A nervous mom brought in her 13-month-old baby daughter who had a rash on her face and trunk.

 

This rash consisted of small red spots that were flat and somewhat splotchy. The child had no fever and looked well after a normal exam. She smiled and was engaging and playful.

 

Then mom confessed that the child had 3-to-4 days of high fever prior to the rash, with no other symptoms. She responded nicely to Tylenol and the fever broke yesterday. Now she has this rash.

 

Mom was concerned that the baby might have measles. She felt guilty because she had been dragging her feet on getting the child the MMR vaccine. I smiled and told her unequivocally the baby did NOT have the measles. Instead, she had Roseola which is a benign viral illness that essentially all children get early in life. She would be just fine. Roseola starts with a high fever that can last for a few days with minimal symptoms. Then the fever breaks and the rash appears. I have written articles about Roseola that are available in the archives. Mom let out a big sigh of relief and said that she was more than ready for her daughter to get the MMR vaccine now.
 

What is measles and how does it present itself?

 

Measles is a virus that is known as Rubeola and is one of the most highly contagious of the human pathogens. It is spread via nasal airborne droplets by way of coughing or sneezing, or through contact with secretions from the nose. This is called the incubation period. One may show signs of illness 7-to-10 days after coming in contact with an infected person. The usual course of a measles infection is around 10 days.

 

The first sign to look for is a high fever that can reach up to 105 degrees.

 

A harsh dry cough, runny nose and congestion and red, weepy and inflamed eyes may follow. The child looks and feels very ill. Two-to-three days after the onset of symptoms there may be some lesions inside the mouth. These appear as white grains of salt/sand on a red base on the cheek, opposite the molars. These are known as Koplik spots and are pathognomonic for measles, only seen with this virus. Often times there are swollen and enlarged lymph nodes behind the ears and in the neck.
 

Then 3-to-5 days after the onset of symptoms the rash appears.

 

This is a red and blotchy skin eruption that starts behind the ears and on the face. It spreads to the trunk and down the extremities. It can last 7-to-10 days before slowly resolving from a red to a brown/bronze rash that almost appears to stain the skin before it finally leaves.
 

There should be no question that a child with measles is miserable and that it is a serious infection with many potential complications.

 

Many infected children have significant diarrhea. They may get a middle ear infection, a severe pneumonia, swelling of the brain (encephalitis) or even blindness. The blindness occurs when there is an ulceration of the cornea that can lead to scarring. Most severe complications occur in children under five years of age, adults over 20 years of age and in pregnant women. While most children with measles do survive, 1-in-4 will be hospitalized. And the mortality rate is 1-to-2 per 1000 cases.
 

There is no specific treatment for measles…just supportive care.

 

This would include temperature control with Tylenol or Ibuprofen, plenty of fluids to insure good hydration, elevating the head of the crib or bed and giving something to alleviate the cough and runny nose. While there is no treatment for measles, it is a PREVENTABLE disease with the MMR vaccine (measles, mumps and rubella). In its present form it has been used in the United States since 1971. We normally give the first dose at a year of age This will be 95% effective in preventing measles. A second dose is given before school, around 4-to-5 years of age. This will offer 97-to-99% full protection. The second dose is NOT a booster. It is to pick up the 5% that did not mount a full protective response with the first vaccine. If a child is traveling abroad to an area that is having an outbreak of measles, it is recommended to give a vaccine at nine months of age before he travels. The vaccine cannot be given earlier because there may be some protective antibodies passed to the child from mom through the pregnancy that will mute the infant’s own antibody production.
 

There has been more and more apprehension and reluctance to the MMR vaccine fostered by social media.

 

Now with the influx of immigrants from all over the world, there have been outbreaks of measles in areas of the United States. And this is most likely to get worse. The MMR has been instrumental in preventing measles and almost eradicating it in the United States. I have been in private practice for 42 years. The last case of measles I saw was when I was a resident at LA County-USC Medical Center in the early 1980’s. I’m afraid it is just a matter of time before I see my next case.