Measles

Measles (rubeola) is a highly contagious viral infection—so contagious that 90% of people exposed to it, who are not immune, will develop the disease. Since vaccinations were introduced in 1963, measles has become rare in developed countries, including the United States. However, there are still an estimated 30 million cases of measles worldwide each year, resulting in 888,000 deaths.

Signs and Symptoms

Measles is associated with the following signs and symptoms:

• Malaise
• Moderate to high fever
• Conjunctivitis (red, irritated eyes)
• Cough
• Sore throat; hoarseness
• Runny nose
• Red spots with bluish-white centers, called Koplik's spots, on the inside of the mouth
• Red blotchy rash, which begins on the face and then spreads
• Diarrhea
• Vomiting
• Enlarged lymph nodes
• Rarely (1 in 1000 cases), extreme drowsiness, seizure, or coma, suggesting involvement of the central nervous system

What Causes It?

Measles is caused by a virus (paramyxovirus) that is spread through the air or by contact with infectious droplets from the nose, mouth, or throat. The disease is so contagious that it's possible to contract it by merely being in the same room as an infected person. Most people get measles because they were never immunized. Once someone has had measles, that person is immunized for life.

Who's Most At Risk?

People with the following conditions or characteristics are at risk for developing measles:

• Impaired immunity caused by a congenital immunodeficiency, the human immunodeficiency virus (HIV), or certain drugs that suppress the immune system (for example, cancer chemotherapy medicines)
• Infants less than 1 year of age (too young to be immunized)
• Other children and adults who have not been immunized or who have been insufficiently immunized (single immunization prior to 1989, when two doses became standard)
• Diminished immunity from vaccination in childhood (occurs rarely but with increasing frequency as adults get older)

What to Expect at Your Provider's Office

Anyone with a fever and unexplained rash should see a healthcare provider. He or she will do a physical examination, checking for Koplik's spots or the rash that usually appears several days after the spots have disappeared. Due to the success of immunizations, most young providers have never seen a case of measles. To help confirm the diagnosis, they will frequently order a blood test to detect the presence of antibodies against the measles virus. They may also use other blood tests to help diagnose a bacterial infection that may develop in addition to the original viral infection.

Treatment Options

Prevention

Vaccination is the key to preventing measles. Since the 1980s, the live, weakened measles vaccine, available as the combination vaccine of measles-mumps-rubella (MMR), is administered in two doses—one at age 12 to 15 months and the second at age 5 to 12 years. Of those who receive the vaccine, greater than 95% have lifelong immunity. Note: People allergic to eggs (the vaccine virus is grown in chick embryos), and those allergic to neomycin (a type of antibiotic frequently found in topical preparations for cuts and burns) should consult with their healthcare provider before receiving the vaccine.

Treatment Plan

Rest, drinking plenty of fluids, and treatment to relieve symptoms are adequate if there are no complications.

Drug Therapies

The following medications may be used in the management of measles:

• Antipyretics (for example, acetaminophen) for high fevers
• Antibiotics for bacterial complications such as pneumonia and ear infection
• Ribavirin for antiviral treatment (not FDA-approved for this use)
• Immune globulin followed by measles vaccination 5 to 6 months later

Complementary and Alternative Therapies

Nutrition

• Vitamin A

People who are deficient in vitamin A are more likely to get infections, including measles, and their cases are more likely to be severe, even fatal. In areas of the world where vitamin A deficiency is widespread or where at least 1% of those with measles die, experts (including the World Health Organization) recommend giving high doses of vitamin A supplements to children with the infection.

Herbs
Flavonoids, plant compounds with potent biologic activity, are believed to help fight viruses. Of those tested in vitro (in a lab), the following has demonstrated slight benefit against measles:

• Wax tree (Rhus succedanea L.); rhusflavanone is the active ingredient in the case of measles.

In addition:

• Calendula flower (Calendula officinalis) has shown antiviral activity in vitro and is thought to enhance the immune system, although it has not been studied against measles specifically.
• Spicebush (Lindera benzoin) is a remedy used by Native Americans of the Cherokee nation for measles; not studied scientifically.

Thirty out of 142 extracts of traditional herbal remedies studied in vitro (in test tubes) showed antimeasles activity. The most active included:

• Mugwort (Artemisia princeps)
• Kosam seed (Brucea javanica)
• Sappan wood (Caesalpinia sappan)
• Goldthread (Coptis chinensis)
• Forsythia (Forsythia suspensa)
• Amur corktree (Phellodendron amurense)
• Pomegranate (Punica granatum)
• Japanese sumac (Rhus javanica)
• Chinese Skullcap (Scutellaria baicalensis)
• Fire-flame bush (Woodfordia floribunda)

Test tube studies do not necessarily translate to effectiveness or safety in people; more research is needed to know the value of these herbs in clinical use.

Homeopathy
There have been few studies examining the effectiveness of specific homeopathic remedies. A professional homeopath, however, may recommend one or more of the following treatments for measles based on his or her knowledge and clinical experience. Before prescribing a remedy, homeopaths take into account a person's constitutional type. In homeopathic terms, a person's constitution is his or her physical, emotional, and intellectual makeup. An experienced homeopath assesses all of these factors when determining the most appropriate remedy for a particular individual.

• Aconitum — for symptoms that come on suddenly including fever, conjunctivitis, dry cough, and restlessness; best used very early in the course of the disease
• Apis mellifica — for individuals with swollen lips and eyes and a rash that is not fully developed; warmth increases itchiness as well as swelling
• Belladonna — can be used either during early stages of measles or after the rash has erupted; useful for those who have difficulty sleeping and symptoms that include fever, headache, and drowsiness
• Bryonia — for individuals with a delayed rash who have a dry, painful cough, headaches, and muscle pain that worsens with movement and warmth; this remedy is most appropriate for individuals with a rash primarily on the chest, a dry mouth, and a desire for cold drinks
• Euphrasia — for nasal discharge, red eyes, and tears associated with measles; this remedy is most appropriate for individuals who have a strong sensitivity to light
• Gelsemium — for the early stages of measles when there is a slow onset of fever and chilliness, cough, headache, weakness, and a watery nasal discharge that burns the upper lip; the individual for whom this remedy is most appropriate may be tired, apathetic and have little or no thirst
• Pulsatilla — can be used at any stage of the measles but often used after fever has resolved; the individual for whom this remedy is appropriate may have thick, yellow nasal discharge, a dry cough at night, a productive cough in the daytime, and mild ear pain; symptoms are frequently mild
• Sulphur — for measles in which the skin has a purplish appearance; the individual for whom this remedy is appropriate may have red mucus membranes with a cough and diarrhea that is worse in the mornings

Prognosis/Possible Complications

Measles is most often an uncomplicated childhood illness. However, infants and adults, especially those who are malnourished or whose immune system is weak, may develop complications that involve the respiratory system, central nervous system, or digestive system, in which case hospitalization is required. A small percentage of people who contract measles will die as a result. The measles mortality rate is 0.3% in industrialized countries, and 1% to 10% in developing countries.

Measles in a pregnant woman can result in premature birth, miscarriage, stillbirth, or low-birth-weight babies. Infants of mothers with active measles should be given immune globulin at birth. Pregnant women should not be vaccinated.

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