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{{Infobox Disease
| Name
| ICD10 = {{ICD10|B|05||b|00}}.-
| ICD9 = {{ICD9|055}}
| Image = Morbillivirus measles infection.jpg
| Image_width = 180 px
| DiseasesDB = 7890
| MedlinePlus = 001569
| eMedicineSubj = derm
| eMedicineTopic = 259
| eMedicine_mult = {{eMedicine2|emerg|389}} {{eMedicine2|ped|1388}}
| MeshID = D008457
}}
{{Taxobox | color = violet
| name = ''Measles virus''
| image = Measles virus.JPG
| image_width = 180 px
| image_caption = ''Measles virus''
| virus_group = v
| ordo = ''[[Mononegavirales]]''
| familia = ''[[Paramyxoviridae]]''
| genus = ''[[Morbillivirus]]''
| type_species = '''''Measles virus'''''
}}
'''Measles''' is a [[disease]] caused by a virus, specifically a [[paramyxovirus]] of the genus ''[[Morbillivirus]]''. Morbilliviruses, like other paramyxoviruses, are enveloped, single-stranded, negative-sense RNA viruses. Symptoms include [[fever]], [[cough]], [[coryza|runny nose]], [[conjunctivitis|red eyes]] and a generalized, [[maculopapular rash|maculopapular]], [[erythema]]tous rash.

Measles is spread through respiration (contact with [[fluid]]s from an [[infection|infected]] person's nose and mouth, either directly or through [[Particulate|aerosol]] transmission), and is highly contagious—90% of people without [[immune system|immunity]] sharing a house with an infected person will catch it. The [[incubation period]] usually lasts for 4–12 days (during which there are, by definition, no [[symptom]]s). Infected people remain contagious from the appearance of the first symptoms until 3–5 days after the [[rash]] appears.

'[[German measles]]' is an unrelated condition caused by the [[rubella virus]].

==Symptoms==
The classical symptoms of measles include a four day fever, the three ''C''s—[[cough]], [[coryza]] (runny nose) and [[conjunctivitis]] (red eyes). The fever may reach up to 40° [[Celsius]] (104° [[Fahrenheit]]). ''[[Koplik's spots]]'' seen inside the mouth are [[pathognomonic]] (diagnostic) for measles but are not often seen, even in real cases of measles, because they are transient and may disappear within a day of arising.

The characteristic measles rash is classically described as a generalized, [[maculopapular rash|maculopapular]], [[erythema]]tous rash that begins several days after the fever starts. It starts on the head before spreading to cover most of the body, often causing [[itch]]ing. The rash is said to "stain", changing colour from red to dark brown, before disappearing.{{Fact|date=February 2008}}

==Diagnosis and treatment==
Clinical diagnosis of measles requires a history of fever of at least three days together with at least one of the three ''C''s. Observation of [[Koplik's spots]] is also diagnostic of measles.

Alternatively, laboratory diagnosis of measles can be done with confirmation of positive measles [[IgM]] antibodies or isolation of measles virus RNA from respiratory specimens. In cases of measles infection following secondary vaccine failure IgM antibody may not be present. However, in the rare case of a secondary vaccine failure, other external symptoms may be present, including nausea, headaches, or a feeling of slight dizziness when turning one's head to the left. In these cases serological confirmation may be made by showing IgG antibody rises by enzyme immunoassay or complement fixation. In children, where [[phlebotomy]] is inappropriate, saliva can be collected for salivary measles specific [[IgA]] test.{{Fact|date=March 2008}} Adults are recommended to seek medical help right away.

Positive contact with other patients known to have measles adds strong [[epidemiology|epidemiological]] evidence to the diagnosis. The contact with any infected person in any way, including semen, saliva, or mucus can cause infection.

There is no specific treatment or antiviral therapy for uncomplicated measles. Most patients with uncomplicated measles will recover with rest and supportive treatment.

