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Measles

Measles

Definition

Measles is a viral infection that causes an illness displaying a characteristic skin rash known as an exanthem. Measles is also sometimes called rubeola, five-day measles, or hard measles.

Description

Measles infections appear all over the world. Incidence of the disease in the United States is down to a record low and only 86 confirmed cases were reported in the year 2000. Of these, 62% were definitely linked to

foreigners or international travel. Prior to the current effective immunization program, large-scale measles outbreaks occurred on a two to three year cycle, usually in the winter and spring. Smaller outbreaks occurred during the off-years. Babies up to about eight months of age are usually protected from contracting measles, due to antibodies they receive from their mothers in the uterus. Once someone has had measles, he or she can never get it again.

Causes & symptoms

Measles is caused by a type of virus called a paramyxovirus. It is an extremely contagious infection, spread through the tiny droplets that may spray into the air when a person carrying the virus sneezes or coughs. About 85% of those people exposed to the virus will become infected with it. About 95% of those people infected with the virus will develop the illness. Once someone is infected with the virus, it takes about seven to 18 days before he or she actually becomes ill. The most contagious time period is the three to five days before symptoms begin through about four days after the characteristic measles rash has begun to appear.

The first signs of measles infection are fever , extremely runny nose, red, runny eyes, and a cough . A few days later, a rash appears in the mouth, particularly on the mucous membrane that lines the insides of the cheek. This rash consists of tiny white dots (like grains of salt or sand) on a reddish bump. These are called Koplik's spots, and are unique to measles infection. The throat becomes red, swollen, and sore.

A couple of days after the appearance of the Koplik's spots, the measles rash begins. It appears in a characteristic progression, from the head, face, and neck, to the trunk, then abdomen, and next out along the arms and legs. The rash starts out as flat, red patches, but eventually develops some bumps. The rash may be somewhat itchy. When the rash begins to appear, the fever usually climbs higher, sometimes reaching as high as 105°F (40.5°C). There may be nausea, vomiting, diarrhea , and multiple swollen lymph nodes. The cough is usually more problematic at this point, and the patient feels awful. The rash usually lasts about five days. As it fades, it turns a brownish color, and eventually the affected skin becomes dry and flaky.

Many patients (about 515%) develop other complications. Bacterial infections, such as ear infections, sinus infections, and pneumonia are common, especially in children. Other viral infections may also strike the patient, including croup, bronchitis, laryngitis , or viral pneumonia. Inflammation of the liver, appendix, intestine, or lymph nodes within the abdomen may cause other complications. Rarely, inflammation of the heart or kidneys, a drop in platelet count (causing episodes of difficult-to-control bleeding), or reactivation of an old tuberculosis infection can occur.

An extremely serious complication of measles infection is the inflammation and subsequent swelling of the brain. Called encephalitis, this can occur up to several weeks after the basic measles symptoms have resolved. About one out of every 1,000 patients develops this complication, and about 1015% of these patients die. Symptoms include fever, headache , sleepiness, seizures, and coma. Long-term problems following recovery from measles encephalitis may include seizures and mental retardation.

A very rare complication of measles can occur up to 10 years or more following the initial infection. Called subacute sclerosing panencephalitis, this is a slowly progressing, smoldering, swelling, and destruction of the entire brain. It is most common among people who had measles infection prior to the age of two years. Symptoms include changes in personality, decreased intelligence with accompanying school problems, decreased coordination, and involuntary jerks and movements of the body. As the disease progresses, the patient becomes increasingly dependent, ultimately becoming bedridden and unaware of his or her surroundings. Blindness may develop, and the temperature may spike (rise rapidly) and fall unpredictably as the brain structures responsible for temperature regulation are affected. Death is inevitable.

Measles during pregnancy is a serious disease, leading to increased risk of a miscarriage or stillbirth. In addition, the mother's illness may progress to pneumonia.

Diagnosis

Measles is almost always diagnosed based on its characteristic symptoms, including Koplik's spots, and a rash that spreads from central body structures out towards the arms and legs. If there is any doubt as to the diagnosis, then a specimen of body fluids (mucus or urine) can be collected and combined with fluorescent-tagged measles virus antibodies. Antibodies are produced by the body's immune cells that can recognize and bind to markers (antigens) on the outside of specific organisms, in this case the measles virus. Once the fluorescent antibodies have attached themselves to the measles antigens in the specimen, the specimen can be viewed under a special microscope to verify the presence of the measles virus.

Treatment

There are a variety of general measures that can be taken to treat measles and help the patient feel more comfortable. These include:

  • humidifying the air to ease cough
  • drinking plenty of fluids to prevent dehydration
  • keeping the room lights dim to relieve sensitivity to light
  • getting plenty of rest
  • eating nutritious and easily digestible food

Herbals and Chinese medicine

There are specific acupuncture and acupressure therapies for measles. The following herbals can also help relieve the symptoms associated with measles:

  • Chamomile tea for restlessness.
  • Echinacea plus goldenseal to clear infection, boost the immune system, and soothe skin and mucous membranes.
  • A tea of lemon balm leaf, chamomile flower, peppermint leaf, licorice root, and elder flower to reduce fever and chills and increase perspiration.
  • Ginger tea to reduce fever.
  • Shiitake mushrooms to boost the immune system.
  • Witch hazel (Hamamelis virginiana ), chickweed (Stellaria media ), or oatmeal baths to reduce itching.
  • Eyebright (Euphrasia officinalis ) eyewash to soothe eyes.
  • Garlic to fight infection and boost the immune system.
  • Flos lonicerae (10 g) and Radix glycyrrhizae (3 g) decoction to wash the mouth, eyes, and nose.

Supplements

Some studies have shown that children with measles encephalitis or pneumonia benefit from relatively large doses of vitamin A . Vitamin A may also heal mucous membranes. Bioflavinoids and vitamin C boost the immune system. Zinc promotes healing and is an immune system stimulant. Zinc can cause nausea and vomiting, and chronic use can cause low levels of copper and iron-deficiency anemia .

Homeopathy

Homeopathic remedies cater to the patient's specific symptoms. Remedies for common measles symptoms are listed. The patient can take 30x or 9c of the following remedies four times daily for two days:

  • Apis mellifica: for swollen throat, breathing difficulty, and painful cough.
  • Arsenicum album: for restlessness, feeling worse after midnight, and thirst.
  • Belladonna: for high fever, red eyes, flushed face, headache, and swallowing difficulty.
  • Gelsemium: for fever, droopy eyes, cough, feeling cold, and runny nose.
  • Pulsatilla: for eye problems (tears, drainage, light sensitivity), dark red rash, thick yellow nasal discharge, and dry cough.

Allopathic treatment

There are no medications available to cure measles. Treatment is primarily aimed at helping the patient to be as comfortable as possible, and watching carefully so that antibiotics can be started promptly if a bacterial infection develops. Fever and discomfort can be treated with acetaminophen (Tylenol) or ibuprofen (Advil, Motrin, Nuprin). Children with measles should never be given aspirin, as this increases the risk of the fatal disease Reye's syndrome.

Expected results

The prognosis for an otherwise healthy, well-nourished child who contracts measles is usually quite good. In developing countries, however, death rates may reach 1525%, as malnutrition, especially protein deficiency, for six months prior to the onset of measles increases the risk of death. Adolescents and adults usually have a more difficult course. Women who contract the disease while pregnant may give birth to a baby with a hearing impairment. Although only one in 1,000 patients with measles will develop encephalitis, 1015% of those who do will die, and about another 25% will be left with permanent brain damage.

Prevention

Measles is a highly preventable infection. A very effective vaccine exists, made of live measles viruses that have been treated so they cannot cause infection. The important markers on the viruses are intact and cause the immune system to produce antibodies. In the event of a future infection with measles virus the antibodies will quickly recognize the organism and eliminate it. Measles vaccines are usually given at about 15 months of age. Prior to that age, the baby's immune system is not mature enough to initiate a reaction strong enough to ensure long-term protection from the virus. A repeat injection should be given at about 10 or 11 years of age. Outbreaks on college campuses have occurred among nonimmunized or incorrectly immunized students.

Measles vaccine should not be given to a pregnant woman, however, in spite of the seriousness of gestational measles. The reason for not giving this particular vaccine during pregnancy is the risk of transmitting measles to the unborn child.

Surprisingly, new cases of measles began being reported in some countriesincluding Great Britainin 2001 because of parents' fears about vaccine safety. The combined vaccine for measles, mumps , and rubella (MMR) was claimed to cause autism or bowel disorders in some children. However, the World Health Organization (WHO) says there is no scientific merit to these claims. The United Nations expressed concern that unwarranted fear of the vaccine would begin spreading the disease in developing countries, and ultimately in developed countries as well. Parents in Britain began demanding the measles vaccine as a separate dose and scientists were exploring that option as an alternative to the combined MMR vaccine. Unfortunately, several children died during an outbreak of measles in Dublin because they had not received the vaccine. Child mortality due to measles is considered largely preventable, and making the MMR vaccine widely available in developing countries is part of WHO's strategy to reduce child mortality by two-thirds by the year 2015.

Resources

BOOKS

Gershon, Anne. "Measles (Rubeola)." In Harrison's Principles of Internal Medicine, edited by Anthony S. Fauci, et al. New York: McGraw-Hill, 1998.

Stoffman, Phyllis. The Family Guide to Preventing and Treating 100 Infectious Diseases. New York: John Wiley and Sons, Inc., 1995.

