Measles (Rubeola)



Background

Koplik Spots
Koplik spots
  • RNA virus
    • Morbillivirus genus, Paramyxoviridae family
  • Highly contagious, respiratory transmission
  • Winter and early spring
  • Incubation period long (7 - 10 days)

Complications

Assoc. immunosuppression:

  • Otitis media
  • Bronchopneumonia
  • Laryngotracheobronchitis (croup)

Encephalitis:

  • 1:1000 cases get encephalitis
  • These at risk of developing SSPE (panencephalitis)

Coagulation:

  • Haemorrhagic measles
  • Hepatitis
  • DIC

Clinical suspicion

measles on day 3
Measles on day 3

Consider the diagnosis of measles in all children (and adult) presenting with: fever, rash, cough, conjunctivitis

  • Prodromal 3Cs
    • Malaise and Conjunctivitis, Cough (tracheobronchitis), and Coryza
  • Initial fever (usually high) x4/7
  • Koplik spots (salt grain like or bluish opposite 2nd molar) day 5 - 7
  • Rash day 7 (lasts 5 days)
    • Starts on face ears, spreads centrifugally
    • Maculopapular then confluent
    • Involves palms and soles
  • Generalised lymphadenopathy
  • Hepatomegaly
  • Abdo. pain (appendicitis or mesenteric adenitis)
  • Cough often late
  • Resolution by day 14

Management

What to do if you have a suspected case:

  • Isolate patient (plus infection control measures)
  • An “oracol” oral fluid swab should be sent to the Micro. lab. Swabs are available in the paeds treatment room CUH PED cupboard (bottom shelf). Please record the date of rash onset and the vaccination history on the form when sending a swab
  • Ensure staff are protected (MMR, previous exposure, born before 1978)
  • Unimmunised children requiring admission should be immunised if no contraindications
  • Opportunistic MMR immunisation is encouraged in other children who attend the ED
  • Measles is a notifiable disease. If in the HSE South please inform on 066 7184548 of any suspect case as soon as possible. Outside of normal working hours the Public Health Doctor on call for emergencies can be contacted through the Ambulance Services at 021-4209848
  • For those unfortunate enough not to live in Cork, here is a list of regional medical officer contact details
  • Please complete a Measles - Surveillance form


Content by Dr Íomhar O' Sullivan. Last review Dr Saema Saeed, Dr ÍOS 10/06/21.