Doctor's Notes on Measles (Rubeola)
Measles is a disease that usually causes fever and a rash in children and sometimes, in adults. There are two types of measles; the most common one is termed measles, rubeola, red measles or hard measles. The early phase has symptoms of fever, lethargy, cough, conjunctivitis, runny nose and loss of appetite. In about 2 to 4 days a rash starts on the face spreads to the trunk in the into the arms and legs. The rash consists of small red bumps or spots that may blend together. This rash may peel off as the patient recovers. Koplik spots, gray spots, may appear inside the mouth. This disease makes patients more vulnerable to pneumonia and occasionally, encephalitis.
The second less common type of measles is termed Rubella, German measles or the 3-day measles. It has the same signs and symptoms as the more common type but the symptoms are much milder and last a shorter time. About 25 to 50% of people with rubella infection have no symptoms or signs. Swollen lymph nodes may occur in the back of the neck. Unfortunately, pregnant women who get the disease to her unborn child producing birth defects and possible miscarriage or stillbirth.
Both types of measles are caused by viruses. However, each type is caused by a different viral type. The most common form of measles is caused by the Rubeola virus while the less common form of measles is caused by the Rubella virus. Vaccination with the measles-mumps-rubella (MMR) vaccine protects against both types of measles and in the US, is required for entry into school.
Measles (Rubeola) Symptoms
Rubeola ("red measles" or "hard measles")
Symptoms appear about eight to 12 days after the rubeola virus infects a person. This is the incubation period. During this period, the virus is multiplying. Symptoms occur in two phases.
- The early phase begins with these symptoms:
- The red measles rash develops from two to four days later.
- The rash usually starts on the face, spreading to the trunk and then to the arms and legs.
- The rash is initially small red bumps that may blend into each other as more appear. From a distance, the rash often looks uniformly red. The rash lasts for five to seven days.
- People with measles may develop small grayish spots on the inside of the cheek, called "Koplik spots."
- The rash is usually not itchy, but as it clears up, the skin may shed (this looks like skin that is peeling after sunburn).
- Although red measles is often a mild disease, a few serious complications may occur. Red measles makes people more vulnerable to pneumonia and bacterial ear infections. Pneumonia as a complication of measles is especially serious in infants and is responsible for most deaths in this age group. Inflammation of the brain (encephalitis) occurs about once in every thousand cases of measles and is a serious complication that can be fatal.
- Red measles is particularly severe in people with weakened immune systems, including people who are malnourished or have HIV.
Rubella ("German measles")
German measles causes milder symptoms than red measles. The incubation period between getting the virus and getting sick is 16-18 days.
- Initially, some people experience fatigue, low-grade fever, headache, or red eyes several days before the rash appears. These symptoms are more common in adults than in children.
- Swollen, tender lymph nodes may occur in the back of the neck.
- The rash is light red to pink. It starts as individual spots that may merge over time. The rash usually starts on the face and moves down to the trunk.
- The rash does not usually itch, but as it clears up, the skin may shed. Individuals are most contagious a few days before the rash develops to seven days after it first appeared.
- Adolescents and adults who get rubella may get painful joints for days to weeks after the infection. This typically affects the hands, wrists, and knees.
- Symptoms and signs may be so mild that people do not notice them, especially in children. Studies have shown that approximately 25%-50% of infected people do not have any symptoms or signs. Most symptoms resolve in a few days, but swollen lymph nodes may persist for a few weeks.
- The most feared complication of rubella is "congenital rubella," which occurs when an infected pregnant woman passes the virus to her unborn child. Among other problems and birth defects, affected infants may have cataracts, heart defects, hearing impairment, and learning disabilities. The risk of transmission is highest early in pregnancy. The virus may also cause miscarriage or stillbirth.
Measles (Rubeola) Causes
Both the rubeola and rubella viruses spread through the respiratory route. This means they infect susceptible individuals exposed to an infected person who is coughing and sneezing. In fact, the rubeola virus is one of the most contagious viruses known to man. As a result, it can spread rapidly in a susceptible population. Infected people carry the virus in their respiratory tract before they get sick, so they can spread the disease without being aware of it. This is because there is an eight- to 12-day incubation period. The incubation period is the time between exposure to the measles virus and the onset of first symptoms.
If people are immune to the virus (either through vaccination or by having had measles in the past), they cannot get the disease caused by that virus. For example, someone who had rubeola as a child would not be able to get the disease again. Remember that rubella and rubeola are different viruses. An infection with or vaccination against one of these viruses does not protect against infection with the other.
There are so many childhood diseases, infectious and noninfectious, that it would be impossible to list them all here. However, we will introduce some of the most common ones, including viral and bacterial infections as well as allergic and immunologic illnesses.
Kasper, D.L., et al., eds. Harrison's Principles of Internal Medicine, 19th Ed. United States: McGraw-Hill Education, 2015.