"Viral Infections: Measles." Section 19, Chapter 265 in The Merck Manual of Diagnosis and Therapy, edited by Mark H. Beers, MD, and Robert Berkow, MD. Whitehouse Station, NJ: Merck Research Laboratories, 2002.

Ying, Zhou Zhong, and Jin Hui De. "Childhood Infections." In Clinical Manual of Chinese Herbal Medicine and Acupuncture. New York: Churchill Livingston, 1997.

PERIODICALS

Borton, Dorothy. "Keeping Measles at Bay: Use These Four Techniques to Stop the Spread." Nursing 27, no. 12 (December 1997): 26.

Chiba, M. E., M. Saito, N. Suzuki, et al. "Measles Infection in Pregnancy." Journal of Infection 47 (July 2003): 4044.

Hussey, Greg. "Managing Measles: Integrated Case Management Reduces Disease Severity." British Medical Journal 314, no. 7077 (February 1, 1997): 316+.

Jones, G., R. W. Steketee, R. E. Black, et al. "How Many Child Deaths Can We Prevent This Year?" Lancet 362 (July 5, 2003): 6571.

McBrien, J., J. Murphy, D. Gill, et al. "Measles Outbreak in Dublin, 2000." Pediatric Infectious Disease Journal 22 (July 2003): 580584.

"MeaslesUnited States, 2000. (From the Centers for Disease Control and Prevention)." Journal of the American Medical Association 287, no. 9 (March 6, 2002): 11051112.

"Progress Toward Global Measles Control and Elimination, 1990-1996." Journal of the American Medical Association 278, no. 17 (November 5, 1997): 1396+.

Scott, L. A., and M. S. Stone. "Viral exanthems." Dermatology Online Journal 9 (August 2003): 4.

Sur, D. K., D. H. Wallis, and T. X. O'Connell. "Vaccinations in Pregnancy." American Family Physician 68 (July 15, 2003): 299304.

"WHO: Vaccine Fears Could Lead to Unnecessary Deaths." Medical Letter on the CDC & FDA (March 17, 2002): 11.

ORGANIZATIONS

American Academy of Pediatrics (AAP). 141 Northwest Point Boulevard, Elk Grove Village, IL 60007. (847) 434-4000. <http://www.aap.org>.

Centers for Disease Control and Prevention. 1600 Clifton Rd., Atlanta, GA 30333. (404) 639-3311. <http://www.cdc.gov>.

OTHER

Zand, Janet. "Measles." HealthWorld Online [cited October 2002]. <http://www.healthy.net/library/books/smart/measles.htm>.

Belinda Rowland

Teressa G. Odle

Rebecca J. Frey, PhD

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Measles

Measles

Definition

Measles is an infection caused by a virus, which causes an illness displaying a characteristic skin rash known as an exanthem. Measles is also sometimes called rubeola, 5-day measles, or hard measles.

Description

Measles infections appear all over the world. Prior to the current effective immunization program, large-scale measles outbreaks occurred on a two to three-year cycle, usually in the winter and spring. Smaller outbreaks occurred during the off-years. Babies up to about eight months of age are usually protected from contracting measles, due to immune cells they receive from their mothers in the uterus. Once someone has had measles infection, he or she can never get it again.

Causes and symptoms

Measles is caused by a type of virus called a paramyxovirus. It is an extremely contagious infection, spread through the tiny droplets that may spray into the air when an individual carrying the virus sneezes or coughs. About 85% of those people exposed to the virus will become infected with it. About 95% of those people infected with the virus will develop the illness called measles. Once someone is infected with the virus, it takes about 7-18 days before he or she actually becomes ill. The most contagious time period is the three to five days before symptoms begin through about four days after the characteristic measles rash has begun to appear.

The first signs of measles infection are fever, extremely runny nose, red, runny eyes, and a cough. A few days later, a rash appears in the mouth, particularly on the mucous membrane which lines the cheeks. This rash consists of tiny white dots (like grains of salt or sand) on a reddish bump. These are called Koplik's spots, and are unique to measles infection. The throat becomes red, swollen, and sore.

A couple of days after the appearance of the Koplik's spots, the measles rash begins. It appears in a characteristic progression, from the head, face, and neck, to the trunk, then abdomen, and next out along the arms and legs. The rash starts out as flat, red patches, but eventually develops some bumps. The rash may be somewhat itchy. When the rash begins to appear, the fever usually climbs higher, sometimes reaching as high as 105°F (40.5°C). There may be nausea, vomiting, diarrhea, and multiple swollen lymph nodes. The cough is usually more problematic at this point, and the patient feels awful. The rash usually lasts about five days. As it fades, it turns a brownish color, and eventually the affected skin becomes dry and flaky.

Many patients (about 5-15%) develop other complications. Bacterial infections, such as ear infections, sinus infections, and pneumonia are common, especially in children. Other viral infections may also strike the patient, including croup, bronchitis, laryngitis, or viral pneumonia. Inflammation of the liver, appendix, intestine, or lymph nodes within the abdomen may cause other complications. Rarely, inflammations of the heart or kidneys, a drop in platelet count (causing episodes of difficult-to-control bleeding), or reactivation of an old tuberculosis infection can occur.

An extremely serious complication of measles infection is swelling of the brain. Called encephalitis, this can occur up to several weeks after the basic measles symptoms have resolved. About one out of every thousand patients develops this complication, and about 10-15% of these patients die. Symptoms include fever, headache, sleepiness, seizures, and coma. Long-term problems following recovery from measles encephalitis may include seizures and mental retardation.

A very rare complication of measles can occur up to 10 years following the initial infection. Called subacute sclerosing panencephalitis, this is a slowly progressing, smoldering swelling and destruction of the entire brain. It is most common among people who had measles infection prior to the age of two years. Symptoms include changes in personality, decreased intelligence with accompanying school problems, decreased coordination, involuntary jerks and movements of the body. The disease progresses so that the individual becomes increasingly dependent, ultimately becoming bedridden and unaware of his or her surroundings. Blindness may develop, and the temperature may spike (rise rapidly) and fall unpredictably as the brain structures responsible for temperature regulation are affected. Death is inevitable.

Measles during pregnancy is a serious disease, leading to increased risk of a miscarriage or stillbirth. In addition, the mother's illness may progress to pneumonia.

Diagnosis

Measles infection is almost always diagnosed based on its characteristic symptoms, including Koplik's spots, and a rash which spreads from central body structures out towards the arms and legs. If there is any doubt as to the diagnosis, then a specimen of body fluids (mucus, urine) can be collected and combined with fluorescent-tagged measles virus antibodies. Antibodies are produced by the body's immune cells that can recognize and bind to markers (antigens) on the outside of specific organisms, in this case the measles virus. Once the fluorescent antibodies have attached themselves to the measles antigens in the specimen, the specimen can be viewed under a special microscope to verify the presence of measles virus.

Treatment

There are no treatments available to stop measles infection. Treatment is primarily aimed at helping the patient to be as comfortable as possible, and watching carefully so that antibiotics can be started promptly if a bacterial infection develops. Fever and discomfort can be treated with acetaminophen. Children with measles should never be given aspirin, as this has caused the fatal disease Reye's syndrome in the past. A cool-mist vaporizer may help decrease the cough. Patients should be given a lot of liquids to drink, in order to avoid dehydration from the fever.

Some studies have shown that children with measles encephalitis benefit from relatively large doses of vitamin A.

Alternative treatment

Botanical immune enhancement (with echinacea, for example) can assist the body in working through this viral infection. Homeopathic support also can be effective throughout the course of the illness. Some specific alternative treatments to soothe patients with measles include the Chinese herbs bupleurum (Bupleurum chinense ) and peppermint (Mentha piperita ), as well as a preparation made from empty cicada (Cryptotympana atrata ) shells. The itchiness of the rash can be relieved with witch hazel (Hamamelis virginiana ), chickweed (Stellaria media ), or oatmeal baths. The eyes can be soothed with an eyewash made from the herb eyebright (Euphrasia officinalis ). Practitioners of ayurvedic medicine recommend ginger or clove tea.

Prognosis

The prognosis for an otherwise healthy, well-nourished child who contracts measles is usually quite good. In developing countries, however, death rates may reach 15-25%. Adolescents and adults usually have a more difficult course. Women who contract the disease while pregnant may give birth to a baby with hearing impairment. Although only 1 in 1,000 patients with measles will develop encephalitis, 10-15% of those who do will die, and about another 25% will be left with permanent brain damage.

Prevention

Measles is a highly preventable infection. A very effective vaccine exists, made of live measles viruses which have been treated so that they cannot cause actual infection. The important markers on the viruses are intact, however, which causes an individual's immune system to react. Immune cells called antibodies are produced, which in the event of a future infection with measles virus will quickly recognize the organism, and kill it off. Measles vaccines are usually given at about 15 months of age; because prior to that age, the baby's immune system is not mature enough to initiate a reaction strong enough to insure long-term protection from the virus. A repeat injection should be given at about 10 or 11 years of age. Outbreaks on college campuses have occurred among unimmunized or incorrectly immunized students.

Measles vaccine should not be given to a pregnant woman, however, in spite of the seriousness of gestational measles. The reason for not giving this particular vaccine during pregnancy is the risk of transmitting measles to the unborn child.

