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Rubeola

Also known as measles or morbilli, rubeola is an acute, highly contagious paramyxovirus infection. It is one of the most common and the most serious of all communicable childhood diseases.

In temperate zones, incidence is highest in late winter and early spring. Before the availability of measles vaccine, epidemics occurred every 2 to 5 years in large urban areas. Use of the vaccine has reduced the occurrence of measles during childhood; as a result, measles is becoming more prevalent in adolescents and adults.

In the United States, the prognosis is usually excellent. However, measles is a major cause of death in children in underdeveloped countries.

Causes

Signs and symptoms

It may take between eight to 12 days for a child to develop symptoms of rubeola after being exposed to the disease. It is important to know that a child is contagious one to two days before the onset of signs and symptoms and three to five days after the rash develops. Therefore, children may be contagious before they even know they have the disease.

During the early phase of the disease (which lasts between one to four days), symptoms usually resemble those of an upper respiratory infection. The following are the common symptoms of rubeola. However, each child may experience symptoms differently. Symptoms may include:

• hacking cough
• redness and irritation of the eyes
• fever
• small red spots with white centers appear on the inside of the cheek (usually occur two days before the rash on the skin appears)
• rash - deep, red, flat rash that starts on the face and spreads down to the trunk, arms, and legs. The rash starts as small distinct lesions, which then combines as one big rash. After three to four days, the rash will begin to clear leaving a brownish discoloration and skin peeling.

The most serious complications from rubeola include the following:

• ear infections
• pneumonia
• croup
• inflammation of the brain

The symptoms of rubeola may resemble other skin conditions or medical problems. Always consult your child's physician for a diagnosis.

Diagnosis

Measles results in distinctive clinical features, especially the pathognomonic Koplik's spots. Mild measles may resemble rubella, roseola infantum, enterovirus infection, toxoplasmosis, and drug eruptions; laboratory tests are required for a differential diagnosis.

If necessary, measles virus may be isolated from the blood, nasopharyngeal secretions, and urine during the febrile period. Serum antibodies appear within 3 days after onset of the rash and reach peak titers 2 to 4 weeks later.

Complications

Severe infection may lead to secondary bacterial infection and to autoimmune reaction or organ invasion by the virus, resulting in otitis media, pneumonia, and encephalitis. Subacute sclerosing panencephalitis (SSPE), a rare and invariably fatal complication, may develop several years after measles. SSPE is less common in patients who have received the measles vaccine.

Treatment

Prevention

Since the use of the rubeola (or measles) vaccine, the incidence of measles has decreased by 99 percent. About 5 percent of measles are due to vaccine failure. The measles vaccine is usually given in combination with the mumps and rubella vaccine. It is called the MMR. It is usually given when the child is 12 to 15 months old and then again between 4 to 6 years of age.Other ways to prevent the spread of rubeola:

• Children should not attend school or daycare for four days after the rash appears.
• Assure all of your child's contacts have been properly immunized.