Measles B05.99

ar-Razi (Rhazes) around 900

Severe, highly contagious (transmitted by droplet infection), notifiable(obligation to report by name in case of suspicion and manifest disease) infectious disease caused by an RNA virus (family of paramyxoviruses) with typical exanthema and enanthema.

Measles virus (RNA virus of the paramyxovirus family. Transmission by droplet infection. Infectious during the catarrhal stage and in the first days of exanthema.

Worldwide, around 200,000 people contract measles every year (mainly in African countries). The infestation rate is almost 100%. In Germany, local outbreaks with varying numbers of cases are reported time and again. According to the Robert Koch Institute, 2,464 cases were reported in Germany in 2015, 325 cases in 2016 and slightly more than 900 cases in 2017.

Due to a herd effect, measles can lead to the clustering of individuals in sub-populations who are themselves immune to the pathogens of transmissible infectious diseases neither through infection nor vaccination. If germ carriers enter this group and the herd effect for this group is insufficient for the measles virus, the affected persons risk contracting a disease that is so far "only" known as a childhood disease. Such age shifts have been documented for measles. At an older age, measles is more difficult to detect, so that measles pneumonia, for example, is treated appropriately at a later stage.

In addition, measles occurs somewhat more frequently in newborns in the period up to the first vaccination (recommended between the completed 11th and 14th month of life) if their mothers were vaccinated against these pathogens than if the mothers had experienced measles as an infection, because the surrogate immunity caused via the placenta wears off more quickly after vaccination than after infection.

• Stage-like course.
  • Incubation period: 8-10 days until prodromia, 14 days until exanthema
  • Catarrhal prodromal stage: severe generalized feeling of illness, fever up to 40 °C, rhinitis, conjunctivitis, photophobia, pharyngitis, tracheitis, generalized lymphadenopathy. On the 2nd to 3rd day coplik spots (white spots of the cheek mucosa opposite the molars), defibrillation with rapid temperature rise with simultaneous development of enanthema and exanthema.
  • Exanthematic stage: On the 3rd day of the disease, enanthema of the palate, tonsils, uvula. Large red, round or oval, initially pale and then dark red spots, also haemorrhagic; spots tend to confluence.
  • Craniocaudal course beginning first behind the ears, then on the neck and trunk, and finally on the extremities. Enlargement and confluence of the spots. After 3-4 days of temperature drop, fading of the exanthema in the mentioned order. Small lamellar white (bran-like) scaling of the affected skin areas.
• Special forms of progression:
  • Abortive form: Morbilloid
  • Measles pemphigoid
  • Primary toxic measles: Foudroyanter course with somnolence, hyperpyrexia, bloody stools, circulation disorders, cramps and lethal outcome is possible.

Prodromal stage: Leukocytosis. Exanthematic stage: leukopenia, neutropenia, thrombopenia, eosinopenia. A previously positive tuberculin test can become negative!

Industrialized countries: in 10-15% of cases bronchopneumonia, otitis media, measles croup. Rare: measles encephalitis, subacute sclerosing panencephalitis. Complications are due to virus-induced immunosuppression which persists for about 6 weeks.

The occurrence of TEN after measles vaccination has been described in the literature.

In children at risk or immunosuppressed, IVIG therapy e.g. with gamma globulin (e.g. beriglobin 0.2-0.5 ml/kg bw i.m.), effective up to the 3rd day after contact (between the 4th and 7th day of incubation, the course of the disease may be attenuated).

Otherwise symptomatic therapy: In the prodromal stage, bed rest in darkened rooms and, if necessary, antipyretic measures such as paracetamol (e.g. ben-u-ron juice or supp.) 15 mg/kg bw as ED, up to 50 mg/kg bw/day. Expectorants such as acetylcysteine (e.g. ACC granules): infants 100 mg/day, children 200-400 mg/day, adults and adolescents 600 mg/day. Fluid and electrolyte intake.

In case of bacterial superinfection (e.g. skin, bronchopneumonia), hospitalisation and antibiotic treatment if necessary, initially with broad-spectrum antibiotics such as dicloxacillin (e.g. InfectoStaph), then according to antibiogram. According to the clinic, intensive medical care if necessary.

In case of laryngotracheitis with croup (danger of suffocation!) emergency admission to hospital.

Active immunisation with live attenuated vaccines towards the end of the 1st year of life. Repeat vaccination between the 3rd and 6th year of life.

Since March 1, 2020, the Measles Protection Act has come into force. The law stipulates that all children from the completed first year of life must have the measles vaccinations recommended by the Permanent Vaccination Commission when entering school or kindergarten. Proof of measles vaccination is also generally required when a child is cared for by a daycare provider.

The same applies to persons working in community facilities or medical institutions such as educators, teachers, day care workers and medical personnel (as long as these persons were born after 1970). Asylum seekers and refugees must also have the vaccination four weeks after admission to a communal accommodation.

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3. Duke T et al (2003) Measles: not just another viral exanthem. Lancet 361: 763-773
4. Hellenbrand W et al (2003) Progress towards measles elimination in Germany. J Infect Dis 187: S208-216
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