Some patients will develop [[pneumonia]] as a sequela to the measles. Histologically, a unique cell can be found in the paracortical region of hyperplastic lymph nodes in patients affected with this condition. This cell, known as the [[Warthin-Finkeldey cell]], is a multinucleated giant with eosinophilic cytoplasmic and nuclear [[Inclusion bodies|inclusions]].{{Fact|date=March 2008}}

==Transmission==
The measles is a highly contagious airborne pathogen which spreads primarily via the respiratory system. The virus is transmitted in respiratory secretions, and can be passed from person to person via aerosol droplets containing virus particles, such as those produced by a coughing patient. Once transmission occurs, the virus infects and replicates in the [[lymphatic system]], [[urinary tract]], [[conjunctiva]]e, [[blood vessel]]s and [[central nervous system]] of its new host.<ref name="principlesofvirology">{{cite book |author=Skalka, Anna M.; Johnson, Flint; Enquist, L. W.; Racaniello, Vincent R. |title=Principles of Virology: Molecular Biology, Pathogenesis, and Control of Animal Viruses |publisher=American Society Microbiology |location= |year=2003 |pages= |isbn=1-55581-259-7 |oclc= |doi= |accessdate= |edition=2nd ed.}}</ref> The role of [[epithelial cell]]s is uncertain, but the virus must infect them to spread to a new individual.<ref>{{cite journal |author=Leonard VH, Sinn PL, Hodge G, ''et al'' |title=Measles virus blind to its epithelial cell receptor remains virulent in rhesus monkeys but cannot cross the airway epithelium and is not shed |journal=J. Clin. Invest. |volume=118 |issue=7 |pages=2448–2458 |year=2008 |pmid=18568079 |pmc=2430500 |doi=10.1172/JCI35454 |url=}}</ref>

Patients with the measles should be placed on ''droplet precautions.''

Humans are the only known natural hosts of measles, although the virus can infect some non-human primate species.

==Complications==
Complications with measles are relatively common, ranging from relatively mild and less serious [[diarrhea]], to [[pneumonia]] and [[encephalitis]] ([[subacute sclerosing panencephalitis]]), [[corneal ulcer]]ation leading to [[Corneal abrasion|corneal scarring]]<ref>http://www.iceh.org.uk/files/tsno4/resources/no04.doc</ref> Complications are usually more severe amongst adults who catch the virus.

The [[fatality rate]] from measles for otherwise healthy people in developed countries is 3 deaths per thousand cases.
<ref name="The Clinical Significance of Measles: A Review">
{{cite journal
| last = Perry
| first = Robert T.
| coauthors = Neal A. Halsey
| date = May 1, 2004
| year = 2004
| month = May
| title = The Clinical Significance of Measles: A Review
| journal = The Journal of Infectious Diseases
| volume = 189
| issue = S1
| pages = 1547-1783
| publisher = Infectious Diseases Society of America
| url = http://www.journals.uchicago.edu/doi/full/10.1086/377712
| language = English
| format = html
| accessdate = January 14, 2009
}}
</ref>
In [[developing country|underdeveloped nation]]s with high rates of [[malnutrition]] and poor [[healthcare]], fatality rates have been as high as 28%. <ref name="The Clinical Significance of Measles: A Review"/>In [[immunodeficiency|immunocompromised]] patients, the fatality rate is approximately 30 percent.<ref name="Measles in hospitalized African children with human immunodeficiency virus">
{{cite journal
| last = Sension
| first = MG
| coauthors = Quinn TC, Markowitz LE, Linnan MJ, Jones TS, Francis HL, Nzilambi N, Duma MN, Ryder RW
| date = December 1988
| year = 1988
| month = December
| title = Measles in hospitalized African children with human immunodeficiency virus
| journal = American Journal of Diseases of Children
| volume = 142
| issue = 12
| pages = 1271-1272
| url = http://www.popline.org/docs/0832/055280.html
| language = English
| format = html
| accessdate = January 14, 2009
}}
</ref>

==Prevention and Public health==
Measles is a significant infectious disease because, while the rate of complications is not high, the disease itself is so infectious that the sheer number of people who would suffer complications in an outbreak amongst non-immune people would quickly overwhelm available hospital resources. If vaccination rates fall, the number of non-immune persons in the community rises, and the risk of an outbreak of measles consequently rises.