Surprisingly, new cases of measles began being reported in some countriesincluding Great Britainin 2001 because of parents' fears about vaccine safety. The combined vaccine for measles, mumps, and rubella (MMR) was claimed to cause autism or bowel disorders in some children. However, the World Health Organization (WHO) says there is no scientific merit to these claims. The United Nations expressed concern that unwarranted fear of the vaccine would begin spreading the disease in developing countries, and ultimately in developed countries as well. Parents in Britain began demanding the measles vaccine as a separate dose and scientists were exploring that option as an alternative to the combined MMR vaccine. Unfortunately, several children died during an outbreak of measles in Dublin because they had not received the vaccine. Child mortality due to measles is considered largely preventable, and making the MMR vaccine widely available in developing countries is part of WHO's strategy to reduce child mortality by two-thirds by the year 2015.

KEY TERMS

Antibodies Cells made by the immune system which have the ability to recognize foreign invaders (bacteria, viruses), and thus stimulate the immune system to kill them.

Antigens Markers on the outside of such organisms as bacteria and viruses, which allow antibodies to recognize foreign invaders.

Encephalitis Swelling, inflammation of the brain.

Exanthem (plural, exanthems or exanthemata) A skin eruption regarded as a characteristic sign of such diseases as measles, German measles, and scarlet fever.

Koplik's spots Tiny spots occurring inside the mouth, especially on the inside of the cheek. These spots consist of minuscule white dots (like grains of salt or sand) set onto a reddened bump. Unique to measles.

Resources

BOOKS

Beers, Mark H., MD, and Robert Berkow, MD, editors. "Viral Infections: Measles." Section 19, Chapter 265. In The Merck Manual of Diagnosis and Therapy. Whitehouse Station, NJ: Merck Research Laboratories, 2004.

PERIODICALS

Chiba, M. E., M. Saito, N. Suzuki, et al. "Measles Infection in Pregnancy." Journal of Infection 47 (July 2003): 40-44.

Jones, G., R. W. Steketee, R. E. Black, et al. "How Many Child Deaths Can We Prevent This Year?" Lancet 362 (July 5, 2003): 65-71.

McBrien, J., J. Murphy, D. Gill, et al. "Measles Outbreak in Dublin, 2000." Pediatric Infectious Disease Journal 22 (July 2003): 580-584.

"MeaslesUnited States, 2000. (From the Centers for Disease Control and Prevention)." Journal of the American Medical Association 287, no. 9 (March 6, 2002): 1105-1112.

Scott, L. A., and M. S. Stone. "Viral Exanthems." Dermatology Online Journal 9 (August 2003): 4.

Sur, D. K., D. H. Wallis, and T. X. O'Connell. "Vaccinations in Pregnancy." American Family Physician 68 (July 15, 2003): 299-304.

"WHO: Vaccine Fears Could Lead to Unnecessary Deaths." Medical Letter on the CDC & FDA March 17, 2002: 11.

ORGANIZATIONS

American Academy of Pediatrics (AAP). 141 Northwest Point Boulevard, Elk Grove Village, IL 60007. (847) 434-4000. http://www.aap.org.

Centers for Disease Control and Prevention. 1600 Clifton Rd., NE, Atlanta, GA 30333. (800) 311-3435, (404) 639-3311. http://www.cdc.gov.

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Measles

Measles

Definition

Measles is an infection caused by a virus, which causes an illness displaying a characteristic skin rash known as an exanthem. Measles is also sometimes called rubeola, five-day measles, or hard measles.

Description

Measles is a very contagious disease primarily characterized by cough , runny nose, red eyes (conjunctivitis ), and a characteristic rash on the skin and inside of the cheeks. The most common complications are ear infection and diarrhea , although more serious complications can include pneumonia , meningitis , or encephalitis . Measles is fatal (due to complications) in about two out of every 1,000 cases.

Demographics

Measles infections appear all over the world. Prior the effective immunization program used in the early 2000s, large-scale measles outbreaks occurred on a two to three-year cycle, usually in the winter and spring. Smaller outbreaks occurred during the off years. Babies up to about eight months of age are usually protected from contracting measles, due to immune cells they receive from their mothers in the uterus. Once someone has had measles infection, he or she can never get it again.

Causes and symptoms

Measles is caused by a type of virus called a paramyxovirus. It is an extremely contagious infection, spread through the tiny droplets that may spray into the air when an individual carrying the virus sneezes or coughs. About 85 percent of those people exposed to the virus will become infected with it. About 95 percent of those people infected with the virus will develop the illness called measles. Once someone is infected with the virus, it takes about seven to 18 days before he or she actually becomes ill. The most contagious time period is the three to five days before symptoms begin through about four days after the characteristic measles rash has begun to appear.

The first signs of measles infection are fever ; extremely runny nose; red, runny eyes; and a cough. A few days later, a rash appears in the mouth, particularly on the mucous membrane that lines the cheeks. This rash consists of tiny white dots (like grains of salt or sand) on a reddish bump. These are called Koplik's spots and are unique to measles infection. The throat becomes red, swollen, and sore.

A couple of days after the appearance of the Koplik's spots, the measles rash begins. It appears in a characteristic progression, from the head, face, and neck, to the trunk, then abdomen, and next out along the arms and legs. The rash starts out as flat, red patches but eventually develops some bumps. The rash may be somewhat itchy. When the rash begins to appear, the fever usually climbs higher, sometimes reaching as high as 105°F (40.5°C). There may be nausea , vomiting , diarrhea, and multiple swollen lymph nodes. The cough is usually more problematic at this point, and the patient feels awful. The rash usually lasts about five days. As it fades, it turns a brownish color and eventually the affected skin becomes dry and flaky.

Many patients (about 515%) develop other complications. Bacterial infections, such as ear infections, sinus infections, and pneumonia are common, especially in children. Other viral infections may also strike the patient, including croup , bronchitis , laryngitis, or viral pneumonia. Inflammation of the liver, appendix, intestine, or lymph nodes within the abdomen may cause other complications. Rarely, inflammations of the heart or kidneys, a drop in platelet count (causing episodes of difficult-to-control bleeding), or reactivation of an old tuberculosis infection can occur.

An extremely serious complication of measles infection is swelling of the brain. Called encephalitis, this condition can occur up to several weeks after the basic measles symptoms have resolved. About one out of every thousand patients develops this complication, and about 10 to 15 percent of these patients die. Symptoms include fever, headache , sleepiness, seizures, and coma. Long-term problems following recovery from measles encephalitis may include seizures and mental retardation .

A very rare complication of measles can occur up to ten years following the initial infection. Called subacute sclerosing panencephalitis, this is a slowly progressing, smoldering swelling and destruction of the entire brain. It is most common among people who had measles infection prior to the age of two years. Symptoms include changes in personality, decreased intelligence with accompanying school problems, decreased coordination, involuntary jerks and movements of the body. The disease progresses so that the individual becomes increasingly dependent, ultimately becoming bedridden and unaware of his or her surroundings. Blindness may develop, and the temperature may spike (rise rapidly) and fall unpredictably as the brain structures responsible for temperature regulation are affected. Death is inevitable.

Measles during pregnancy is a serious disease, leading to increased risk of a miscarriage or stillbirth. In addition, the mother's illness may progress to pneumonia.

Diagnosis

Measles infection is almost always diagnosed based on its characteristic symptoms, including Koplik's spots, and a rash which spreads from central body structures out towards the arms and legs. If there is any doubt as to the diagnosis, then a specimen of body fluids (mucus, urine) can be collected and combined with fluorescent-tagged measles virus antibodies. Antibodies are produced by the body's immune cells that can recognize and bind to markers (antigens) on the outside of specific organisms, in this case the measles virus. Once the fluorescent antibodies have attached themselves to the measles antigens in the specimen, the specimen can be viewed under a special microscope to verify the presence of measles virus.

Treatment

As of 2004 there are no treatments available to stop measles infection. Treatment is primarily aimed at helping the patient to be as comfortable as possible and watching carefully so that antibiotics can be started promptly if a bacterial infection develops. Fever and discomfort can be treated with acetaminophen . Children with measles should never be given aspirin, as aspirin is correlated with the fatal disease Reye's syndrome . A cool-mist vaporizer may help decrease the cough. Patients should be given a lot of liquids to drink, in order to avoid dehydration from the fever.

Some studies have shown that children with measles encephalitis benefit from relatively large doses of vitamin A.

Prognosis

The prognosis for an otherwise healthy, well-nourished child who contracts measles is usually quite good. In developing countries, however, death rates may reach 15 to 25 percent. Adolescents and adults usually have a more difficult course. Women who contract the disease while pregnant may give birth to a baby with hearing impairment . Although only one in 1,000 patients with measles will develop encephalitis, 10 to 15 percent of those who do will die, and about another 25 percent will be left with permanent brain damage.

Prevention

Measles is a highly preventable infection. A very effective vaccine exists, made of live measles viruses that have been treated so that they cannot cause actual infection. The important markers on the viruses are intact, however, which causes an individual's immune system to react. Immune cells called antibodies are produced, which in the event of a future infection with measles virus quickly recognize the organism and kill it off. Measles vaccines are usually given to children at about 15 months of age; prior to that age, the baby's immune system is not mature enough to initiate a reaction strong enough to insure long-term protection from the virus. A repeat injection should be given at about ten or 11 years of age. Outbreaks on college campuses have occurred among students who were not immunized or who were incorrectly immunized.

KEY TERMS

Antibody A special protein made by the body's immune system as a defense against foreign material (bacteria, viruses, etc.) that enters the body. It is uniquely designed to attack and neutralize the specific antigen that triggered the immune response.

Antigen A substance (usually a protein) identified as foreign by the body's immune system, triggering the release of antibodies as part of the body's immune response.

