May 25, 2022 Author : Saraiva da Cunha Measles is a disease caused by a virus . It has a worldwide distribution; It continues to be a cause of death. In 2018, 140 thousand people died worldwide from measles, mainly children under 5 years of age; In the same year, cases of measles in Europe increased 15 times compared to 2016 (which was the year with the lowest number of cases ever) and 72 children and adults died. Although humans are the only reservoir of the measles virus, eradication of the disease is hampered by the high transmissibility of the virus , the difficulty in extending vaccination to children around the world and also by the anti-vaccine movements and non-adherence to vaccination . How measles is transmitted Measles virus is transmitted via the air, through droplets or aerosols from infected people , for example when they sneeze or cough. The virus remains active and contagious for hours on these expelled particles, or for periods of up to 2 hours on contaminated surfaces; Therefore, close contact between infected and uninfected people is not mandatory for measles to be transmitted. An infected person can expel droplets or aerosols that transmit the disease for 8-9 days : from 4-5 days before the rash appears (red spots on the skin), until 4 days later. - After exposure or contact with the virus, about 90% of susceptible people develop the disease. People at higher risk of having measles : Children who have not reached the age to be vaccinated, who have not completed vaccination (two doses), who cannot or have not been vaccinated or who have not developed an adequate immune response ( eg immunocompromised); Pregnant women who have not been vaccinated. Measles symptoms and complications Between the contact with the virus and the first symptoms (incubation period) of measles, an average of 10-12 days pass (with a range of 6 to 21 days). The first symptoms of measles include high fever, malaise and lack of appetite; This is followed by rhinorrhea (runny nose), conjunctivitis (inflammation of the eye conjunctiva) and cough; Koplik spots (white spots on the oral mucosa) are considered pathognomonic (very suggestive) of the disease and appear 1-2 days before the rash; 2-4 days after the onset of fever, red patches (rash) of skin appear. Usually they start in the head, face and neck and extend downwards to the trunk and limbs; The spots remain for 5-6 days and begin to disappear in the same order they appeared; Rash phase is accompanied by high fever, which usually does not last longer than 3-4 days. The cough can last for 1-2 weeks. The disease is more severe in malnourished children, especially when there is vitamin A deficient, or immunologically weakened. Most measles-associated deaths are due to complications of the disease , for example, severe diarrhea and dehydration, ear infections, pneumonia, encephalitis, blindness, myocarditis, and pericarditis. Diarrhea appears in about 8% of cases; Ear infections occur in 7%-9% of cases and especially in children; Pneumonia and encephalitis are the leading cause of measles-related death. The groups that have a higher risk of measles complications are: Immunocompromised people; Pregnant women; People with vitamin A deficiency; People with deficient nutritional status; Extremes of life, that is the young children and the elderly; Serious complications are more common in children under 5 years of age and in adults over 30 years of age. Measles treatment In most cases, measles has a benign course and resolves on its own. There is no specific treatment for the virus; Whenever treatment is necessary, it should only be symptomatic , that is, directed at the symptoms of the disease. Prevention Measles can only be prevented by vaccination . The measles vaccine has high safety and efficacy . It has existed since 1963 and the vaccination programs implemented since then have significantly altered the disease course and distribution: Incidence and mortality have decreased. Before vaccination, measles was responsible for an estimated 2.6 million deaths annually worldwide; Between 2000-2018, vaccination reduced measles mortality worldwide by 73%; The global distribution of the disease has changed with vaccination, but measles remains endemic in countries and regions where the vaccination rate is low. In 2018, about 86% of the children in the world received 1 dose of the measles vaccine by their first birthday, and 69% of children received the second dose of the vaccine. In the same year, of the estimated 19.2 million babies not vaccinated with at least one dose of the vaccine, about 6.1 million were in India, Nigeria and Pakistan. Measles vaccination in Portugal The measles vaccine is part of the Portuguese National Vaccination Program . Its abbreviated name is VASPR ; Complete vaccination includes two doses . The first is given at 12 months and the second at 5 years of age; In addition to measles, VASPR is also a vaccine against mumps and rubella . In particular circumstances and upon medical evaluation, measles vaccination may be recommended in other circumstances, such as travel to countries with lower vaccination coverage or where recent outbreaks have occurred. Sources: World Health Organization. Measles . 2019. World Health Organization. Measles in Europe: record number of both sick and immunized. 2019. Gans H, Madonado Y. Measles: Epidemiology and transmission . 2022. Strebel PM, Orenstein WA. Measles . N Engl J Med 2019; 381:349-357. 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