In developed countries, most children are immunized against measles by the age of 18 months, generally as part of a three-part [[MMR vaccine]] (measles, [[mumps]], and [[rubella]]). The vaccination is generally not given earlier than this because children younger than 18 months usually retain anti-measles [[immunoglobulins]] (antibodies) transmitted from the mother during pregnancy. A second dose is usually given to children between the ages of four and five, in order to increase rates of immunity. Vaccination rates have been high enough to make measles relatively uncommon. Even a single case in a college dormitory or similar setting is often met with a local vaccination program, in case any of the people exposed are not already immune.

In developing countries where measles is highly endemic, the [[World Health Organization|WHO]] recommend that two doses of vaccine be given at six months and at nine months of age. The vaccine should be given whether the child is HIV-infected or not.<ref>{{cite journal|author=Helfand RF, Witte D, Fowlkes A, ''et al.''|title=Evaluation of the immune response to a 2-dose measles vaccination schedule administered at 6 and 9 months of age to HIV-infected and HIV-uninfected children in Malawi|journal=J Infect Dis|year=2008|volume=198|pages=1457&ndash;1465|doi=10.1086/592756}}</ref> The vaccine is less effective in HIV-infected infants, but the risk of adverse reactions is low.

Unvaccinated populations are at risk for the disease. After vaccination rates dropped in northern [[Nigeria]] in the early 2000s due to religious and political objections, the number of cases rose significantly, and hundreds of children died.<ref>{{cite news |title= Measles kills more than 500 children so far in 2005 |publisher=IRIN |date=2005-03-21 |url=http://www.irinnews.org/Report.aspx?ReportId=53506 |accessdate=2007-08-13}}</ref> A 2005 measles outbreak in [[Indiana]] was attributed to children whose parents refused vaccination.<ref>{{cite journal |author=Parker A, Staggs W, Dayan G ''et al.'' |title= Implications of a 2005 measles outbreak in Indiana for sustained elimination of measles in the United States |journal= N Engl J Med |volume=355 |issue=5 |pages=447–55 |year=2006 |pmid=16885548 | doi = 10.1056/NEJMoa060775}}</ref> In the early 2000s the [[MMR vaccine controversy]] in the [[United Kingdom]] regarding a potential link between the combined MMR vaccine (vaccinating children from mumps, measles and rubella) and [[autism]] prompted a comeback in the measles party, where parents deliberately infect the child with measles to build up the child's immunity without an injection. This practice poses many health risks to the child, and has been discouraged by the public health authorities.<ref>{{cite news |author= Dillner L |title= The return of the measles party |work= Guardian |date=2001-07-26 |accessdate=2007-08-13|url=http://lifeandhealth.guardian.co.uk/health/story/0,,1610704,00.html}}</ref> [[Evidence-based medicine|Scientific evidence]] provides no support for the hypothesis that MMR plays a role in causing autism.<ref>{{cite journal |author= [[Michael Rutter|Rutter M]] |title= Incidence of autism spectrum disorders: changes over time and their meaning |journal= Acta Paediatr |volume=94 |issue=1 |date=2005 |pages=2–15 |pmid=15858952 |doi= 10.1080/08035250410023124}}</ref> However, the MMR scare in Britain caused uptake of the vaccine to plunge, and measles cases came back: 2007 saw 971 cases in England and Wales, the biggest rise in occurrence in measles cases since records began in 1995.<ref>{{cite journal |journal= Health Serv J |date=2008-04-17 |pages=22–4 |title= Disease: a warning from history |author= Torjesen I |pmid=18533314 |url=http://www.hsj.co.uk/insideknowledge/features/2008/03/ingrid_torjesen_on_the_diseases_we_thought_had_gone_away.html}}</ref>

According to the [[World Health Organization]] (WHO), measles is a leading cause of vaccine preventable childhood mortality. Worldwide, the fatality rate has been significantly reduced by partners in the [[Measles Initiative]]: the [[American Red Cross]], the United States Centers for Disease Control and Prevention (CDC), the United Nations Foundation, UNICEF and the World Health Organization (WHO). Globally, measles deaths are down 60 percent, from an estimated 873,000 deaths in 1999 to 345,000 in 2005. Africa has seen the most success, with annual measles deaths falling by 75 percent in just 5 years, from an estimated 506,000 to 126,000.<ref name="UNICEF" />