Encephalitis Inflammation of the brain, usually caused by a virus. The inflammation may interfere with normal brain function and may cause seizures, sleepiness, confusion, personality changes, weakness in one or more parts of the body, and even coma.

Exanthem A skin eruption regarded as a characteristic sign of such diseases as measles, German measles, and scarlet fever.

Koplik's spots Tiny spots occurring inside the mouth, especially on the inside of the cheek. These spots consist of minuscule white dots (like grains of salt or sand) set onto a reddened bump and are characteristic of measles.

Measles vaccine should not be given to pregnant women, however, in spite of the seriousness of gestational measles. The reason for not giving this particular vaccine during pregnancy is the risk of transmitting measles to the unborn child.

Parental concerns

New cases of measles began being reported in some countriesincluding Great Britainin 2001 because of parents' fears about vaccine safety. The combined vaccine for measles, mumps , and rubella (MMR) was claimed to cause autism or bowel disorders in some children. However, the World Health Organization (WHO) position is there is no scientific merit to these claims. The United Nations expressed concern that unwarranted fear of the vaccine would begin spreading the disease in developing countries and ultimately in developed countries as well. Parents in Britain began demanding the measles vaccine as a separate dose, and scientists were exploring that option as an alternative to the combined MMR vaccine . Unfortunately, several children died during an outbreak of measles in Dublin because they had not received the vaccine. Child mortality due to measles is considered largely preventable, and making the MMR vaccine widely available in developing countries is part of WHO strategy to reduce child mortality by two-thirds by the year 2015.

Resources

BOOKS

Katz, Samuel L. "Measles (Rubeola)." In Principles and Practice of Pediatric Infectious Diseases, 2nd ed. Edited by Sarah S. Long et al. St. Louis, MO: Elsevier, 2003.

Maldonado, Yvonne. "Measles." In Nelson Textbook of Pediatrics. Edited by Richard E. Behrman et al. Philadelphia: Saunders, 2004.

PERIODICALS

Kerr, C. "Good response rate for MMRV vaccine." Lancet Infectious Disease 3 (December 2003): 748.

Stalkup, J. R. "A review of measles virus." Dermatology Clinics 20 (April 2002): 209215.

ORGANIZATIONS

American Academy of Pediatrics (AAP). 141 Northwest Point Blvd., Elk Grove Village, IL 60007. Web site: <www.aap.org>.

Centers for Disease Control and Prevention. 1600 Clifton Rd., NE, Atlanta, GA 30333. Web site: <www.cdc.gov>.

Rosalyn Carson-DeWitt, MD Rebecca J. Frey, PhD

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Measles

Measles

Measles is an infectious disease caused by a virus of the paramyxovirus group. It infects only man and the infection results in life-long immunity to the disease. It is one of several exanthematous (rash-producing) diseases of childhood, the others being rubella (German measles), chicken pox, and the now rare scarlet fever. The disease is particularly common in both pre-school and young school children.

The measles virus mainly infects mucous membranes of the respiratory tract and the skin. The symptoms include high fever, headache, hacking cough, conjunctivitis, and a rash that usually begins inside the mouth on the buccal mucosa as white spots, (called Koplik's spots) and progresses to a red rash that spreads to face, neck, trunk and extremities. The incubation period varies but is usually 10 to 12 days until symptoms appear. Four to five days before the onset of the rash, the child has fever or malaise and then may develop a sore throat and cough. The duration of the rash is usually five days. The child is infectious throughout the prodromal (early) period and for up to four days after the first appearance of the rash. The virus is highly contagious and is transmitted through respiratory droplets or though direct contact. Measles is also sometimes called rubeola or the nine-day measles.

Although certain complications can arise, in the vast majority of cases, children make a full recovery from measles. Acute local complications can occur if there is a secondary infection, for example pneumonia due to bacteria such as staphylococci , Streptococcus pyogene, pneumococci, or caused by the virus itself. Also, ear infections and secondary bacterial otitis media can seriously aggravate the disease. Central nervous system (CNS) complications include post-measles encephalitis, which occurs about 10 days after the illness with a significant mortality rate. Also, sub-acute sclerosing panencephalitis (SSPE), a rare fatal complication, presents several years after the original measles infection. Because hemorrhagic skin lesions, viraemia, and severe respiratory tract infection are particularly likely in malnourished infants, measles is still frequently a life-threatening infection in Africa and other underdeveloped regions of the world. The microbiological diagnosis of measles is not normally required because the symptoms are characteristic. However, if an acute CNS complication is suspected, paired sera are usually sent for the estimation of complement fixing antibodies to measles. If SSPE is suspected, the measles antibody titres in the CSF (determining the level of antibodies present) are also estimated.

Epidemiological studies have shown that there is a good correlation between the size of a population and the number of cases of measles. A population of at least 500,000 is required to provide sufficient susceptible individuals (i.e. births) to maintain the virus within the population. Below that level, the virus will eventually die out unless it is re-introduced from an outside source. On the geological time-scale, man has evolved recently and has only existed in large populations in comparatively modern times. In the past, when human beings lived in small populations, it is concluded that the measles virus could not exist in its present form. It may have had another strategy of infection such as to persist in some form and infect the occasional susceptible passer-by, but this remains unproven. It has been suggested that the modern measles virus evolved from an ancestral animal virus, which is also common to the modern canine distemper and the cattle disease rinderpest. This theory is based on the similarities between these viruses , and on the fact that these animals have been commensal (living in close proximity) with man since his nomadic days. The ancestral virus is thought to have evolved into the modern measles virus when changes in the social behavior of man gave rise to populations large enough to maintain infection. This evolutionary event would have occurred within the last 6000 years when the river valley civilizations of the Tigris and Euphrates were established. To our knowledge, measles was first described as a disease in ninth century when a Persian physician, Rhazes, was the first to differentiate between measles and smallpox . The physician Rhazes also made the observation that the fever accompanying the disease is a bodily defense and not the disease itself. His writings on the subject were translated into English and published in 1847.

The measles virus itself was first discovered in 1930, and John F. Enders of the Children's Hospital in Boston successfully isolated the measles virus in 1954. Enders then began looking for an attenuated strain, which might be suitable for a live-virus vaccine . A successful immunization program for measles was begun soon after. Today measles is controlled in the United States with a vaccination that confers immunity against measles, mumps , and rubella and is commonly called the MMR vaccine. Following a series of measles epidemics occurring in the teenage population, a second MMR shot is now sometimes required by many school-age children as it was found that one vaccination appeared not to confer life-long immunity.

In October 1978, the Department of Health, Education, and Welfare announced their intention of eliminating the measles virus from the U.S.A. This idea was inspired by the apparently successful global elimination of smallpox by the World Health Organization vaccination program, which recorded its last smallpox case in 1977.

Death from measles due to respiratory or neurological causes occurs in about 1 out of every 1000 cases and encephalitis also occurs at this frequency, with survivors of the latter often having permanent brain damage. Measles virus meets all the currently held criteria for successful elimination. It only multiplies in man; there is a good live vaccine (95 % effective) and only one sero-type of the virus is known. Usually measles virus causes an acute infection but, rarely (1 out of every million cases), the virus persists and reappears some 2-6 years causing SSPE. However, measles virus can only be recovered with difficulty from infected tissue and SSPE is a non-transmissible disease. To successfully eliminate measles, it would be necessary to achieve a high immunization level, especially in children.

See also Antibody-antigen, biochemical and molecular reactions; History of immunology; History of public health; Immunity, active, passive and delayed; Immunology; Varicella; Viruses and responses to viral infection

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Mumps

Mumps

Mumps is a contagious viral disease that causes painful enlargement of the salivary glands, most commonly the parotids. Mumps is sometimes known as epidemic parotitis and occurs most often in children between the ages of 4 and 14.

Mumps was first described by Hippocrates (c.460c.370 b.c.), who observed that the diseases occurred most commonly in young men, a fact that he attributed to their congregating at sports grounds. Women, who were inclined to be isolated in their own homes, were seldom taken ill with the disease. Over the centuries, medical writers paid little attention to mumps. Occasionally, mention was made of a local epidemic of the disease, as recorded in Paris, France, in the sixteenth century by Guillaume de Baillou (15381616). Most physicians believed that the disease was contagious, but no studies were made to confirm this suspicion. The first detailed scientific description of mumps was provided by the British physician Robert Hamilton (17211793) in 1790. Hamilton's paper in the Transactions of the Royal Society of Edinburgh finally made the disease well known among physicians. Efforts to prove the contagious nature of mumps date around 1913. In that year, two French physicians, Charles-Jean-Henri Nicolle (18661936) and Ernest Alfred Conseil, attempted to transmit mumps from humans to monkeys, but were unable to obtain conclusive results. Eight years later, Martha Wollstein injected viruses taken from the saliva of a mumps patient into cats, producing inflammation of the parotid, testes, and brain tissue in the cats. Conclusive proof that mumps is transmitted by a filterable virus was finally obtained by two American researchers, Claude D. Johnson and Ernest William Goodpasture (18861960), in 1934.

The mumps virus has an incubation period of 12-28 days with an average of 18 days. Pain and swelling in the region of one parotid gland, accompanied by some fever, is the characteristic initial presenting feature. About five days later, the other parotid gland may become affected while the swelling in the first gland has mainly subsided. In most children, the infection is mild and the swelling in the salivary glands usually disappears within two weeks. Occasionally, there is no obvious swelling of the glands during the infection. Children with mumps are infectious from days one to three before the parotid glands begin to swell, and remain so until about seven days after the swelling has disappeared. The disease can be transmitted through respiratory droplets. There are occasional complications in children with mumps. In the central nervous system (CNS), a rare complication is asceptic meningitis or encephalitis. This usually has an excellent prognosis. In about 20% of post-pubertal males, orchitis may arise as a complication and, rarely, can lead to sterility. A very rare additional complication is pancreatitis, which may require treatment and hospitalization.

