Measles (probably from Middle Dutch or Middle High German masel(e), meaning "blemish, blood blister") is a highly contagious, vaccine-preventable infectious disease caused by the measles virus. Other names include morbilli, rubeola, 9-day measles, red measles, and English measles. Symptoms usually develop 10–12 days after exposure to an infected person and last 7–10 days. Initial symptoms typically include fever, often greater than 40 °C (104 °F), cough, runny nose, and inflamed eyes. Small white spots known as Koplik spots may form inside the mouth two or three days after the start of symptoms. A red, flat rash which usually starts on the face and then spreads to the rest of the body typically begins three to five days after the start of symptoms. Common complications include diarrhea (in 8% of cases), middle ear infection (7%), and pneumonia (6%). These occur in part due to measles-induced immunosuppression. Less commonly, seizures, blindness, or inflammation of the brain may occur. Measles is an airborne disease which spreads easily from one person to the next through the coughs and sneezes of infected people. It may also be spread through direct contact with mouth or nasal secretions. It is extremely contagious: nine out of ten people who are not immune and share living space with an infected person will be infected. Furthermore, measles's reproductive number estimates vary beyond the frequently cited range of 12 to 18, with a 2017 review giving a range of 3.7 to 203.3. People are infectious to others from four days before to four days after the start of the rash. While often regarded as a childhood illness, it can affect people of any age. Most people do not get the disease more than once. Testing for the measles virus in suspected cases is important for public health efforts. Measles is not known to occur in other animals. Once a person has become infected, no specific treatment is available, although supportive care may improve outcomes. Such care may include oral rehydration solution (slightly sweet and salty fluids), healthy food, and medications to control the fever. Antibiotics should be prescribed if secondary bacterial infections such as ear infections or pneumonia occur. Vitamin A supplementation is also recommended for children under the age of 5. Among cases reported in the U.S. between 1985 and 1992, death occurred in 0.2% of cases, but may be up to 10% in people with malnutrition. Most of those who die from the infection are less than five years old. The measles vaccine is safe and very effective at preventing the disease and is often delivered in combination with other vaccines. Due to the ease with which measles is transmitted from person to person in a community, more than 95% of the community must be vaccinated in order to achieve herd immunity. Vaccination resulted in an 80% decrease in deaths from measles between 2000 and 2017, with about 85% of children worldwide having received their first dose as of 2017. Measles affects about 10 million people a year, primarily in the developing areas of Africa and Asia. It is one of the leading vaccine-preventable disease causes of death. In 1980, 2.6 million people died from measles, and in 1990, 545,000 died due to the disease; by 2014, global vaccination programs had reduced the number of deaths from measles to 73,000. Despite these trends, rates of disease and deaths have increased from 2017 onwards due to a decrease in vaccination.
Signs and symptoms The initial symptoms of measles are non-specific, resembling a common cold - raised temperature, runny nose, sneezing, cough, and sore eyes (conjunctivitis). These symptoms begin 7–23 days (most commonly, 10–14 days) after exposure to an infected person. The fever may reach or exceed 104 °F (40 °C). After a couple more days, little white spots may appear inside the mouth (Koplik spots); they are short lived and may not be noticed. At this stage of infection a characteristic skin rash appears, initially on the face and behind the ears, spreading to the rest of the body. Uncomplicated cases of measles typically improve within days of rash onset and resolve within 7–10 days. The virus is contagious from four days before to four days after the rash appears.
Because development of the rash and conjunctivitis requires a functional immune system, immunocompromised people may not be diagnosed as readily.
Complications Immediate complications of measles are relatively common, affecting approximately 30% of cases. Common complications are middle ear infections, conjunctivitis, severe diarrhea (leading to dehydration), and breathing problems such as croup and pneumonia. Complications can be severe, such as encephalitis, deafness, and blindness. In the US, the CDC estimates 1 out of every 5 unvaccinated people who get measles will need to be hospitalized; and that between 1 and 3 out of every 1,000 children with the disease will die of its complications. Mortality is worse in places with poor nutrition and poor healthcare - in parts of Africa, the case fatality rate is estimated up to 6% for settled populations, rising as high as 30% in refugee settlements. Pneumonia and encephalitis are the leading causes of death following measles.
Pregnancy Measles during pregnancy can have serious consequences for both mother and child. Pregnant women infected with measles are significantly more likely to need hospitalisation and are at greater risk of pneumonia and death. There are also increased risks of miscarriage, premature delivery, and of babies having low birth weight,
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