Measles in children: symptoms, complications and prevention - vaccination and doctor’s appointment in Tashkent

Why measles is not a harmless childhood disease

The idea of measles as a mild, obligatory childhood disease developed in those days when there was no vaccination and everyone got sick, and severe cases were simply lost against the background of general morbidity. Modern data looks different.

• Complications develop in approximately 30% of patients
• Pneumonia is the most common fatal complication, about 1 case per 20 sick children; most often this is what leads to a serious outcome
• Otitis media - affects about 1 in 10 children, sometimes with permanent hearing loss
• Encephalitis, inflammation of the brain, approximately 1 case in 1000; some survivors are left with irreversible neurological damage
• Subacute sclerosing panencephalitis is a rare, but incurable and fatal brain lesion that develops 7–10 years after measles; the risk is highest in children who were ill in the first or second year of life
• Severe diarrhea with dehydration, measles croup, vision-threatening keratitis
• In pregnant women, measles increases the risk of premature birth and pregnancy loss

How it occurs: from colds to rashes

The insidiousness of measles is that its onset is no different from a common respiratory infection, and these days the child is most contagious to others.

1. Инкубационный период — обычно 8–14 дней после контакта, иногда до 21 дня. Никаких симптомов нет.
2. Катаральный период, 3–4 дня: высокая температура, сухой навязчивый кашель, обильный насморк, осиплость. Очень характерны воспаление глаз и светобоязнь — ребёнок жмурится от света, глаза красные, отёчные, слезятся. Лицо выглядит одутловатым.
3. Пятна Филатова-Коплика: за сутки-двое до сыпи на слизистой щёк напротив коренных зубов появляются мелкие белесоватые точки, будто крупинки манной крупы на красном фоне. Держатся они недолго и исчезают с появлением сыпи, но это самый специфичный признак кори.
4. Период высыпаний: температура вновь резко подскакивает, и появляется сыпь. Она распространяется строго сверху вниз — в первый день лицо и шея, во второй туловище и руки, в третий ноги. Элементы яркие, крупные, склонны сливаться в пятна.
5. Период пигментации: сыпь угасает в том же порядке, оставляя коричневатые пятна и мелкое отрубевидное шелушение. Температура нормализуется, самочувствие улучшается, слабость и кашель сохраняются ещё 1–2 недели.

How contagious is measles and what to do if exposed

Measles is more contagious than influenza, chicken pox and coronavirus infection. One patient in an unvaccinated environment infects on average 12–18 people - this figure is one of the highest among all known infections.

• Airborne transmission; the virus remains in the indoor air for up to 2 hours after the patient leaves
• The infectious period is from 4 days before the rash appears to 4 days after its appearance.
• You can become infected without directly communicating with the patient: in an elevator, in a queue, in a common corridor
• Children under one year old have not yet been vaccinated according to their age and are protected only by maternal antibodies, which quickly decrease - they are the most vulnerable group
• In case of contact, an unvaccinated person can be given a vaccine in the first 72 hours, and certain groups can be given immunoglobulin within 6 days; the doctor makes the decision
• Contacts are placed under medical observation for 21 days

Diagnosis and treatment

The diagnosis is made based on the clinical picture and confirmed by laboratory tests, since each case of measles is subject to registration and anti-epidemic measures.

1. Осмотр врача с оценкой этапности сыпи, состояния слизистых, глаз и лёгких.
2. Определение антител класса IgM к вирусу кори в крови — main подтверждающий метод; кровь берут не ранее чем через несколько дней после появления сыпи.
3. ПЦР-исследование мазка of носоглотки или мочи для выявления вируса, особенно на ранних сроках.
4. Общий анализ крови — при кори типично снижение числа лейкоцитов; повторный анализ помогает заподозрить бактериальное осложнение.
5. Рентгенография грудной клетки при подозрении на пневмонию.
6. Консультация офтальмолога при выраженном поражении глаз, отоларинголога — при боли в ухе.

There is no medicine that kills the measles virus. Treatment is supportive: sufficient fluids, antipyretics as prescribed by the doctor, rest, dim light in the room for photophobia, eye and oral care, humidified air. Antibiotics are not prescribed “for prophylaxis”, but only when a bacterial complication develops - otitis media, pneumonia. In some cases, children with measles are prescribed vitamin A: its use according to a schedule determined by the doctor reduces the severity of the disease and the risk of eye complications.

Vaccination: what is important to know

Vaccination against measles is the only way of reliable protection. The vaccine is live, administered twice, and after two doses the protection reaches approximately 97%.

• The first dose is administered in the second year of life, the second - before school; specific dates are determined by the national vaccination calendar
• One dose provides protection of about 93%, two - approximately 97%; It is for the sake of these percentages that the second dose is administered, and not because the first “did not work”
• Adults who have not been sick and have not been vaccinated or have been vaccinated once can be vaccinated at any age; if there is an unknown vaccination history, antibodies are checked or vaccinated
• Women are scheduled for vaccination before pregnancy: the vaccination is live and is not carried out during pregnancy
• After vaccination, some children may develop a fever and a slight rash on days 5–12 - this is an expected reaction, and not measles; such a child is not contagious
• For a child with a weakened immune system, a live vaccine may be contraindicated - only the vaccinated environment protects him

Child care at home

1. Обильное питьё маленькими порциями: при высокой температуре и поносе потери жидкости значительны.
2. Приглушённый свет и отсутствие яркого экрана — при светобоязни это существенно облегчает состояние. Носить тёмные очки в помещении не нужно, достаточно задёрнуть шторы.
3. Промывание глаз чистой водой или назначенным врачом раствором; не тереть глаза руками.
4. Прохладный влажный воздух в комнате облегчает мучительный сухой кашель.
5. Полоскание рта и уход за губами: слизистые при кори страдают, ребёнку больно есть.
6. Кормить по аппетиту, не настаивать; предпочтительна мягкая негорячая пища.
7. Изоляция от других членов семьи, особенно от непривитых, грудных детей и беременных, минимум до 5 дня от появления сыпи.
8. Ежедневная оценка состояния врачом при тяжёлом течении и обязательный повторный осмотр при возврате температуры.

We will separately warn you about the most common mistake in care: parents sometimes perceive a repeated rise in temperature after it has normalized as a “second wave of the disease” and continue to treat it at home. In fact, with measles, this is almost always a sign of an additional bacterial complication - pneumonia or otitis - and a reason to show the child to the doctor on the same day.