The diagnosis of mumps in children is usually made on the basis of its very characteristic symptoms. The virus can be cultured, however, and can be isolated from a patient by taking a swab from the buccal (mouth) outlet of the parotid gland duct. The swab is then broken off into viral transport medium. Culture of the virus is rarely necessary in a straightforward case of mumps parotitis. Occasionally, it is necessary to isolate the virus from the cerebro-spinal fluid (CSF) of patients with CNS complications such as mumps meningitis. Also, serological investigations may be useful in aseptic meningitis and encephalitis.

A vaccine for mumps was developed by the American microbiologist, John Enders, in 1948. During World War II, Enders had developed a vaccine using a killed virus, but it was only moderately and temporarily successful. After the war, he began to investigate ways of growing mumps virus in a suspension of minced chick embryo and ox blood. The technique was successful and Enders' live virus vaccine is now routinely used to vaccinate children. In the U.S.A., the live attenuated mumps vaccine is sometimes given alone or together with measles and/or rubella vaccine. The MMR vaccine came under investigation with regard to a possible link to autism in children. The United States Centers for Disease Control concludes that current scientific evidence does not support any hypothesis that the MMR vaccine causes any form of autism. The hypothetical relationship, however, did discourage and continues to discourage some parents from allowing their children to receive the triple vaccine.

See also Antibody-antigen, biochemical and molecular reactions; History of immunology; History of public health; Immunity, active, passive and delayed; Immunology; Varicella; Viruses and responses to viral infection

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Measles

MEASLES

Measles is a viral respiratory illness characterized by high fever and generalized rash. Symptoms start ten to twelve days after airborne exposure and include fever, malaise, conjunctivitis, runny nose, and cough. About fourteen days after exposure, a maculopapular rash appears at the hairline, extends to the face and upper neck, and, over the next three days, spreads down the body to the hands and feet. Although measles is usually not severe in developed countries, it can lead to serious complications including diarrhea (8% of cases), ear infections (7%), pneumonia (6%), encephalitis (0.1%), subacute sclerosing panencephalitis (SSPE)(0.001%), and death (0.2%). Measles is much more serious in developing countries, causing about one million deaths annually during the 1990s. The case fatality rate can be as high as 25 percent, with deaths often caused by secondary infections such as diarrhea or pneumonia. Measles is also a common cause of blindness in the developing world.

Measles is one of the most contagious diseases in the world. The virus, a paramyxovirus containing a single strand of RNA, is normally spread through respiratory droplets and can be transmitted from four days before to four days after rash onset. Before vaccines were introduced, nearly everyone was infected by age ten to twelve years. Immunity is lifelong following infection.

A live attenuated vaccine was licensed in 1963, and further attenuated vaccines are now used around the world. The vaccine is about 95 percent effective in the United States when administered at the recommended age of twelve to fifteen months, and immunity is considered lifelong. It is usually given in conjunction with the mumps and rubella vaccines. Children in developing countries are vaccinated at nine months of age because of the higher risk of infection in infancy.

Routine treatment of measles includes supportive care such as oral rehydration therapy for diarrhea and respiratory care for patients with pneumonia. Antibiotics are used to treat secondary bacterial infections. Although antiviral medications have been used to treat complex measles infections, there are few studies to confirm their effectiveness. High-dose vitamin A therapy reduces mortality and prevents blindness and is recommended by the World Health Organization for children in developing countries.

Global measles eradication has been a goal since the development of an effective vaccine. Humans are the only reservoir for the measles virus, which can survive only hours in the environment. Endemic measles can be eliminated from large geographic areas using intensive vaccination programs, as seen in the United States in the late 1990s. However, measles is so infectious that immunization rates of at least 90 to 95 percent must be attained to interrupt transmission. In addition, the billions of doses required to achieve eradication highlight the need for injection safety and the potential development of needle-free vaccination methods. Finally, the HIV (human immunodeficiency virus) epidemic presents several barriers to measles eradication. HIV-infected persons have a lower response to measles vaccination, develop more severe cases of the disease, and, theoretically, may be infectious for longer periods of time. There is hope that these challenges will be surmounted and measles will be eradicated, following smallpox into the history books.

Sonia Klemperer-Johnson

Mark Papania

(see also: Communicable Disease Control; Disease Prevention; Eradication of Disease; Immunizations )

Bibliography

Atkinson, W.; Wolfe, C.; Humizter, S.; and Nelson, R., eds. (2000). "Measles." In Epidemiology and Prevention of Vaccine-Preventable Diseases: The Pink Book. Atlanta, GA.: U.S. Department of Health and Human Services.

Redd, S. C.; Markowitz, L. E.; and Katz, S. L. (1999). "Measles Vaccine." In Vaccines, eds. S. A. Plotkin and W. A. Orenstein. Philadelphia, PA: W. B. Sanders.

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measles

measles or rubeola (rōōbē´ələ), highly contagious disease of young children, caused by a filterable virus and spread by droplet spray from the nose, mouth, and throat of individuals in the infective stage. This period begins 2 to 4 days before the appearance of the rash and lasts from 2 to 5 days thereafter. The first symptoms of measles, after an incubation period of 7 to 14 days, are fever, nasal discharge, and redness of the eyes. Characteristic white spots appear in the mouth, followed by a rash on the face that spreads to the rest of the body. The symptoms disappear in 4 to 7 days. One attack of measles confers lifelong immunity. However, it renders the patient susceptible to other more serious infections such as bronchial pneumonia and encephalitis. The measles virus has also been associated with subacute sclerosing panencephalitis (SSPE), which causes chronic brain disease in children and adolescents. After the attack of measles, it can cause intellectual deterioration, convulsive seizures, and motor abnormalities and is usually fatal. Common measles in pregnant women can be a threat to the unborn child, and vaccination of women well before pregnancy is recommended (see also rubella, or German measles).

Immunization by injection of live measles-virus vaccine, first marketed in 1963, has proven effective. Given at first with gamma globulin, the vaccine was further developed by 1965 so that one shot alone gives long-term, probably lifetime, immunity; a nationwide program was established in the United States for the vaccination of all children over the age of nine months.

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Measles

MEASLES

DEFINITION


Measles is a viral infection (an infection caused by a virus). Its most characteristic feature is a reddish skin rash. Measles is also known as rubeola, five-day measles, or hard measles.

DESCRIPTION


Measles infections occur throughout the world. At one time, they reappeared in two- or three-year cycles, usually in the winter and spring. Today, there is a very effective measles vaccine. This vaccine has greatly reduced the occurrence of measles in many parts of the world.

Babies up to the age of eight months usually do not get measles. They receive special cells from their mothers that protect them against the disease. A person who has had measles will never get the disease again.

CAUSES


Measles is a very contagious disease. That is, it can be transmitted from one person to another very easily. The usual method of transmission is through coughing or sneezing. The virus that causes measles is contained in tiny droplets of moisture released when an infected person coughs or sneezes. A person who inhales those droplets will almost certainly develop measles.

The incubation period for measles is seven to eighteen days. The incubation period is the time between the moment the virus enters a person's body and the appearance of symptoms. A person is contagious (capable of passing on the infection) from three to five days before symptoms appear to about four days after the rash shows up.

SYMPTOMS


The first signs of measles are a fever, runny nose, red and runny eyes, and a cough. A few days later, a rash appears in the mouth. The rash consists of tiny white dots on a reddish bump. This rash is called Koplik's spots. They are important in diagnosing measles because they do not occur with other diseases. Koplik's spots are accompanied by a red, sore, swollen throat.

Measles: Words to Know

Encephalitis:
An infection of the brain that results in a high fever and swelling of the brain.
Koplik's spots:
Tiny white spots on a reddish bump on the inside of the mouth that are a characteristic marker for measles.

About two days after Koplik's spots appear, the measles rash begins. It first shows up on the head, face, and neck. It then travels to the abdomen and, finally, to the arms and legs. At first, the rash consists of flat, red patches. Eventually, bumps appear. The rash may or may not be itchy. As the rash develops, the patient's temperature begins to rise and may so as high as 105°F (40.5°C). Other symptoms include nausea, vomiting, diarrhea, and swollen lymph nodes. The patient usually feels very ill.

The rash normally lasts about five days. As it fades, it becomes more brownish in color. The affected skin becomes dry and flaky.

A bout of measles leads to other infections in 5 percent to 15 percent of patients. Some of these infections are caused by bacteria. These include ear infections, sinus infections, and pneumonia (see pneumonia entry). Other infections are caused by viruses. Some common viral infections are croup, bronchitis (see bronchitis entry), laryngitis (see laryngitis entry), and viral pneumonia. Inflammation of the liver, appendix, intestines, and lymph nodes are other problems that may develop as a result of a measles infection. Less common complications include inflammation of the heart or kidney, loss of blood platelets (the blood cells that help blood clot; pronounced PLATE-lits), and recurrence of old tuberculosis (see tuberculosis entry) infections.