The joint press release by members of the [[Measles Initiative]] brings to light another benefit of the fight against measles: "Measles vaccination campaigns are contributing to the reduction of child deaths from other causes. They have become a channel for the delivery of other life-saving interventions, such as bed nets to protect against malaria, de-worming medicine and vitamin A supplements. Combining measles immunization with other health interventions is a contribution to the achievement of Millennium Development Goal Number 4: a two-thirds reduction in child deaths between 1990 and 2015."<ref name="UNICEF">[http://www.unicef.org/media/media_38076.html UNICEF Joint Press Release]</ref>

==History==
The first scientific description of measles and its distinction from [[smallpox]] and [[chickenpox]] is credited to the [[Medicine in medieval Islam|Persian physician]], [[Muhammad ibn Zakariya ar-Razi]] (860-932), known to the West as "Rhazes", who published a book entitled ''The Book of Smallpox and Measles'' (in [[Arabic language|Arabic]]: ''Kitab fi al-jadari wa-al-hasbah'').<ref>{{citation|last=Harminder S. Dua, Ahmad Muneer Otri|first=Arun D. Singh|year=2008|title=Abu Bakr Razi|journal=British Journal of Ophthalmology|publisher=[[BMJ Group]]|volume=92|page=1324}}</ref> In roughly the last 150 years, measles has been estimated to have killed about 200 million people worldwide.<ref>Torrey EF and Yolken RH. 2005. Their bugs are worse than their bite. Washington Post, April 3, p. B01.</ref> In 1954, the virus causing the disease was isolated from an 11-year old boy from the [[United States]], [[David Edmonston]], and adapted and propagated on [[chick]] [[embryo]] [[tissue culture]].<ref>{{cite journal |author= |title=Live attenuated measles vaccine |journal=EPI Newsl |volume=2 |issue=1 |pages=6 |year=1980 |pmid=12314356 |doi= |url=}}</ref> To date, 21 strains of the measles virus have been identified.<ref>{{cite journal |author=Rima BK, Earle JA, Yeo RP, ''et al'' |title=Temporal and geographical distribution of measles virus genotypes |journal=J. Gen. Virol. |volume=76 |issue=5 |pages=1173–80 |year=1995 |pmid=7730801 |doi= |url=http://vir.sgmjournals.org/cgi/pmidlookup?view=long&pmid=7730801}}</ref> Licensed [[vaccine]]s to prevent the disease became available in 1963.

==Recent outbreaks==
{{Main|Measles outbreaks in the 2000s}}
In 2007, a large measles outbreak in [[Japan]] caused a number of universities and other institutions to close in an attempt to contain the disease.<ref>{{cite web |url=http://www.phac-aspc.gc.ca/tmp-pmv/2007/measjap070601_e.html|title=The Public Health Agency of Canada Travel Advisory |accessdate=2008-05-02|format= |work=}}</ref><ref>{{cite news |first=Justin |last=Norrie |authorlink= |coauthors= |title=Japanese measles epidemic brings campuses to standstill |url=http://www.smh.com.au/news/world/japanese-measles-epidemic-brings-campuses-to-standstill/2007/05/27/1180205052602.html |work= |publisher=The Sydney Morning Herald |date=May 27, 2007 |accessdate=2008-07-10 }} </ref>

