Understanding Measles in Children: a simple guide

Introduction:

Measles, a highly infectious viral illness, can be particularly severe in children under one year of age. The aim of this article is to provide essential guidelines for parents and caregivers to understand, identify, and manage measles in children, particularly in the recent outbreak of measles in the UK

Let’s start with the basics…….

What causes Measles?

Measles is a very contagious illness causes by  the measles virus, which is a part of the paramyxovirus family (RNA viruses that cause respiratory illnesses). 

It’s spread through droplets one breathes out, like when someone sneezes (snot!). In fact, it’s so infectious that just spending 15 minutes with someone who has measles is enough to catch it and one person with measles can pass it on to 15-20 others!

The incubation period (the period during which the virus is multiplying within the body, but the individual does not yet show signs of being sick) is between 7-21 days, and the infective period (when it can be passed from one person to another) is from 4 days before the rash develops, to 4 days after. The tricky part is that during those 4 days before the rash, when a person may not even know they have the infection, it can still be spread. 

There is such panic around measles these days. How to know if your child has measles?

Do not worry, I am here to help you with simple understanding of the symptoms. The early signs of measles include cold-like symptoms, such as a runny or blocked nose, sneezing, and a troublesome cough. Your child will likely have a high fever. 

Additionally, sore, red eyes that may be sensitive to light, and small greyish-white spots in the mouth are key indicators. 

Now, let’s talk about these spots I have just alluded to. Known in the medical world as Koplik spots, these are difficult to see and are only present transiently (usually 2 or 3 days prior to the rash), so are not always helpful. However, when they are present, these small, red spots, with bluish-white centres, seen on the inside of the cheek, are typical for measles. 

A few days later, a red-brown blotchy rash appears, typically starting on the head or upper neck and spreading downwards.

How to differentiate the Measles rash from other viral illnesses?

The measles rash resembles many other rashes caused by viruses – it's red, can be pressed and turn white (blanching), and consists of both raised and flat spots. 

What makes it truly unique, though, is that it typically starts behind the ears, on the neck, or on the face, and then spreads downward. In contrast, some other rashes, like Roseola, often begin on the trunk and spread outward. The measles rash persists for about 5 or 6 days before gradually fading, and its colour may change to brownish during this time.

It's important to note that most children with measles appear unhappy. They are unlikely to be the cheerful, playful child at the colouring table and are more likely to be the distressed, clingy child with a rash, red and watery eyes, and a bothersome cough.

Who could be at risk of having measles?

In short, we should consider that anyone might have measles, though certain individuals are more likely to be susceptible to the virus. Factors influencing risk include:

1. Unvaccinated individuals: People who have not received the measles vaccine.

2. Partially vaccinated individuals: Those who have not completed the full MMR (Measles, Mumps, and Rubella) vaccine course.

3. Contact with a confirmed or highly likely case: Individuals who may have been notified by organizations like UKHSA (United Kingdom Health Security Agency) that they have been in contact with someone known to have measles.

4. Members of under-vaccinated communities: For example, individuals in refugee communities or traveller communities where vaccination rates may be lower.

5. Travel to areas with measles circulation: This can include both domestic and international travel to regions where measles is prevalent.

6. Attendance at mass gathering events: Being in crowded settings, especially where people come together in large numbers, may pose an increased risk.

When to Seek Medical Advice:

I advise seeking immediate medical attention if you suspect your child has measles. It's crucial to call the healthcare provider beforehand to inform them of your concerns about measles, as special arrangements may be needed to prevent the spread of the virus to others.

How to diagnose measles:

To determine if someone has measles, the diagnostic process typically involves obtaining oral swabs, oral fluid, blood samples, or a combination of these. Practices may change based on local rates, so it's important to refer to local pathways as advised by the local health practitioners. 

The diagnostic approach may also differ if the patient has been in contact with a vulnerable individual, potentially requiring accelerated prophylaxis (treatment to prevent infection). Inquiring about contacts involves checking if the person spent more than 15 minutes near an infected person, and seeking advice from experts when necessary.

Vaccination and Prevention:

The most effective way to prevent measles is through the MMR vaccine (measles, mumps, and rubella), as per NICE guidelines. This vaccine is routinely given to children in the UK and is highly effective. NICE recommends ensuring that your child receives the vaccine on schedule.

A complete course of MMR includes 2 doses of vaccines – the first is usually given at 12 months old, before they start school, usually around 3 years and 4 months of age. Again, these ages are approximate, and actual scheduling may vary.

For the most accurate and current information, please refer to the latest guidelines provided by the NHS or consult with a healthcare provider. One dose is reported to confer 95% protection.

Treatment and Care at Home:

There's no specific treatment for measles, but you can help alleviate symptoms. However the good news is that like most viral illnesses, Measles is self-limiting!

NICE suggests giving your child plenty of fluids, ensuring they rest, and using fever-reducing medications, paracetamol or ibuprofen, for symptomatic relief if needed. 

If your child’s symptoms worsen or if they develop complications like breathing difficulties, hearing difficulties or ear discharge, or a severe headache, or becomes very unwell, seek further medical attention promptly.

Managing Complications:

Unfortunately, in a small proportion of cases, measles can lead to complications, especially in children under 5 and those with weakened immune systems.

It is important to emphasise the importance of monitoring for signs of complications, such as ear infections, diarrhoea, croup, pneumonia, and encephalitis. Immediate medical care is essential if complications arise. These complications encompass conditions like otitis media (which can result in hearing loss), extensive diarrhoea (posing the risk of dehydration), pneumonia, encephalitis (which may lead to seizures), and subacute sclerosing panencephalitis (SSPE – an extremely rare, slowly progressing, and fatal disease affecting the brain).

Some patients with secondary bacterial infections like pneumonia may need antibiotics which your health practitioner can advise on.

Individuals most vulnerable to severe measles or associated complications include those with compromised immune systems, such as those undergoing chemotherapy or long-term steroid treatment, young children who haven't been vaccinated, children with complex health conditions or comorbidities that elevate their risk, and pregnant individuals.

Preventing Spread in Communities:

It is important to know how to prevent the spread of measles. Infected individuals should stay away from school, nursery, or work until at least four days have passed since the onset of the rash, which signifies the end of the infectious period. Good hygiene practices, like regular hand washing and using tissues when sneezing, are vital.

Remember, measles is a notifiable illness:

This means that your healthcare provider has a duty to report suspected cases to the UK Health Security Agency (UKHSA), previously known as the Public Health Agency. 

What to expect after notification?

This initiates contact tracing procedures. The specifics of these processes may differ based on your location within the country. Your health practitioner may not want to delay diagnosis pending lab confirmation, although the lab will notify on their own if the test turns out positive. Identifying cases early increases the chances of preventing additional infections. There's no need to be concerned about making mistakes – prioritizing caution is preferable.

Conclusion:

Measles can be a serious illness in children, but understanding and adhering to the advice given here can help manage the disease effectively. Recognizing symptoms, ensuring vaccination, and understanding when to seek medical help are crucial steps in dealing with measles. Through awareness and proper care, we can protect children and communities from the impact of this infectious illness.

Finally measles in adults:

I would be failing in my duty if I didn’t advice about vaccination of parents or care giving adults who are not vaccinated. 

Remember, it is never too late to receive vaccination against measles!!

References:

1. Clinical Knowledge Summaries. Measles. National Institute for Health and Care Excellence (NICE); Available from: https://cks.nice.org.uk/topics/measles/

2. RCEMLearning. Measles. Royal College of Emergency Medicine; Available from: https://www.rcemlearning.co.uk/foamed/measles/

(article written on 24th Jan 2024)