevention

  • The Measles Initiative is a collaborative effort of the WHO, the United Nations Children's Fund (UNICEF), the American Red Cross, the CDC, and the United Nations Foundation, along with other public and private partners.
  • The WHO and UNICEF are collaborating to reduce global measles death by 90% by the year 2010. The goals of the program include the following:
    • Routine immunization for children by their first birthday
    • A second opportunity for measles immunization through mass vaccination campaigns to ensure that all children receive at least one dose
    • Effective surveillance in all countries to quickly recognize and respond to measles outbreaks
    • Enhanced treatment of measles, including vitamin A supplements and supportive care and antibiotics if needed to prevents complications
  • Prevention requires vaccination with live-attenuated measles vaccine (per routine) or earlier immunization (ie, no <6 mo) during epidemics.
  • Human immunoglobulin (Ig) prevents or modifies disease in susceptible contacts if administered within 6 days of exposure.

Complications

  • Common infectious complications include otitis media, interstitial pneumonitis, bronchopneumonia, laryngotracheobronchitis (ie, croup), exacerbation of tuberculosis, transient loss of hypersensitivity reaction to tuberculin skin test, encephalomyelitis, and diarrhea.
  • Rare complications include hemorrhagic measles, purpura fulminans, hepatitis, disseminated intravascular coagulation (DIC), and subacute sclerosing panencephalitis (SSPE). Transient hepatitis may occur during an acute infection. Approximately 1 of every 1,000 patients develops acute encephalitis, which often results in permanent brain damage. SSPE, a degenerative CNS disease, can result from a persistent measles infection. SSPE is characterized by the onset of behavioral and intellectual deterioration and seizures years after an acute infection (the mean incubation period for SSPE is approximately 10.8 y).

Prognosis

  • Most children recover uneventfully. High case-fatality rates may be observed among children who are malnourished or immunodeficient, particularly in developing nations. Overall, case-fatality rate in the United States has been less than 0.1%.

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • Failure to diagnose measles or its complications

Special Concerns

  • Because the transmission of indigenous measles has been interrupted in the United States and all recent US epidemics have been linked to imported cases, immediately reporting any suspected case of measles to a local or state health department is imperative, as is obtaining serum for IgM antibody testing as soon as possible (ie, on or after the third day of rash).
  • Airborne precautions are indicated for hospitalized children during the period of communicability (ie, 3-5 d before appearance of rash to 4 d after the rash develops in healthy children and for the duration of illness in patients who are immunocompromised). Susceptible health care workers should be excused from work from the fifth to the 21st day after exposure.
  • A syndrome called atypical measles has been described in individuals who were infected with wild measles virus (MV) several years after immunization with a killed measles vaccine (a vaccine used in the United States from 1963-1967). The disease tends to be more prolonged and severe than regular measles and is marked by a prolonged high fever, pneumonitis, and a rash that begins peripherally and may be urticarial, maculopapular, hemorrhagic, and/or vesicular. The assumed pathogenesis is hypersensitivity to MV in a partially immune host. Laboratory tests reveal a very low measles antibody titer early in the course of the disease, followed soon thereafter by the appearance of an extremely high measles IgG antibody titer (eg, 1:1,000,000) in the serum.
 


More on Measles

Overview: Measles
Differential Diagnoses & Workup: Measles
Treatment & Medication: Measles
Follow-up: Measles
Multimedia: Measles
References
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References

  1. [Guideline] Centers for Disease Control and Prevention. Recommended immunization schedules for persons aged 0 through 18 years---United States, 2009. CDC Recommended Vaccine Schedule. Dec 2008;57(51;52):[Full Text].

  2. Meissner HC, Strebel PM, Orenstein WA. Measles vaccines and the potential for worldwide eradication of measles. Pediatrics. 2004;114(4):1065-9. [Medline]. [Full Text].

  3. Smeeth L, Cook C, Fombonne E, et al. MMR vaccination and pervasive developmental disorders: a case-control study. Lancet. 2004;11-17;364(9438):963-9. [Medline].

  4. Centers for Disease Control and Prevention. Program in brief: Measles Mortality Reduction and Regional Global Measles Elimination. Available at http://www.cdc.gov/ncird/progbriefs/downloads/global-measles-elim.pdf. Accessed April 14, 2009.

  5. Forni AL, Schluger NW, Roberts RB. Severe measles pneumonitis in adults: evaluation of clinical characteristics and therapy with intravenous. Clin Infect Dis Sep. 1994;19(3):454-62. [Medline].

  6. Garenne M. Sex differences in measles mortality: a world review. Int J Epidemiol. Jun 1994;23(3):632-42. [Medline].

  7. Helfand RF, Heath JL, Anderson LJ, et al. Diagnosis of measles with an IgM capture EIA: the optimal timing of specimen collection after rash onset. J Infect Dis. Jan 1997;175(1):195-9. [Medline].

  8. American Academy of Pediatrics. Measles. In: Pickering LK, ed. Red Book: Report of the Committee on Infectious Disease. Elk Grove, Ill: AAP; 2006:441-52.

  9. Hosoya M, Shigeta S, Mori S, et al. High-dose intravenous ribavirin therapy for subacute sclerosing panencephalitis. Antimicrob Agents Chemother. Mar 2001;45(3):943-5. [Medline].

