Measles

Measles (morbilli) is the most contagious of all childhood diseases. Measles often starts with fever, cough and runny nose and eyes. The fever then subsides for a period, before it rises again at the same time as the typical measles rash appears. Measles is very easily transmitted via droplet transmission and through contact with secretions (excretion product) from the respiratory tract. The disease can cause serious complications ("after-disease"), such as encephalitis.

What is Measles?

Measles, also called morbilli, is caused by the measles virus morbillivirus. The virus exists in several different variants, and measles outbreaks have been detected from several of the different variants of the virus. Measles is a highly contagious viral disease, and the disease can cause a serious illness in the infected person. Inflammation of the brain (encephalitis) is a serious but rare complication ("after-disease") of measles. Measles vaccine (incorporated into the MMR vaccine) is part of the childhood vaccination program.

Incidence of measles

Measles has always been a feared childhood disease in Norway, but after the introduction of the measles vaccine in the 1960s, the number of measles outbreaks steadily decreased, and the disease is now considered a rare disease in Norway. On average, 10 cases of measles have been observed in Norway in the period 2010-2015. Worldwide, the incidence of measles has also dropped drastically. Nevertheless, it is still considered the most common cause of death among childhood diseases for which a vaccine is available. Although there are relatively few cases of measles in Norway today, people can become infected abroad and bring the virus back to the country. The virus can then be spread further in unvaccinated environments. Young children who have not been vaccinated are particularly vulnerable, but other age groups can also be affected by the disease in rare cases.

From 2016, an increasing trend of measles outbreaks has been observed across large parts of Europe, and the virus is spreading in a number of European countries. Norwegian authorities therefore emphasize the importance of maintaining good vaccination coverage despite few measles outbreaks in Norway in recent years.

Causes of Measles

The measles virus morbillivirus is spread very easily via droplet infection or through other contact with secretion products from the respiratory tract. The virus is present in large quantities in saliva, and is spread with the small droplets of saliva when, for example, coughing or sneezing. We do not have measles virus circulating in Norway today, so possible infection occurs when traveling abroad and importing the virus from such trips.

Symptoms of measles

• fever

• recurrent fever after a few days of being fever-free

• cough

• runny nose and eyes

• photosensitivity

• small, white spots in the mouth with a red zone around

• rash with 1-2 mm red spots that start behind the ears and quickly spread to the rest of the body. The rash may increase in size.

Disease course in measles

In case of infection with the measles virus, it takes approx. 10-14 days before symptoms of illness appear. The course of the disease can then be divided into two phases:

The initial phase starts with fever and typical cold symptoms such as cough, runny nose and eyes and sensitivity to light. Small, white spots in the mouth with a red ring around them appear after 1-2 days. After a few more days of illness, an improvement is usually experienced, and the fever subsides or disappears.

The measles phase then starts with a new rise in fever and the typical measles rash begins to appear, first behind the ears and then spreads to the rest of the body within a short time. The rash appears as small, light pink dots, but can eventually increase in size and become darker in colour. The skin may appear slightly thicker and swollen. The symptoms subside after 2-5 days in this phase of the disease.

A person with measles is contagious from the first sign of illness in the initial phase and up to 3-5 days after the rash has appeared.

If the fever continues after the end of the measles phase, this may be a sign of complications ("after-illness"). This occurs in approx. 6-7%. Encephalitis is a serious but rare complication and usually appears 1-2 weeks after the rash. Other complications are otitis media, pneumonia, sinusitis, eye damage and blindness. Therefore, pay extra close attention to signs that may indicate a new illness in the period after measles.

Children can go to nursery school and school no earlier than four days after the rash has first appeared, if the general condition is good.

Treatment and good advice for measles

There is no specific treatment against the measles virus itself. The individual symptoms, such as fever, cough and runny nose, can be treated with medicines against fever and colds. If you have a fever, it is also important to drink enough fluids.

Any subsequent illnesses are treated based on the type of illness and needs.

However, it is important that you try to find out how the person has been infected, and that the infected person avoids contact with other unvaccinated people.

Pregnancy and measles

Measles can be harmful to both the pregnant woman and the unborn child. The mother has an increased risk of complications afterwards, and infection from mother to child can lead to premature birth and in some cases miscarriage. However, birth defects have not been previously demonstrated. The newborn child can also be exposed to serious infections if the mother is infected just before birth.

Measles vaccine

Measles vaccine, or MMR vaccine, is part of the childhood vaccination program. The vaccine consists of three different components and is intended to protect against mumps, measles and rubella. The vaccine is given twice, at 15 months of age and in 6th grade (11-12 years). When traveling abroad to exposed areas, the vaccine can be administered at 9 months of age. In cases where the vaccine is given before the child is 12 months old, a new dose should also be given when the child turns 15 months old.

The aim of the vaccine is to eradicate measles, and the measles vaccine provides lifelong protection. In 2016, vaccination coverage for the MMR vaccine was 96% for 2-year-olds and 91% for 16-year-olds.

It is recommended that everyone who has not previously been vaccinated and who has not had the disease, be vaccinated.

After vaccination, some people may experience mild reactions to the vaccine, such as a slight fever, a feeling of sickness in the body and a rash. The symptoms usually appear 5-12 days after vaccination. This is not dangerous, but is a natural process in the body, as the MMR vaccine consists of live but weakened disease viruses similar to those it is vaccinated against.

Travel to measles-prone areas

In 2017, a number of measles outbreaks were detected throughout Europe. If unvaccinated children and adults are to travel to exposed areas where measles outbreaks have occurred, it is recommended to carry out vaccination (MMR vaccine) before travelling. If the child is under 15 months and you are planning to travel, the vaccination can already take place at 9 months of age.