Probably the most serious complication of a measles infection is encephalitis (see encephalitis entry). Encephalitis is a brain infection that results in a very high fever and swelling of the brain. Symptoms of encephalitis include fever, headaches, sleepiness, seizures, and coma. People with encephalitis may suffer serious, long-term brain damage. Encephalitis occurs in about 1 out of every 1,000 cases of measles. About 10 percent to 15 percent of those who develop the disease die from it.

A very rare complication of measles is called subacute sclerosing panencephalitis. This disease can occur up to ten years after infection by the measles virus. It develops slowly over a period of years and causes massive destruction of the brain. It eventually results in death.

DIAGNOSIS


Measles is fairly easy to diagnose because of its characteristic symptoms. The presence of Koplik's spots is often the most important clue. The appearance of a rash that travels from the head and neck out to the arms and legs is also an important indicator of a measles infection.

In case of doubt, a variety of laboratory tests can be performed. These tests are used to identify the presence of the measles virus in body fluids, such as urine and mucus.

TREATMENT


There is no treatment that can kill the measles virus or stop the course of the disease. Treatments instead are used to make a patient feel more comfortable during the disease. For example, acetaminophen (pronounced uh-see-tuh-MIN-uhfuhn, trade name Tylenol) can relieve pain and fever. Aspirin, however, should never be given to children who have measles. Aspirin has been found to cause Reye's syndrome (see Reye's syndrome entry), a potentially fatal disease.

A cool-mist vaporizer may help relieve the cough that comes with measles. Patients should also drink lots of liquids. The patient should be watched carefully to make sure that complications do not appear. If they do, antibiotics may be used to treat bacterial infections.

Alternative Treatment

Some practitioners believe that certain herbs can strengthen the body's immune system. Purple coneflower (echinacea; pronounced ek-i-NAY-see-uh) is one such herb. Homeopathic support can also be effective in helping a person feel more comfortable during a measles infection.

Some of the symptoms of measles can be relieved by using various herbs, such as bupleurum, peppermint, witch hazel, chickweed, or eyebright (for sore eyes). A preparation made from empty cicada shells has also been recommended.

PROGNOSIS


The prognosis for a child who is otherwise in good health is usually very good. In developing countries, however, death rates from measles can reach 15 percent to 25 percent. The prognosis for adolescents and adults is less favorable. Women who contract the disease while pregnant may give birth to a baby with hearing problems.

The most serious consequence of a measles infection is encephalitis. One in 1,000 measles patients will develop encephalitis. Of this number, about 10 percent to 15 percent will die; 25 percent will suffer permanent brain damage.

PREVENTION


A highly effective vaccine is now available to prevent measles. The vaccine is usually given at about fifteen months of age. A repeat injection should be given at about ten or eleven years of age.

FOR MORE INFORMATION


Books

Silverstein, Alvin, Virginia Silverstein, and Robert Silverstein. Measles and Rubella. Hillside, NJ: Enslow Publishers, Inc., 1997.

Stoffman, Phyllis. The Family Guide to Preventing and Treating 100 Infectious Diseases. New York: John Wiley & Sons, 1995.

Periodicals

Ramsey, Alison. "Childhood Diseases Are Back." Reader's Digest (February 1996): pp. 73+.

Organizations

Centers for Disease Control and Prevention. http://www.cdc.gov.

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measles

measles (mee-zŭlz) n. a highly infectious virus disease that mainly affects children. Early symptoms are those of a cold accompanied by a high fever, and Koplik's spots may appear on the inside of the cheeks. On the third to fifth day a blotchy slightly elevated pink rash develops; it lasts 3–5 days. The patient is infectious throughout this period. In most cases the symptoms soon subside but patients are susceptible to pneumonia and middle ear infections. Medical names: rubeola, morbilli.
www.measlesinitiative.org/index3.asp More information about measles from this multiorganizational international website

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Measles (Rubeola)

Measles (Rubeola)

KEYWORDS

for searching the Internet and other reference sources

Koplik spots

MMR vaccine

Rubeola

What Is Measles?

How Common Is Measles?

How Does Measles Spread?

What Are the Signs and Symptoms?

How Do Doctors Make the Diagnosis?

What Is the Treatment for Measles?

What to Expect

How Can Measles Be Prevented?

Resources

Measles (ME-zuls) is a viral respiratory system* infection that is best known for the rash of large, flat, red blotches that appear on the arms, face, neck, and body.

*respiratory system ,
or respiratory tract, includes the nose, mouth, throat, and lungs. It is the pathway through which air and gases are transported down into the lungs and back out of the body.

What Is Measles?

Measles, also known as rubeola (roo-be-O-luh), is a highly contagious viral infection caused by the measles virus. Most people are familiar with its most recognized feature: a near full-body rash of red blotches. In fact, measles is primarily an infection of the respiratory system. The disease has been diagnosed throughout the world, and before a vaccine* was available it commonly appeared in the United States in springtime epidemics* every few years. In the United States, 1 to 2 deaths occur for every 1,000 cases of measles. In developing countries, the fatality rate can be as high as 1 in every 4 people who contract the disease. Most deaths from measles in the United States are caused by pneumonia (nu-MO-nyah, inflammation of the lung), either from the measles virus itself or from a bacterial infection that arises as a complication of measles.

*vaccine
(vak-SEEN) is a preparation of killed or weakened germs, or a part of a germ or product it produces, given to prevent or lessen the severity of the disease that can result if a person is exposed to the germ itself. Use of vaccines for this purpose is called immunization.
*epidemics
(eh-pih-DEH-miks) are outbreaks of disease, especially infectious disease, in which the number of cases suddenly becomes far greater than usual. Usually, epidemics are outbreaks of diseases in specific regions, whereas worldwide epidemics are called pandemics.

How Common Is Measles?

Before the introduction of the measles vaccine in 1963, approximately 500,000 reported cases of measles and 500 deaths occurred in the United States each year. Since the start of measles vaccination programs, though, infection rates have dropped by more than 98 percent, and epidemics have all but disappeared. According to the U.S. Centers for Disease Control and Prevention, between 1993 and 2001 there were fewer than 500 cases of measles diagnosed each year (in 2000 there was an all-time low of 86 cases). However, an earlier resurgence of measles between 1989 and 1991 led to more than 55,000 diagnosed cases and 123 deaths. This epidemic arose because many children were not being vaccinated.

Measles Redux

Cases of measles infection rose dramatically during the years 1989 to 1991 in the United States and other countries. Nearly half of the U.S. patients were unvaccinated preschool children living in urban areas. The epidemic began because of a lapse in measles vaccinations and public education. Many people were unaware that measles was still a threat, because years of public vaccinations had controlled the infection; some were afraid of adverse reactions to the vaccine itself. Emergency vaccinations eventually contained the epidemic, but the outbreak revealed the persistence of a virus that many believed was no longer a cause for concern.

By contrast, the effect of measles in the developing world remains staggering. The disease accounted for about 777,000 deaths in 2001. Limited access to the vaccine is the primary reason that developing countries continue to see huge numbers of measles cases. Immigrants to the United States who have not received the vaccine in their native countries account for many of the cases of the disease that occur in the United States.

How Does Measles Spread?

Measles is highly contagious and can spread quickly among people who have not been immunized against it. The measles virus spreads by direct contact with an infected person or by breathing in tiny drops of fluid sent into the air when the person sneezes, coughs, or laughs. A cough or sneeze releases thousands of microscopic particles that contain the virus. They can stay in the air, able to infect people, for up to 2

The Spread of Measles

Historically, infectious diseases have been powerful players on the world stage. They have toppled kingdoms, swept through countries with devastating results, and altered world economies and religions. Measles traveled around the globe with European adventurers and explorers. The disease cut a swath through the inhabitants of the Pacific Islands and the Americas (North America, South America, and Central America). When the Spanish conquistadors Hernán Cortés (14851547) and Francisco Pizarro (ca. 14751541) arrived in the Americas, they unknowingly carried with them measles and smallpox, which resulted in the death of an estimated one-third of the native populations.

hours. In some cases, people have caught measles after entering a room that an infected person has already left. A person with measles is contagious from 1 to 2 days before the symptoms begin until 4 or 5 days after the rash appears.

Measles poses a serious health treat to children, especially in developing countries where adequate medical treatment is difficult to obtain. Custom Medical Stock Photo, Inc.

What Are the Signs and Symptoms?

After a person has been exposed to the virus, there is an incubation period that averages 10 to 12 days. The first symptoms include fever, runny nose, cough, and reddened eyes that are sensitive to light. Koplik spots, a unique sign of measles, break out 1 to 2 days before the rash begins and usually are gone by the time it appears; they are bluish-white dots found on the inside of the cheeks and other places on the mucous membranes (moist linings) in the mouth.

The measles rash typically begins on the forehead and extends down across the face, neck, and body. It generally takes several days for the rash to travel from head to toes. The red blotches often spread out and join, completely covering the skin, especially on the face and shoulders. Once the rash appears, 2 to 4 days after the onset of illness, the fever rises and may peak at 104 to 105 degrees Fahrenheit. During this time, the patient looks and feels very ill. Symptoms improve soon after the rash has traveled down to the legs and feet, usually accompanied by a rapid drop in temperature. The rash fades along the same path that it appeared, beginning at the forehead and working its way down. As the rash disappears, the skin may temporarily look brown, dry, and flaky. Other symptoms of measles include loss of appetite, vomiting, and diarrhea (dye-uh-REE-uh), especially in young children. Hemorrhagic (heh-muh-RAH-jik) measles is a rare and serious form of the disease characterized by hemorrhaging (uncontrolled or abnormal bleeding), high fever, seizures*, and delirium*.