Approximately 1000 cases of the disease were reported in [[Israel]] between August 2007 and May 2008 (in sharp contrast to just some dozen cases the year before).{{Fact|date=July 2008}} Many children in ultra-Orthodox Jewish communities were affected due to low vaccination coverage.<ref>{{cite journal |last=Stein-Zamir |first=C. |coauthors=G. Zentner, N. Abramson, H. Shoob, Y. Aboudy, L. Shulman and E. Mendelson |year=2008 |month=February |title=Measles outbreaks affecting children in Jewish ultra-orthodox communities in Jerusalem |journal=Epidemiology and Infection |volume=136 |issue=2 |pages=207–214 |pmid=17433131 |doi=10.1017/S095026880700845X |url= |accessdate= |quote= }}</ref><ref>{{cite news |first=Tamar |last=Rotem |coauthors= |title=Current measles outbreak hit ultra-Orthodox the hardest |url=http://www.haaretz.com/hasen/spages/921836.html |work= |publisher=Haaretz |date=August 11, 2007 |accessdate=2008-07-10 }}</ref> As of 2008 the disease is [[endemic]] in the [[United Kingdom]] with 1,217 cases diagnosed in 2008
<ref name="Record number of measles cases sparks fear of epidemic">
{{cite news
| first = David
| last = Batty
| title = Record number of measles cases sparks fear of epidemic
| url = http://www.guardian.co.uk/society/2009/jan/09/measles-record-numbers
| format = html
| publisher = guardian.co.uk
| date = Friday 9 January 2009 15.38 GMT
| accessdate = January 15th, 2009
| language = English
}}
</ref>
and epidemics have been reported in [[Austria]], [[Italy]] and [[Switzerland]]. Low vaccination rates are responsible.<ref>http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=18919</ref>

=== The Americas ===

Indigenous measles were declared to have been eliminated in North, Central, and South America; the last endemic case in the region was reported on November 12, 2002. Outbreaks are still occurring, however, following importations of measles viruses from other [[World Health Organization #Regional Offices|world regions]]. In June 2006, an outbreak in [[Boston]] resulted after a resident became infected in [[India]],<ref name="titleMeasles outbreak shows a global threat - The Boston Globe">{{cite web |url=http://www.boston.com/yourlife/health/diseases/articles/2006/06/10/measles_outbreak_shows_a_global_threat/ |title=Measles outbreak shows a global threat - The Boston Globe |accessdate=2007-12-05 |format= |work=}}</ref> and in October 2007, a [[Michigan]] girl who had been vaccinated contracted the disease in [[Sweden]].<ref>{{cite news |first=David |last=Jesse |authorlink= |coauthors= |title=Measles outbreak may have spread |url=http://blog.mlive.com/study_hall/2007/10/measles_outbreak_may_have_spre.html |work= |publisher=The Ann Arbor News |date=October 4, 2007 |accessdate=2008-07-10 }}</ref>

Between January 1 and April 25, 2008, a total of 64 confirmed measles cases were preliminarily reported in the United States to the Centers for Disease Control and Prevention,<ref>{{cite web |url=http://www.cdc.gov/mmwr/preview/mmwrhtml/mm57e501a1.htm?s_cid=mm57e501a1_e |title=cdc.gov |accessdate=2008-05-02 |format= |work=}}</ref><ref>[http://www.jsonline.com/story/index.aspx?id=738120 JS Online: Measles outbreak brewing, city health officials say<!-- Bot generated title -->]</ref> the most reported by this date for any year since 2001. Of the 64 cases, 54 were associated with importation of measles from other countries into the United States, and 63 of the 64 patients were unvaccinated or had unknown or undocumented vaccination status.<ref>{{cite web |url=http://www.cdc.gov/Features/MeaslesUpdate/ |title=cdc.gov MeaslesUpdate |accessdate=2008-05-02 |format= |work=}}</ref>

By July 9, 2008, a total of 127 cases were reported in 15 states (including 22 in [[Arizona]]<ref>{{cite news |first=Arthur |last=Rotstein |authorlink= |coauthors= |title=Response curtailed measles outbreak |url=http://www.tucsoncitizen.com/daily/local/90471.php |work= |publisher=The Associated Press |date=July 9, 2008 |accessdate=2008-07-10 }}</ref>), making it the largest U.S. outbreak since 1997 (when 138 cases were reported).<ref>{{cite news |first=Will |last=Dunham |authorlink= |editors=Julie Steenhuysen and Peter Cooney |title=Measles outbreak hits 127 people in 15 states |url=http://www.reuters.com/article/newsOne/idUSN0943743120080709 |work= |publisher=Reuters |date=July 9, 2008 |accessdate=2008-07-10 }}</ref> Most of the cases were acquired outside of the United States and afflicted individuals who had not been vaccinated.

