Measles: The road to eradication

Measles, or rubeola, is a highly contagious viral disease most commonly seen in young children who are unvaccinated against it. It is caused by a single-stranded, negative-sense, nonsegmented, enveloped RNA virus. In the pre-vaccine era, annual seasonal epidemics (lasting 3–4 months) superimposed upon longer epidemic cycles were seen, with regular outbreaks every 2–5 years. Measles virus is highly contagious, with nonimmune exposed persons having a > 90% secondary attack rate in close contact settings. Following infection via the respiratory route, measles has an incubation period of about 10–14 days. A prodromal phase with fever and the “3 Cs” (cough, conjunctivitis and coryza) initially occurs. Measles rash is maculopapular and erythematous, beginning on the face and back of the ears, then spreading downward and outward. The rash may desquamate and fades about 5 days later in the same order as it appeared. Complications occur in up to 40% of patients including pneumonia, encephalitis, and death. Viral tests are used to confirm infection. RT-PCR has replaced viral culture for diagnosis. Primary treatment of measles is supportive care. Vitamin A supplementation is recommended by the World Health Organization to be administered orally to children with measles. Airborne transmission precautions should be used for hospitalized patients. Vaccination with live-attenuated vaccines is the best method to prevent measles. As humans are the only host for the measles virus, eradication may be possible.