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Friday, January 23, 2015
Disease Risk -- Measles
There has been a concern about the recent increase in incidence of Rubeola (Measles)
Measles (also known as Rubeola or morbilli) is a viral infection of the respiratory system. It is classically characterized by initial fever followed by a rash that covers most of the body. Measles is highly infectious and is spread through aerosolized droplets from infected persons. It is contagious from 2-4 days prior to and 2-5 days after the onset of the rash. Prior to vaccination, 90% of the population in the US contracted measles by the time they turned 15. Although it is generally a mild illness, it can be accompanied by very serious complications (pneumonia, encephalitis, SSPE) or death in a small number of cases.  Measles can be very serious in immunocompromised persons.
There is considerable evidence that the risk from severe measles disease is highly variable depending on factors influenced by economic and living conditions. Morbidity and mortality due to measles is far higher in the developing world. In a study from the UK, Maclure found that the risk of hospitalization from measles in children living in deprived households was over 10 times higher than in areas where households were not deprived. For measles, overcrowding and unemployment were more correlated with measles hospitalization than vaccination rates. In the developing world, the majority of complications occur in the younger children. Gordon et al describe that in Guatemala, nutritional supplements reduced the annual mortality rate by 65% while medical care reduced it by almost 70% .
Two or three days after symptoms begin, tiny white spots (Koplik spots) may appear inside the mouth.
Three to five days after symptoms begin, a rashbreaks out. It usually begins as flat red spots that appear on the face at the hairline and spread downward to the neck, trunk, arms, legs, and feet. Small raised bumps may also appear on top of the flat red spots. The spots may become joined together as they spread from the head to the rest of the body. When the rash appears, a person’s fever may spike to more than 104° Fahrenheit.
After a few days, the fever subsides and the rash fades.