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Health Matters


Dr. João Colaço . 20/04/2017

Measles is a highly contagious viral disease. Infection is characterised by fever, discomfort, cough, runny nose and conjunctivitis, followed by a skin rash. After exposure, approximately 90 percent of susceptible individuals will develop measles. The disease can spread in public spaces, even without person to person contact.

The incubation period of measles is 7 to 21 days (10 to 12 days after exposure). The contagious period is estimated to be from four days before the fever or rash appears, to four days afterwards. Infected individuals are typically asymptomatic during the incubation period, although some cases may experience transient respiratory symptoms.

There is a prodromal period (the period between symptoms and the appearance of signs of the disease) that lasts two to four days, but can persist for up to eight days and may reveal symptoms such as fever, discomfort and anorexia, followed by conjunctivitis, runny nose and cough. These signs and symptoms may intensify before the disease’s skin rash appears.

The typical measles skin rash is maculopapular and begins on the face, spreading to the neck, upper torso, lower torso and extremities.

It is important to carefully study Koplik spots on patients suspected to have measles, since these are considered pathognomonic of the infection.

Clinical improvement generally occurs up to 48 hours after the appearance of the skin rash. After three or four days, the rash darkens to a brownish colour and starts to disappear, followed by fine flaking in the most severely affected areas. The rash generally lasts six to seven days and disappears in the same order it appeared. Coughing can continue for one to two weeks after the measles. If fever persists after the third or fourth day of the rash, this suggests a measles-related complication.

Measles-specific immunity is important for viral elimination and provides long-term protective immunity, although there are rare cases of reinfection.

Vaccination led to an interruption in transmission of the measles virus in the developed world, and offers protection to unvaccinated individuals through group immunity. To interrupt widespread transmission, group immunity should be maintained above 85 to 95 percent.

Measles is a benign disease, but in children and immuno-compromised adults, as well as pregnant women, the disease can be serious and quite aggressive. Therefore it should be diagnosed early with identification of contacts, and prophylactic measures should be taken to reinforce immunity.

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