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Measles

What is Measles?

Measles, also known as Rubeola, is a highly infectious viral infection that normally affects children. The illness is unpleasant and can be fatal, but individuals who become infected with measles will develop antibodies and life-long immunity to the disease. It is used to be quite rare due to effective childhood immunisation programmes, but recently there has been an increase in the number of cases seen in the UK which has raised concerns at World Health Organisation level due to the increasing global burden of health.  There has been a decrease in the number of vaccines over the past years which has led to outbreaks of this condition.

How is it spread?

Measles is highly contagious and on average, each infected person infects 12 – 18 other people who are not immune. The measles virus lives in the mucus and throat of an infected individual and is spread when the individual coughs or sneezes. The virus can live for up to 2 hours on environmental surfaces. It usually takes about 10 days for symptoms to develop after exposure to the virus although the incubation period for the virus varies between 7-21 days. Generally, persons with measles are infectious to others from 4 days before and 4 days after the onset of the rash.  Any person who has been in close contact with someone with measles for 15 minutes is considered a close contact, the virus ia airbone, so even if you do not touch the person with measles you are at risk if contracting the virus.

Symptoms

The measles virus can multiply in the back of the throat and lungs and then spreads through the body. Common symptoms include:

  • High temperature, sore eyes (conjunctivitis) and runny nose.
  • Harsh, dry cough
  • Tiredness, body ache and poor appetite
  • Diarrhoea and vomiting
  • Small white spots that develop inside the mouth and last several days
  • Appearance of red blotchy skin 3-4 days after the first symptoms that usually starts on the neck and head and spreads down the body within 2-3 days. The rash is typically flat and fades under pressure.
  • The rash eventually turns brown and becomes lighter over a few days.
  • Feeling generally unwell for 3-5 days

Prevention

Measles can be effectively prevented by immunisation with the MMR vaccine, which is available to all anyone in Gibraltar and is given in 2 doses:

  • 1st dose at 12 to13 months of age
  • 2nd dose at 3years 4months to 5 years of age
  • Adults that have not had measles as a child, or have not received 2 doses of the MMR vaccines can also be vaccinated on request.

If you are planning to have a baby and are not immune to measles or have not been vaccinated against measles, or if you are unsure of your immunity status, the MMR Vaccine is strongly recommended.  It is also recommended to delay getting pregnant until you have had the full does of the MMR vaccine.  If you are unsure about your vaccination or immunity status, please discuss with your GP.

Controlling the spread

It is important that children or adults with measles remain at home and off school or work from the onset for at least 4days.
You can prevent the spread of measles by regularly washing your hands with soap and water and disposing of tissues in the bin after sneezing or coughing. The infected person should also avoid contact with any individual who has a weakened immune system as well as young children and pregnant women.

Complications of Measles

Complications from measles are most common in children under the age of 5 years and in adults over the age of 20 years. Measles is often accompanied by many bacterial infections.
Complications that can be distressing and may require medical attention and review include:

  • Eye infection with red, swollen eyes (Conjunctivitis)
  • Inflammation of the voice box or larynx resulting in hoarse voice (Laryngitis)
  • Ear infection
  • Infection of the airways causing bronchitis or croup
  • Fits due to high fever (convulsions)
  • Inflammation of the brain (encephalitis) that starts 7-10 days after the onset of the rash and causes drowsiness, headache, vomiting
  • Lung infection (pneumonia) that causes difficulty in breathing and chest pains
  • Squint due to the virus affecting the nerves or muscles in the eyes

Complications in pregnant women include the risk of miscarriage, stillbirth, premature delivery, low birth-weight babies. If you are pregnant and have not been immunised but come in contact with someone who has measles, please contact your GP as soon as possible.

Treatment

There is no specific treatment for measles. The main aim is to relieve the symptoms by:

  • Giving paracetamol or ibuprofen to ease fever or pain
  • Encouraging plenty fluids ( water is preferable as fruit juice may stimulate the salivary glands to produce more saliva and this can cause more pain)
  • Wearing loose clothing to keep cool

Antibiotics are not effective against measles but they may be prescribed by your GP to treat an accompanying bacterial infection such as ear or chest infections.
Most individuals recover fully. However, it is important that you seek immediate medical attention if:

  • There are signs of increasing drowsiness
  • Little urine is passed
  • Mouth and tongue remain very dry
  • There are difficulties in breathing
  • Convulsions (fits) occur

For further information, contact the Infection Prevention and Control Department at St Bernard’s Hospital
Telephone: 20072266 Ext 2315
Email: infections@gha.gi

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Measles FAQ’s

What do I do if I have been in contact with someone who has measles?

If you have been a close contact with someone who has measles particularly if the contact has been for over 15 minutes, then call 111 and they will advise you on the steps that you have to take.  If you are a healthcare worker, or a carer of vulnerable people, please contact your line manager for a risk assessment of your role.

What do I do if I have measles?

If you have measles, contact 111 for advice.  DO NOT attend A&E or the primary care center unless advised to do so by 111.  You will be infectious 4 days before the rash appears and 4 days after the rash, so it is important that you stay at home for this period of time.   You can then return to school  / work 4 days from when the rash appears.  DO NOT share any cutlery, cups, towels clothes or bedding during this period, as you can spread the virus this way.

Drink plenty of fluids and take paracetamol / ibuprofen if required to help control the fever.   It is important that you wash your hands frequently, cough or sneeze into a tissue and dispose of that tissue immediately into a bin.

I do not know if I have had measles as a child or had my MMR vaccines?

If you do not know if you have had measles as a child, or your MMR vaccines, then you can speak to your GP as they can help you with this.  If you know that you have not had either, you can call 200 66966 to arrange an appointment for vaccination.

Is the MMR vaccine safe?

Yes, the MMR vaccine is safe, if you have any concerns about the vaccine, please discuss with your GP or the vaccination clinic.  Occassionally there may be a person that may have an allergic reaction to the vaccine, but this is quite rare.

I am pregnant, can I have the vaccine?

If you are pregnant, it is important to speak to your GP with regards vaccination.  There are different options available for people who are pregnant.

I am planning on becoming pregnant, can I have the vaccine?

If you are planning on becoming pregnant, it is important that you have your vaccines before this happens, even if it means delaying the pregnancy until you have achieved full immunity.

I have a vaccine scar on my arm, is that my MMR vaccine?

No, the small pox vaccine give you the vaccination scar on your arm, that does not protect you against measles.

What should I do if my child is 3 years old and had 1 dose of MMR can they have the second dose early?

One dose of the vaccine will give you ~93% protection against measles. We advise to follow the routine schedule of having a second dose ~3.5 years old. This will then give your child ~97% protection. In an outbreak scenario we may advise having the second dose earlier as a form of post exposure protection against developing measles. If this is the case we will contact parents directly.

Please click on the link below for further information on measles

Measles info

NHS Measles page

CDC page on measles

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