Measles

A Comprehensive Clinical & Nursing Guide

Definition

Measles is an acute, highly contagious viral illness caused by the Measles virus (genus Morbillivirus, family Paramyxoviridae). It presents with fever, cough, coryza, conjunctivitis, Koplik spots, and a maculopapular rash that spreads from the face downward.

Causative Agent

Measles virus – an RNA virus belonging to the Paramyxovirus group.

Risk Factors

• Age: Common in children under 5 years, but can affect any age without immunity.
• Sex: Equal incidence in both sexes.
• Immunity:
  • Single natural infection gives lifelong immunity.
  • Second attacks are rare.
  • Unvaccinated individuals at highest risk.
• Malnutrition: Especially Vitamin A deficiency increases severity.
• Poor living conditions: Overcrowding, poor ventilation.

💡 Global Note: Measles remains a leading cause of vaccine-preventable death in children worldwide, especially where vaccination rates are low.

Source of Infection

Infected human is the only reservoir.

Virus present in:

• Nasal secretions
• Throat secretions
• Respiratory droplets

Mode of Transmission

Highly contagious. Spread by:

• Droplet infection
• Airborne droplet nuclei
• Direct contact with respiratory secretions

Infectious period: 4 days before rash → 4 days after rash.
Maximum infectivity just before the rash appears.

Incubation Period

10–12 days (range: 7–14 days).
Prodromal symptoms appear before rash.

Clinical Manifestations

1. Prodromal Stage (Catarrhal Stage)

• High fever (100–103°F and rising)
• The 3 C’s:
  • Cough
  • Coryza (runny nose)
  • Conjunctivitis
• Watery eyes, photophobia
• Hoarseness of voice
• Koplik spots:
  • Small bluish-white spots on buccal mucosa
  • Seen 1–2 days before rash
  • Pathognomonic sign

2. Rash Stage (Exanthem Stage)

• Rash begins on face and behind ears, then spreads downward to trunk and limbs.
• Reddish, maculopapular, blanching initially.
• Lasts 5–6 days.
• Followed by brownish discoloration and fine desquamation.

3. Recovery Stage

• Fever subsides gradually.
• Rash fades in the same order it appeared.

Diagnostic Evaluation

• Clinical diagnosis is usually sufficient (Koplik spots + rash).
• Giemsa stain: Shows multinucleated giant cells.
• Immunofluorescence: Detects viral antigens in tissue.
• ELISA (IgM):
  • Confirms acute infection
  • CSF IgM used in measles encephalitis
• RT-PCR: Highly sensitive, detects viral RNA.

Complications

Common

• Otitis media
• Bronchopneumonia
• Acute gastroenteritis
• Laryngotracheobronchitis (croup)

Serious

• Acute encephalitis
• Febrile seizures
• Conjunctivitis → corneal ulcer, blindness

Long-term

• SSPE (Subacute Sclerosing Panencephalitis) – fatal, occurs years after infection
• Immunosuppression leading to secondary infections

Management

General

• Strict bed rest in a quiet, darkened room.
• Ensure good ventilation.
• Encourage plenty of fluids (water, juices, ORS, milk).
• Provide soft, nutritious, high-calorie diet.
• Maintain hygiene and comfort.

Medications

• Antipyretics: Paracetamol for fever.
• Antibiotics: Only if bacterial infection suspected (e.g., pneumonia, otitis media).
• Vitamin A Supplementation:
  • Reduces severity & risk of blindness
  • 1 lakh IU (6–11 months) or 2 lakh IU (>1 year), given on 2 consecutive days.

Isolation

• Isolate the patient until 4 days after rash onset.
• Avoid contact with unimmunized persons.

Prevention

Active Immunization

• Measles vaccine / MMR vaccine
• 0.5 mL subcutaneous
• Given at 9 months, 16–24 months, and 5 years (as per local schedule).

Passive Immunization

Human immunoglobulin for:

• Malnourished children
• Immunocompromised individuals
• Infants <6 months
• Pregnant women exposed to measles

🌍 Herd Immunity: ≥95% two-dose MMR coverage is needed to stop community transmission.

Nursing Management

1. Assessment
   • Monitor: Temperature, respiratory rate, hydration, rash, eye/ear symptoms, neurological signs
   • Check immunization history.
2. Infection Control
   • Airborne + droplet precautions
   • Well-ventilated, separate room
   • Caregivers must be immune
   • Use masks, gloves; practice hand hygiene
3. Comfort Measures
   • Tepid sponging for fever
   • Darkened room for photophobia
   • Clean eyes with warm water
   • Petroleum jelly for dry lips
4. Hydration & Nutrition
   • Encourage frequent fluids
   • Soft, easy-to-digest foods
   • Monitor intake/output
5. Eye Care
   • Prevent eye rubbing
   • Watch for ulceration; refer promptly
6. Skin Care
   • Keep skin clean and dry
   • Trim nails to prevent scratching
   • Use soothing lotions if needed
7. Medication Administration
   • Give antipyretics as ordered
   • Administer Vitamin A
   • Antibiotics only when prescribed
8. Prevention of Complications
   • Monitor for: breathing difficulty, persistent fever, ear discharge, drowsiness, seizures
9. Health Education
   • Vaccination importance
   • No school until after isolation period
   • Maintain nutrition & hygiene
   • Recognize warning signs needing medical care

Prepared for nursing education • Updated December 2025