Measles (Rubeola)
Background
- 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
Consider the diagnosis of measles in all children (and adult) presenting with: fever, rash, cough, conjunctivitis
- Prodromal 3Cs
- Malaise and conjunctivitis, cough, and coryza
- Initial fever (usually high) x4/7
- Koplik spots (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
- Diagnostic testing is by oral swab or serum to labs
- Implement infection control measures
- 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. Please notify public health officer of any cases (contact tracing and vaccination)