*seizures
(SEE-zhurs) are sudden bursts of disorganized electrical activity that interrupt the normal functioning of the brain, often leading to uncontrolled movements in the body and sometimes a temporary change in consciousness.
*delirium
(dih-LEER-e-um) is a condition in which a person is confused, is unable to think clearly, and has a reduced level of consciousness.

How Do Doctors Make the Diagnosis?

Measles can be diagnosed by asking a patient about symptoms and performing a physical examination. If there is a question about the diagnosis or if it is necessary to confirm a suspected case of measles, blood tests can determine whether antibodies* to the virus have developed in the body.

*antibodies
(AN-tih-bah-deez) are protein molecules produced by the bodys immune system to help fight specific infections caused by microorganisms, such as bacteria and viruses.

What Is the Treatment for Measles?

Because measles is caused by a virus, treatment generally is aimed at keeping the patient comfortable until the infection runs its course. The high fever and sweating that accompany measles raise the risk of dehydration*, so patients should have plenty of rest and fluids. Taking vitamin A may aid recovery in some cases, especially among children with poor nutrition. Serious cases may require a hospital stay and intravenous fluids*. Antibiotics are given when bacterial infections (such as ear infections or pneumonia) develop as complications of the disease.

*dehydration
(dee-hi-DRAY-shun) is a condition in which the body is depleted of water.
*intravenous
(in-tra-VEE-nus) fluids are fluids injected directly into a vein.

What to Expect

Measles generally lasts between 10 and 14 days from the onset of symptoms through the fading of the rash. Ear infections, croup*, and pneumonia sometimes accompany measles. Less commonly, inflammation of the brain (known as encephalitis, en-seh-fuh-LYE-tis) or inflammation of the heart muscle (known as myocarditis, my-oh-kar-DYE-tis) can occur. Subacute sclerosing panencephalitis* (SSPE), a type of encephalitis, is an extremely rare late complication of lasting measles virus infection that can cause gradual loss of brain function. SSPE may occur months, years, or even decades after measles infection, but it is almost never seen in the United States, as a result of widespread use of the measles vaccine. If a pregnant woman contracts measles, the infection can harm her developing baby, leading to miscarriage*, premature labor*, or low birth weight.

*croup
(KROOP) is an infection involving the trachea (windpipe) and larynx (voice box) that typically occurs in childhood. It causes inflammation and narrowing of the upper airway, sometimes making it difficult to breathe. The characteristic symptom is a barking cough.
*subacute sclerosing panencephalitis
(sub-uh-KYOOT skluh-RO-sing pan-en-seh-fuh-LYE-tis), or SSPE, is a chronic brain disease of children and adolescents that occurs months or years after having had measles; it causes convulsions, movement problems, and mental retardation and is usually fatal.
*miscarriage
is the ending of a pregnancy through the death of the embryo or fetus before birth.
*premature labor
is labor (the birth process) that begins too early, before the fetus has developed fully in the womb.

How Can Measles Be Prevented?

The best protection against measles is immunization. The vaccine usually is given as part of a combined measles-mumps-rubella (MMR) vaccine that children typically receive twice in their lives. The first round is given when an infant is 12 to 15 months old and the second when the child is ready to start school, at 4 to 5 years old. Children also may receive the second vaccine when they are 11 or 12 years old, if they do not receive it earlier. Because about 5 percent of people do not develop protective antibodies after the first MMR vaccine, the second dose offers better protection against infection. If someone comes into contact with a person who has measles and then is vaccinated within 3 days of that exposure, the vaccine may prevent or lessen the severity of a case of measles. Immune globulin* can have the same result if it is given within 6 days of exposure to the virus.

*immune globulin
(ih-MYOON GLAH-byoo-lin), also called gamma globulin, is the protein material that contains antibodies.

See also

Encephalitis

Mumps

Myocarditis/Pericarditis

Pneumonia

Rubella (German Measles)

Vaccination (Immunization)

Resources

Organization

U.S. Centers for Disease Control and Prevention (CDC), 1600 Clifton Road, Atlanta, GA 30333. Through the website of the National Center for Infectious Diseases, the CDC provides a fact sheet and other information on measles.

Telephone 800-311-3435 http://www.cdc.gov/ncidod/

Website

KidsHealth.org. KidsHealth is a website created by the medical experts of the Nemours Foundation and is devoted to issues of childrens health. It contains articles on a variety of health topics, including measles.

http://www.KidsHealth.org

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measles

measles infectious disease marked by an eruption. XIV. ME. maseles (pl.), prob. — MLG. masele, MDu. masel pustule, spot on the skin (Du. mazelen measles) = OHG. masala blood-blister, f. Gmc. *mas- spot, excrescence (cf. MAZER). The change of form from masel to mesel (whence the present form) appears to be due to assim. to ME. mesel leper (- OF. mesel :- L. misellus, f. miser wretched, MISERABLE).

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measles

measles (rubeola) Extremely infectious viral disease most common in children. The symptoms (fever, catarrh, skin rash and spots inside the mouth) appear about two weeks after exposure. Hypersensitivity to light is characteristic. Complications such as pneumonia occasionally occur, and middle-ear infection is also a hazard. Vaccination produces life-long immunity.

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measles

mea·sles / ˈmēzəlz/ • pl. n. (often the measles) [treated as sing.] an infectious viral disease causing fever and a red rash on the skin, typically occurring in childhood. ∎  a disease of pigs and other animals caused by the encysted larvae of the human tapeworm.

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measles

measles •Casals • Charles •Dardanelles, Seychelles, Wells •Hales, Swales, Wales •entrails • telesales • cat-o'-nine-tails •Hills, Mills, Sills, Wills •Giles, Miles, Smiles, Stiles •hols • consols •balls, Rawls, Walls •Fowles •Bowles, Coles, Rolls •gules, Jules •collywobbles • Gorbals • Mumbles •Goebbels • Needles • oodles • Raffles •Engels • Gleneagles • Eccles • Pickles •Naples • Brussels • battels • Beatles •bristols • measles

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Measles (Rubeola)

Measles (Rubeola)

Introduction

Disease History, Characteristics, and Transmission

Scope and Distribution

Treatment and Prevention

Impacts and Issues

Primary Source Connection

BIBLIOGRAPHY

Introduction

Measles is an acute viral illness that is one of the most common diseases of childhood, along with mumps and German measles (rubella). The clinical name for measles is rubeola, which comes from the Latin word ruber meaning red, and is a reference to the pinkish-red rash that is characteristic of the disease. Measles is a highly infectious disease, spread by coughs, sneezes, and person-to-person contact. It will occasionally lead to serious and even potentially fatal complications, such as pneumonia and encephalitis. Once someone has had measles, they are usually immune for life. Vaccination was introduced in the 1960s in the Western world and has led to a dramatic reduction in the number of children contracting measles. Since humans are the only hosts for the measles virus, it should be possible to eradicate measles, through universal vaccination. This requires a global effort to bring the vaccine to children everywhere.

Disease History, Characteristics, and Transmission

Measles is caused by a virus from the Paramyxoviridae family, which also includes the influenza and mumps viruses. It is a single stranded, enveloped, RNA virus— that is, its genetic material is RNA rather than DNA. The incubation time of the measles virus is 9–12 days. The virus first infects the epithelial cells lining the upper respiratory tract and then spreads to the rest of the body. In typical or natural measles, the early symptoms are like those of a common cold and include coughing, sneezing, sore throat, and fever. Within a few days, characteristic small white spots called Koplik's spots develop inside the mouth. A day or so later, a rash appears, starting behind the ears and spreading to the face and down the body and lasting for three or four days. Complications occur in up to 30% of cases of measles, and include pneumonia and otitis media, a middle ear infection that can lead to deafness. Encephalitis, an inflammation of the brain, is a complication in around one out of 1,000 cases of measles and has a 10% mortality rate. Mortality (death) from measles complications is highest among infants under two years old and in adults.

There is also a modified form of measles that occurs among those who have been incompletely vaccinated. Modified measles is less severe than typical measles and Koplik's spots may be absent. However, the risk of complications is the same. Rarely, a form of the disease called atypical measles may occur, usually among those who received vaccine in the 1960s. Atypical measles is characterized by sudden onset of fever, muscle pain, abdominal pain, and headache. Koplik's spots are rarely present and pneumonia is a common complication. Subacute sclerosing panencephalitis is an extremely rare degenerative disease of the brain and nervous system that is thought to arise from persistent measles infection in the brain. It occurs at a rate of around one per 100,000 cases and develops several years after measles exposure.

Measles is spread through the aerosol route—that is, through coughs and sneezes—and also by person-to-person contact. It is one of the most infectious diseases known, with around 90% of those being exposed becoming infected. A person is infectious for three to four days before the rash appears and for up to four days while the rash is present.

Scope and Distribution

Practically all children developed measles at some stage before vaccination, with the disease being most common in the winter and early spring. Before the introduction of the measles vaccine in 1963, there were 200,000–600,000 cases of measles a year in the United States, and this was probably a gross underestimate of the true scale of the disease. Before vaccination, measles killed more children than polio did. There was a sharp decline in measles cases following mass vaccination, followed by resurgence from 1983. This occurred among those who had not been vaccinated and among previously vaccinated teenagers. By 1989, there were 19,000 reported cases. A revised vaccination strategy, involving two doses instead of one, brought measles under control again. By 1993, cases were down to fewer than 1,000 annually in the United States. Measles has always been a global problem and has a major impact upon child health in developing countries, where vaccination is not readily available. According to the World Health Organization (WHO), there were around 30 million cases of measles around the world in 2004, of which 454,000 proved fatal. Measles can be dangerous to the fetus if a pregnant woman contracts measles in the first three months of pregnancy. Patients with weakened immunity, such as those with HIV/AIDS, are also at risk of complications from measles.

