Measles B05.99

ar-Razi (Rhazes) around 900

Severe, highly contagious (transmitted by droplet infection), notifiable(obligation to report by name in case of suspicion and manifest disease) infectious disease caused by an RNA virus (family of paramyxoviruses) with typical exanthema and enanthema.

Measles virus (RNA virus of the paramyxovirus family. Transmission by droplet infection. Infectious during the catarrhal stage and in the first days of exanthema.

Worldwide, around 200,000 people contract measles every year (mainly in African countries). The infestation rate is almost 100%. In Germany, local outbreaks with varying numbers of cases are reported time and again. According to the Robert Koch Institute, 2,464 cases were reported in Germany in 2015, 325 cases in 2016 and slightly more than 900 cases in 2017.

Due to a herd effect, measles can lead to the clustering of individuals in sub-populations who are themselves immune to the pathogens of transmissible infectious diseases neither through infection nor vaccination. If germ carriers enter this group and the herd effect for this group is insufficient for the measles virus, the affected persons risk contracting a disease that is so far "only" known as a childhood disease. Such age shifts have been documented for measles. At an older age, measles is more difficult to detect, so that measles pneumonia, for example, is treated appropriately at a later stage.

In addition, measles occurs somewhat more frequently in newborns in the period up to the first vaccination (recommended between the completed 11th and 14th month of life) if their mothers were vaccinated against these pathogens than if the mothers had experienced measles as an infection, because the surrogate immunity caused via the placenta wears off more quickly after vaccination than after infection.

• Stage-like course.
  • Incubation period: 8-10 days until prodromia, 14 days until exanthema
  • Catarrhal prodromal stage: severe generalized feeling of illness, fever up to 40 °C, rhinitis, conjunctivitis, photophobia, pharyngitis, tracheitis, generalized lymphadenopathy. On the 2nd to 3rd day coplik spots (white spots of the cheek mucosa opposite the molars), defibrillation with rapid temperature rise with simultaneous development of enanthema and exanthema.
  • Exanthematic stage: On the 3rd day of the disease, enanthema of the palate, tonsils, uvula. Large red, round or oval, initially pale and then dark red spots, also haemorrhagic; spots tend to confluence.
  • Craniocaudal course beginning first behind the ears, then on the neck and trunk, and finally on the extremities. Enlargement and confluence of the spots. After 3-4 days of temperature drop, fading of the exanthema in the mentioned order. Small lamellar white (bran-like) scaling of the affected skin areas.
• Special forms of progression:
  • Abortive form: Morbilloid
  • Measles pemphigoid
  • Primary toxic measles: Foudroyanter course with somnolence, hyperpyrexia, bloody stools, circulation disorders, cramps and lethal outcome is possible.

Prodromal stage: Leukocytosis. Exanthematic stage: leukopenia, neutropenia, thrombopenia, eosinopenia. A previously positive tuberculin test can become negative!

Industrialized countries: in 10-15% of cases bronchopneumonia, otitis media, measles croup. Rare: measles encephalitis, subacute sclerosing panencephalitis. Complications are due to virus-induced immunosuppression which persists for about 6 weeks.

The occurrence of TEN after measles vaccination has been described in the literature.

In children at risk or immunosuppressed, IVIG therapy e.g. with gamma globulin (e.g. beriglobin 0.2-0.5 ml/kg bw i.m.), effective up to the 3rd day after contact (between the 4th and 7th day of incubation, the course of the disease may be attenuated).

Otherwise symptomatic therapy: In the prodromal stage, bed rest in darkened rooms and, if necessary, antipyretic measures such as paracetamol (e.g. ben-u-ron juice or supp.) 15 mg/kg bw as ED, up to 50 mg/kg bw/day. Expectorants such as acetylcysteine (e.g. ACC granules): infants 100 mg/day, children 200-400 mg/day, adults and adolescents 600 mg/day. Fluid and electrolyte intake.

In case of bacterial superinfection (e.g. skin, bronchopneumonia), hospitalisation and antibiotic treatment if necessary, initially with broad-spectrum antibiotics such as dicloxacillin (e.g. InfectoStaph), then according to antibiogram. According to the clinic, intensive medical care if necessary.

In case of laryngotracheitis with croup (danger of suffocation!) emergency admission to hospital.

Babies and toddlers should receive the first MMR vaccination at the age of 11 months, the second vaccination at the earliest 4 weeks after the first vaccination, at the age of 15 months.

The Measles Protection Act came into force on March 1, 2020. The law stipulates that all children from the age of one must have the measles vaccinations recommended by the Standing Vaccination Commission when they start school or kindergarten. Proof of the measles vaccination must also generally be provided if the child is cared for by a childminder.

Adults born after 1970 are recommended to receive a single MMR vaccination as a standard vaccination if their vaccination status is unclear or if they received no or only one vaccination in childhood. Explanation: Since the 1970s, live vaccines against measles have been recommended in Germany; people born before then are very likely to have had measles.

Since January 2020, the STIKO has recommended a double measles vaccination for people born after 1970 in certain professional areas of activity such as medical facilities, care facilities, community facilities, technical, vocational and higher education institutions. Asylum seekers and refugees must also be vaccinated four weeks after being admitted to shared accommodation.

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2. Bellini WJ et al. (2003) The challenges and strategies for laboratory diagnosis of measles in an international setting. J Infect Dis 187: S283-290
3. Duke T et al. (2003) Measles: not just another viral exanthem. Lancet 361: 763-773
4. Hellenbrand W et al. (2003) Progress toward measles elimination in Germany. J Infect Dis 187: S208-216
5. Pereira FA et al (2007) Toxic epidermal necrolysis. J Am Acad Dermatol 56: 181-200
6. Spika JS et al. (2003) Measles and rubella in the World Health Organization European region: diversity creates challenges. J Infect Dis 187: S191-197
7. https://www.rki.de/SharedDocs/FAQs/DE/Impfen/MMR/FAQ_Uebersicht_MSG.html#entry_16871018