By July 30, 2008, the number of cases had grown to 131. Of these, about half involved children whose parents rejected vaccination. The 131 cases occurred in 7 different outbreaks. There were no deaths, and 15 hospitalizations. 11 of the cases had received at least one dose of the measles vaccine.<!-- The article doesn't specify how many actually completed their course of immunization, though this would be useful information--> 122 of the cases involved children who were unvaccinated or whose vaccination status was unknown. Some of these were under the age of one year old, and so below the age when vaccination is recommended, but in 63 cases the vaccinations had been refused for religious or philosophical reasons. Many of the cases involved church groups and the home schooled. <ref>{{cite news |first=Mike |last=Stobbe |authorlink= |coauthors= |title= Jump in U.S. measles cases linked to vaccine fears |url=http://news.yahoo.com/s/ap/20080821/ap_on_he_me/med_measles_outbreaks |work= |publisher=The Associated Press |date=August 21, 2008 |accessdate=2008-08-21 }}</ref>

==Additional images==
<gallery>
Image:Measles enanthema.jpg|Measles enanthema
Image:Koplik spots, measles 6111 lores.jpg|This patient presented on the third pre-eruptive day with “Koplik spots” indicative of the beginning onset of measles.
Image:Measles in African Child 3.JPG|Measles in African Child
Image:RougeoleDP.jpg|Measles. This child shows a classic day-4 rash with measles.
Image:Morbillo.jpg|Histopathology of measles pneumonia. Giant cell
Image:Measles vaccination worldwide.png|Measles vaccination worldwide
</gallery>

==See also==
*[[Infectious disease]]
*[[List of epidemics]]
*[[MMR vaccine]]
*[[Rubella|Rubella (German measles)]]
*[[Roseola|Roseola ("baby measles")]]

==References==
{{reflist|2}}

==External links==
{{commonscat|Measles}}
*[http://www.who.int/vaccine_research/diseases/measles/en/ WHO.int] - 'Initiative for Vaccine Research (IVR): Measles', [[World Health Organization]] (WHO)
*[http://www.cdc.gov/nip/diseases/measles/faqs.htm Measles FAQ] from [[Centers for Disease Control and Prevention]] in the United States
*[http://news.bbc.co.uk/1/hi/health/7385020.stm Case of an adult male with measles (facial photo)]
*[http://www.visualdxhealth.com/child/rubeolaMeasles.htm Clinical pictures of measles]

{{Viral diseases}}
{{Exanthema}}

[[Category:Dutch loanwords]]
[[Category:Viral diseases]]
[[Category:Mononegavirales]]
[[Category:Pediatrics]]

{{Link FA|te}}
{{Link FA|de}}

[[af:Masels]]
[[ar:حصبة]]
[[gn:Sarapĩu]]
[[ay:Piyampiya usu]]
[[ca:Xarampió]]
[[cs:Spalničky]]
[[da:Mæslinger]]
[[de:Masern]]
[[et:Leetrid]]
[[es:Sarampión]]
[[eo:Morbilo]]
[[fa:سرخک]]
[[fr:Rougeole]]
[[gl:Sarampelo]]
[[ko:홍역]]
[[id:Demam Campak]]
[[it:Morbillo]]
[[he:חצבת]]
[[ku:Sorik (nexweşî)]]
[[la:Morbillus]]
[[lb:Riedelen]]
[[hu:Kanyaró]]
[[nl:Mazelen]]
[[ja:麻疹]]
[[no:Meslinger]]
[[pl:Odra (choroba)]]
[[pt:Sarampo]]
[[ro:Rujeolă]]
[[ru:Корь]]
[[sk:Ružienka]]
[[sl:Ošpice]]
[[fi:Tuhkarokko]]
[[sv:Mässling]]
[[te:తట్టు]]
[[th:โรคหัด]]
[[vi:Sởi]]
[[tr:Kızamık]]
[[uk:Кір]]
[[zh:痲疹]]

Revision as of 15:46, 10 February 2009

f3276125wer2u b/DYv

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