Treatment and Prevention

Treatment of measles is often unnecessary, although antibiotics may be given for secondary bacterial infections. Vitamin A may be useful in very severe cases and in countries where this vitamin deficiency is common. The antiviral drug ribavirin may be used in very severe cases also, and in patients with weakened immunity.

The spread of measles can be prevented by good hygiene, including handwashing. People with measles should isolate themselves while they are infectious and not attend school or day care. The best way of preventing measles is by vaccination. A killed vaccine was introduced in 1963, followed by a live vaccine from the late 1960s. It is now usual to give a combined measles, mumps, and rubella (MMR) vaccine—one dose between 12 and 15 months and a second before a child enters school. Most people can take MMR, but it is not usually recommended for people with weakened immunity or for pregnant women. Some parents have concerns over the safety of the MMR vaccine, because it has been linked with autism, and have refused vaccination for their children. In areas where vaccination rates have fallen, for this and other reasons, there have been new and significant measles outbreaks.

Impacts and Issues

Measles is the leading cause of vaccine-preventable death among children. The death rate from measles in developed countries is very low but reaches 1–5% in developing countries. The death rate from measles can be as high as 10–30% among malnourished children or those in refugee situations. Around 400,000 children under five years of age die from measles each year. But measles is a disease that could be eradicated from the planet, since humans are the virus’ only host. In 2001, the Measles Initiative was established by the American Red Cross, the Centers for Disease Control and Prevention, UNICEF (the United Nations Children's Fund), and the WHO. The Initiative aims to cut deaths from measles by 90% by 2010 compared to figures from the year 2000, using vaccination that can cost less than a dollar per child. In the first five years, the Initiative supported campaigns, with national governments, that led to the vaccination of more than 217 million children, mainly in Africa. This saw measles deaths in Africa drop by 75%—from 506,000 in 1999 to 126,000 in 2005. The Initiative has now expanded its vaccination activities to Asia and is working in all six WHO regions of the world in an attempt to eradicate measles and its impact on child health.

WORDS TO KNOW

AEROSOL: Particles of liquid or solid dispersed as a suspension in gas.

KOPLIK'S SPOTS: Koplik's spots, named after American pediatrician Henry Koplik (1858–1927) and also called Koplik's sign, are red spots with a small blue-white speck in the center found on the tongue and the insides of the cheeks during the early stages of measles.

MORTALITY: Mortality is the condition of being susceptible to death. The term “mortality” comes from the Latin word mors, which means “death.” Mortality can also refer to the rate of deaths caused by an illness or injury, i.e., “Rabies has a high mortality.”

Primary Source Connection

During the late 1970s and early 1980s, the rise of individualism and the popularity of self-help movements in the United States and Western Europe provided a new challenge to public health officials. Individuals began to take control of their own heath care and, in essence, some control and responsibility was wrested away from the physician and other health care workers. This presented a special challenge to public health agencies because a manifestation of the movement toward self directed health care also involved the rejection of traditional vaccinations such as the MMR vaccine.

Over the last decade, many parents further rejected using the MMR vaccine out of fears that the vaccine was linked to autism.

The newspaper article by Mark Porter and commentary below demonstrate different aspects of the scientific and social debate over the MMR vaccine. The article also demonstrates the attempts by scientific community to be both self-correcting and to discipline breeches of ethics. The commentary offers a view that although the original research linking the MMR vaccine to autism appears tainted, the vigorous investigation might lead to future benefits in the way vaccines are developed and tested.

Mark Porter is is a medical doctor who provides regular advice and commentary on medical issues for radio and television programming in the United Kingdom.

Doctor Who Sparked the MMR Debate Faces Misconduct Charge

THE doctor whose research sparked the international scare over the safety of the MMR vaccine is to be charged with serious professional misconduct.

Andrew Wakefield is to be ordered in front of the General Medical Council after publishing a paper in The Lancet in 1998 that suggested a link between the jab and autism as well as Crohn's, a bowel disease.

A sheet of preliminary charges accuses him of putting out “inadequately founded” research, of failing to obtain ethical committee approval, obtaining funding “improperly” and of subjecting children to “unnecessary and invasive investigations.”

Dr. Wakefield's study is held responsible by many doctors for a dramatic slump in the number of parents allowing their children to have the combined injection against measles, mumps and rubella.

Take-up of the vaccination has fallen to only 12 per cent of children in some areas of London, while city-wide little more than half are having the jab - putting an estimated 100,000 of London children at risk of infection.

In 2004, The Lancet withdrew the paper, with the editor declaring it “fatally flawed” after it emerged Dr. Wakefield had been paid [pounds sterling]55,000 (more than $100,000) by lawyers for parents of children who claimed they had been damaged by the MMR vaccine to look for evidence that could be used in legal action. GMC lawyers are working on the list of charges with a hearing expected next year. If found guilty of serious professional misconduct Dr. Wakefield, 50, faces being struck from the medical register. The GMC decided to bring a case against the doctor contrary to normal procedures. It usually only brings charges when it receives a complaint, but in this case it acted without one, following a two-year investigation.

Why we all owe Wakefield a debt of thanks

COMMENTARY

DR ANDREW WAKEFIELD has had a spectacular fall from grace.

Eight years after sparking worldwide concern about the safety of the MMR vaccine, his research has been rejected by the journal that originally published it, and most of his fellow researchers have distanced themselves from his conclusions.

A promising career in the UK has come to an abrupt end and he has left the country. To cap it all, he is set to be charged with professional misconduct by the General Medical Council. While intrigued by Wakefield's theory that exposure to the measles virus could predispose some children to autism, I have always felt that he was wrong to cast doubts on the safety of MMR without more evidence.

But just because we didn't see eye to eye it doesn't mean that I am comfortable with the public pillorying that he has recently endured. Indeed, I am distinctly uncomfortable with it. We need mavericks like Andrew Wakefield, and his plight can only stifle the sort of independent thinking required to make major breakthroughs in medicine. History has taught us that there is a fine line between being dismissed as an eccentric and being lauded as a genius. Nobel Prize winner Dr. Barry Marshall is a case in point.

At first Dr Marshall's claims that stomach and duodenal ulcers were caused by an infection (H.pylori) and could be treated with antibiotics, rather than a lifetime of acid suppressing drugs, were treated with derision.

But he persevered.

Fifteen years later his discovery has transformed the lives of millions of patients and he has become one of medicine's most distinguished academics.

While Dr. Wakefield has achieved notoriety rather than eminence, his enthusiasm left me in little doubt that he really did believe he had stumbled across something that questioned the safety of the MMR vaccine. Time may have proved him wrong, but back in 1998 when he first raised the possibility, we simply didn't have enough data to back the bland reassurances issued by the Department of Health.

Thanks to him sticking his head above the parapet, we now know far more about the MMR vaccine than we ever would have known had he not questioned its safety.

And I suspect the resulting scepticism, both lay and professional, that now surrounds the introduction of new vaccines will benefit us all in the long-term.

IN CONTEXT: SCIENTIFIC, POLITICAL, AND ETHICAL ISSUES

With regard to a potential connection between the measles, mumps, and rubella vaccine (MMR vaccine) and autism, scientists at the National Immunization Program (NIP) at Centers for Disease Control and Prevention (CDC) state that “the weight of currently available scientific evidence does not support the hypothesis that MMR vaccine causes autism. CDC recognizes there is considerable public interest in this issue, and therefore supports additional research regarding this hypothesis. CDC is committed to maintaining the safest, most effective vaccine supply in history.”

As of May 2007 the CDC further states that, “there is no convincing evidence that vaccines such as MMR cause long term health effects. On the other hand, we do know that people will become ill and some will die from the diseases this vaccine prevents. Measles outbreaks have recently occurred in the UK and Germany following an increase in the number of parents who chose not to have their children vaccinated with the MMR vaccine. Discontinuing a vaccine program based on unproven theories would not be in anyone's best interest. Isolated reports about these vaccines causing long term health problems may sound alarming at first. However, careful review of the science reveals that these reports are isolated and not confirmed by scientifically sound research. Detailed medical reviews of health effects reported after receipt of vaccines have often proven to be unrelated to vaccines, but rather have been related to other health factors. Because these vaccines are recommended widely to protect the health of the public, research on any serious hypotheses about their safety are important to pursue. Several studies are underway to investigate still unproven theories about vaccinations and severe side effects.”

SOURCE: Centers for Disease Control and Prevention, National Immunization Program

Mark Porter

PORTER, MARK. “DOCTOR WHO SPARKED THE MMR DEBATE FACES MISCONDUCT CHARGE.” THE EVENING STANDARD. JUNE 12, 2006.

See AlsoChildhood Infectious Diseases, Immunization Impacts; Mumps; Rubella.

BIBLIOGRAPHY

Books

Tan, James S. Expert Guide to Infectious Diseases. Philadelphia: American College of Physicians, 2002.

Wilson, Walter R., and Merle A. Sande. Current Diagnosis & Treatment in Infectious Diseases. New York: McGraw Hill, 2001.

Web Sites

The Measles Initiative. “Home Page.” March 16, 2007. <http://www.measlesinitiative.org/index3.asp> (accessed March 20, 2007).

Susan Aldridge

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