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Baby and childhood infectious diseases: measles BABY AND CHILDHOOD INFECTIOUS DISEASES: MEASLES
Measles is a highly infectious disease of childhood. Its technical name is rubeola, and it is most common in the 2-14 year age group. By the time a child who has not been vaccinated has reached the age of ten, it is highly probable he or she has contracted the disorder.
It is totally different from German measles (rubella). Even though the names are similar, they are caused by entirely different viruses and the implications are also very different.
The incubation period is between 8 and 14 days; this is the time that elapses between the moment of infection and the onset of symptoms. There is a prodromal period of 3-4 days; this is the period between the onset of symptoms and the appearance of the typical rash.
This is characterized by a fever which persists for several days, and symptoms much like an ordinary cold. There is often a sore throat, nasal discharge, and a dry barking cough. Towards the end of the prodrome, the eyes frequently become sore and inflamed and there may be a discharge. Light often causes uncomfortable irritation, a condition called photophobia. Lymph glands in the neck swell and become uncomfortable.
White spots, called Koplik's spots, may appear on the pink mucous membrane which lines the oral cavity. They start at the back near the molar teeth, and gradually spread until they may cover a large area of tissue. They invariably vanish just before the appearance of the typical skin rash. These spots are of diagnostic significance only—if they are there, then there is no doubt about the diagnosis. However, by the time the doctor arrives, they have usually vanished.
On about the fifth day of the disease, the rash appears. This starts out as a pink, blotchy, irregular reddening of the skin, and it gradually becomes redder and more fiery as the days pass. It starts on the face and behind the ears. From here it spreads to the chest and abdomen, and finally to the limbs.
The rash lasts from four to seven days and it may be itchy. Finally, it tends to fade. Often there is a fine shedding of tissue (a bit like bran); this may last two to three days. After this a light brown pigmentation may be left, and this finally vanishes also. The majority of cases settle down, and the person returns to normal.
However, there are several complications, and a patient can develop one or more of them. The most serious is called encephalitis. Fortunately it occurs in only about one case per 3000. It means the measles virus penetrates the brain barrier and sets up an infection in the brain substance. It may be lethal and is the main reason why vaccination is offered to children as a preventive measure.
There may be a further increase in fever, lethargy, headaches (which may be severe) and convulsions. Infections of the ear are common, and may produce an acute otitis media, in which the temperature remains elevated and there is considerable pain in the ear on one or both sides. Other unrelated germs often complicate the picture, and respiratory ones are notorious and probably affect most cases. Infections of the pharynx, larynx, throat, bronchi and lungs are all well known. These may lead to sore throats, a cough, a husky voice, and severe chest pain.
Treatment
It is customary to isolate the child for about a week from the onset of the rash. The patient is very infectious, and secretions from the nose, eyes and throat particularly so, and can readily spread to others. Isolation need not be an unhappy period—for the first few days the child will be happy to stay in bed and let the world (and school) pass quietly by. Elevated temperature usually makes a person feel lethargic and disinterested in surroundings. The body will usually overcome the infection by its own inbuilt immune system, so all that is necessary is to help nature do its job uninhibited.
Plenty of fluids are a good idea. These assist by helping to swish dead germs and metabolic debris from the system. Water-based fruit juices, water and lemonade are all satisfactory. Sucking flavoured ice-blocks is usually attractive. Add some glucose D and flavouring to make them taste nicer.
There are no food restrictions, but often the child will be off tucker for a few days. Small, high-protein, high-vitamin, attractively served meals are the best when the young patient does feel like eating.
Paracetamol elixir for children under the age of 6 will decrease body temperatures and make them feel brighter and less achey (see the dosage on label). Paracetamol or aspirin tablets for older children are suitable (one tablet four-hourly, or after meals, while the fever persists).
Gargling the throat with hot, salty water often brings relief if it is sore. Nasal drops or steam inhalations will often make the nasal passageways feel clearer and cleaner. Pre-cleanse with paper tissues and burn these after use, for they are very infectious. The same applies to secretions collected from the eyes.
Bathing the eyes with weak saline is advisable two to four times a day. If the eyes are affected, protection from direct bright light is wise, but do not enshroud the room in total darkness, as I have seen frequently done. Tilt Venetian blinds so that bright sunlight is kept out. Watching television or doing a lot of reading is inadvisable whilst the eyes are affected.
If there is a cough, any simple cough mixture is suitable. Lemon and honey is good; or use a pholcodeine cough elixir, available from the pharmacist.
If complications occur, call the doctor. Most cases of measles are self-limiting and simple measures are usually adequate.
However, the final suggestion is to have children vaccinated at the age of 12 months. One single injection is given by the doctor. It is now considered to be quite safe and very effective. Parents should consider this as part of the infant's normal immunization routine. Doctors familiar with the serious complications of measles are very keen on vaccination.
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