  10. Centers for Disease Control and Prevention. CDC Guide to Vaccine Contraindicatons and Precautions. Available at http://www.cdc.gov/vaccines/recs/vac-admin/downloads/contraindications-guide-508.pdf. Accessed April 14, 2009.

  11. Centers for Disease Control and Prevention. Global measles control and regional elimination, 1998-1999. MMWR Morb Mortal Wkly Rep. Dec 17 1999;48(49):1124-30. [Medline].

  12. Centers for Disease Control and Prevention. Measles--United States, 1999. MMWR Morb Mortal Wkly Rep. Jun 30 2000;49(25):557-60. [Medline].

  13. Centers for Disease Control and Prevention. Progress toward global measles control and elimination, 1990-1996. MMWR Morb Mortal Wkly Rep. Sep 26 1997;46(38):893-7. [Medline].

  14. Centers for Disease Control and Prevention. Strategies for reducing global measles mortality. Wkly Epidemiol Rec. Dec 15 2000;75(50):411-6. [Medline].

  15. Gershon AA. Measles virus (rubeola). In: Mandell, Douglas and Bennett's Principles and Practice of Infectious Diseases. Philadelphia, Pa: Churchill Livingstone; 1995:1519-26.

  16. Griffin DE, Bellini WJ. Measles virus. In: Fields BN, Knipe DM, Howley PM, eds. Fields Virology. 3rd ed. Philadelphia, Pa: Lippincott; 1996.

  17. Griffin, DE. Billeter M, ed. Measles Virus. New York, NY: Springer-Verlag; 1995:117-34.

  18. Perry RT, Mmiro F, Ndugwa C, Semba RD. Measles infection in HIV-infected African infants. Ann N Y Acad Sci. Nov 2000;918:377-80. [Medline].

  19. Shah BR, Laude TA. Measles. In: Atlas of Pediatric Clincal Diagnosis. WB Saunders Co; 2000:59-61.

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Further Reading

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Keywords

measles, rubeola, Koplik spots, measles virus, MV, rubeola virus, coryza, conjunctivitis, pathognomonic enanthem, Koplik spots, otitis media, bronchopneumonia, acute encephalitis, subacute sclerosing panencephalitis, SSPE, autism, giant cell pneumonia, interstitial pneumonitis, laryngotracheobronchitis, croup, tuberculosis, encephalomyelitis, hemorrhagic measles, purpura fulminans, hepatitis, disseminated intravascular coagulation, DIC, transient hepatitis, generalized lymphadenopathy, mild hepatomegaly, appendicitis, treatment, diagnosis

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Contributor Information and Disclosures

Author

Selina SP Chen, MD, MPH, Assistant Professor of Pediatrics, Department of Internal Medicine, John A Burns School of Medicine, University of Hawaii; Internal Medicine and Pediatric Hospitalist, Kapiolani Medical Center for Women and Children; Internal Medicine Hospitalist, Straub Clinic and Hospital
Selina SP Chen, MD, MPH is a member of the following medical societies: American Academy of Pediatrics, American College of Physicians-American Society of Internal Medicine, and Society of Hospital Medicine
Disclosure: Nothing to disclose.

Coauthor(s)

Glenn J Fennelly, MD, MPH, Director, Division of Pediatric Infectious Diseases, Jacobi Medical Center; Associate Professor, Department of Pediatrics, Albert Einstein College of Medicine
Glenn J Fennelly, MD, MPH is a member of the following medical societies: Pediatric Infectious Diseases Society
Disclosure: Nothing to disclose.

Medical Editor

Leonard R Krilov, MD, Chief of Pediatric Infectious Diseases, Vice Chair, Department of Pediatrics, Professor of Pediatrics, Winthrop University Hospital
Leonard R Krilov, MD is a member of the following medical societies: American Academy of Pediatrics, American Pediatric Society, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, and Society for Pediatric Research
Disclosure: Medimmune Grant/research funds Cliinical trials; Medimmune Honoraria Speaking and teaching; Medimmune Consulting fee Consulting

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

Joseph Domachowske, MD, Professor of Pediatrics, Microbiology and Immunology, Department of Pediatrics, Division of Infectious Diseases, State University of New York-Upstate Medical University
Joseph Domachowske, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American Society for Microbiology, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, and Phi Beta Kappa
Disclosure: Nothing to disclose.

CME Editor

Robert W Tolan Jr, MD, Chief, Division of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital; Clinical Associate Professor of Pediatrics, Drexel University College of Medicine
Robert W Tolan Jr, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Phi Beta Kappa, and Physicians for Social Responsibility
Disclosure: GlaxoSmithKline Honoraria Speaking and teaching; MedImmune Honoraria Speaking and teaching; Merck Honoraria Speaking and teaching; sanofi pasteur Honoraria Speaking and teaching; Baxter Healthcare Honoraria Speaking and teaching

Chief Editor

Russell W Steele, MD, Head, Division of Pediatric Infectious Diseases, Ochsner Children's Health Center; Clinical Professor, Department of Pediatrics, Tulane University School of Medicine
Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, and Southern Medical Association
Disclosure: None None None

 
 
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