Measles (rubeola) is an extremely contagious disease.

News reports from the CDC and others are indicating that the Winter 2019 Measles outbreak that started in Washington state, has spread to at least 18 other states, including Texas, specifically many cases in the Houston area. While we in Baton Rouge have not yet seen a recent case of measles, we should all be aware of the signs and symptoms of measles.

In the early phase of the illness, patients typically experience fever, cough, photophobia, and coryza (significant nasal congestion) as well as mild-to-moderate gastrointestinal symptoms. Within a few days, Koplik spots (lesions looking like ulcers) involving the buccal mucosa appear as white papules on an erythematous base. At this point, the infection is highly contagious. Within a few days, the enanthem fades, temperature rises, and the beginning of a characteristic erythematous morbilliform exanthema evolves behind the ears and along the hairline margin. The rash progresses over the next 3 to 4 days from head to foot. Gradual clearing occurs in the same direction over a similar period of time, leaving a transient brawny desquamation. Complications during the course of illness can involve various organ systems. About 1 in 1000 patients develops encephalitis, often leading to residual brain damage. Other severe problems may include secondary bacterial infections or an autoimmune reaction. Case fatality rates are highest among children younger than age 5 years.

The optimal approach to preventing measles epidemics and community-wide disease spread is for all eligible individuals to receive timely recommended age appropriate doses of measles vaccine. The first dose can be administered at 12 months or older, with a second dose provided no sooner than 28 days later but more commonly administered at ages 4 to 6 years. The immune response to the initial dose given between 12 and 15 months varies from 96% to 98%; the second dose enhances immunity among initial nonresponders.

Treatment for measles is primarily supportive even if major complications occur.