Measles natural history, complications and prognosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Natural Historu
Measles spreads through the air by breathing, coughing or sneezing. It is so contagious that any child who is exposed to it and is not immune will probably get the disease. Measles is highly contagious and can be spread to others from four days before to four days after the rash appears. Measles is so contagious that if one person has it, 90% of the people close to that person who are not immune will also become infected with the measles virus.
The virus lives in the mucus in the nose and throat of the infected person. When that person sneezes or coughs, droplets spray into the air. The droplets can get into other people’s noses or throats when they breathe or put their fingers in their mouth or nose after touching an infected surface. The virus can live on infected surfaces for up to 2 hours and spreads so easily that people who are not immune will probably get it when they come close to someone who is infected. Measles is a disease of humans; measles virus is not spread by any other animal species.
Complications
Complications with measles are relatively common, ranging from relatively mild and less serious diarrhea, to pneumonia and encephalitis (subacute sclerosing panencephalitis - SSPE). Complications are usually more severe amongst adults who catch the virus. SSPE is a very rare, but fatal degenerative disease of the central nervous system that results from a measles virus infection acquired earlier in life. The first signs of SSPE may be changes in personality, a gradual onset of mental deterioration and myoclonia (muscle spasms or jerks). The diagnosis of SSPE is based on signs and symptoms and on test results, such as typical changes observed in electroencephalographs, an elevated anti-measles antibody (IgG) in the serum and cerebrospinal fluid, and typical histologic findings in brain biopsy tissue. There are reports of remission and some treatments are available; however, the average survival is one to two years. There is no evidence that measles vaccine can cause SSPE.
The fatality rate from measles for otherwise healthy people in developed countries is low: approximately 1 death per thousand cases. In underdeveloped nations with high rates of malnutrition and poor healthcare, fatality rates of 10 percent are common. In immunocompromised patients, the fatality rate is approximately 30 percent.
Serious Complications
- Diarrhea
- Ear infections
- Pneumonia
- Encephalitis
- Seizures
- Death
Approximately 20% of reported measles cases experience one or more complications. These complications are more common among children under 5 years of age and adults over 20 years old. Measles causes ear infections in nearly one out of every 10 children who get it. As many as one out of 20 children with measles gets pneumonia, and about one child in every 1,000 who get measles will develop encephalitis. (This is an inflammation of the brain that can lead to convulsions, and can leave your child deaf or mentally retarded.) For every 1,000 children who get measles, one or two will die from it. Measles can also make a pregnant woman have a miscarriage, give birth prematurely, or have a low-birth-weight baby. In developing countries, where malnutrition and vitamin A deficiency are prevalent, measles has been known to kill as many as one out of four people. It is the leading cause of blindness among African children. Measles kills almost 1 million children in the world each year.
Prognosis
Measles itself is unpleasant, but the complications are dangerous. Six to 20 percent of the people who get the disease will get an ear infection, diarrhea, or even pneumonia. One out of 1000 people with measles will develop inflammation of the brain, and about one out of 1000 will die.