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Diseases / Measles

Measles

What is it?: 

Measles is one of the most contagious diseases of humans. It is caused by the measles virus and occurs as a seasonal disease in endemic areas. In tropical zones, most cases of measles occur during the dry season, whereas in temperate zones, incidence peaks during late winter and early spring.1

The average age for acquiring measles depends on biological and epidemiological factors, mainly population immunity and birth rate. As vaccination coverage increases, the average age of measles infection can shift to adolescents and young adults. These older groups remain susceptible because they had not been vaccinated or exposed to wild-type measles virus due to decreased transmission among younger vaccinated groups.1

In the absence of efforts to vaccinate the older susceptible populations, measles virus introduction can result in an outbreak, reflecting the immunity gaps among these age cohorts.1

In spite of the widespread use of measles vaccines worldwide, measles remains an important cause of death and disability in countries with limited health infrastructure.1

Clinical features: 

Measles was a common childhood infection prior to the introduction of measles vaccine. Affected persons will present initially with fever, cough, runny nose, red eyes and white spots inside the mouth. This is followed 3 to 7 days later by a red blotchy skin rash, which usually spreads from face to the rest of the body. The rash usually lasts 4 - 7 days, but can persist for up to 3 weeks leaving with brownish staining and sometimes fine skin peeling. In severe cases, lung, gut and brain can get involved and lead to serious consequences or even death.2

Measles infection in pregnancy can result in adverse pregnancy outcomes, including pregnancy loss, preterm birth, and low birth weight, but there is no evidence to support an increased risk of congenital defects. Moreover, neonates who get infected because the mother had measles shortly around the period of delivery are at an increased risk of subacute sclerosing panencephalitis (a very rare but fatal disease of the central nervous system) in later life.2

Mode of transmission: 

This can be transmitted airborne by droplet spread or by direct contact with nasal or throat secretions of infected persons, and less commonly, by articles soiled with nasal or throat secretions. Measles is one of the most highly communicable infectious diseases. The patient can pass the disease to other persons from 4 days before to 4 days after appearance of the rash.2

Incubation period: 

It usually ranges from 7 - 18 days, but can be up to 21 days.2

Prevention: 

Maintain good personal hygiene2

  • Perform hand hygiene frequently, especially before touching the mouth, nose or eyes, after touching public installations such as handrails or door knobs or when hands are contaminated by respiratory secretion after coughing or sneezing. 
  • Cover your mouth and nose with tissue paper when sneezing or coughing. Dispose of soiled tissues into a lidded rubbish bin, then wash hands thoroughly.
  • When having a fever, rash or respiratory symptoms, wear a surgical mask, refrain from work or school, avoid going to crowded places and seek medical advice promptly.

Maintain good environmental hygiene2

  • Regularly clean and disinfect frequently touched surfaces such as furniture, toys and commonly shared items with 1:99 diluted household bleach (mixing 1 part of 5.25% bleach with 99 parts of water), leave for 15 – 30 minutes, and then rinse with water and keep dry. For metallic surface, disinfect with 70% alcohol.
  • Use absorbent disposable towels to wipe away obvious contaminants such as respiratory secretions, and then disinfect the surface and neighbouring areas with 1:49 diluted household bleach (mixing 1 part of 5.25% bleach with 49 parts of water), leave for 15 – 30 minutes and then rinse with water and keep dry. 
  • Maintain good indoor ventilation.

Immunization2

  • Vaccination against measles is the most effective preventive measure. Under the Hong Kong Childhood Immunisation Programme, children receive a two-dose course of measles vaccination (Please refer to the Hong Kong Childhood Immunisation Programme).
  • All foreign domestic helpers (FDH) who are non-immune@ to measles should receive Measles, Mumps and Rubella (MMR) vaccine, preferably before they arrive in Hong Kong. If this is not possible, they can consult a doctor after they have arrived in Hong Kong.
  • In general, women should avoid pregnancy for three months after receipt of MMR vaccine and take appropriate contraceptive measure.
Managment: 

Affected persons should avoid contact with non-immune persons, especially those with weakened immunity, pregnant women and infants. Although there is no specific treatment, drugs may be prescribed to reduce the symptoms and antibiotics may be used to treat bacterial complications.2

Reference:

  1. World Health Organization. Weekly epidemiological record. Measles vaccines: WHO position paper - April 2017. 2017;17(92):205-228.
  2. Centre for Health Protection. Communicable diseases – Measles. 9 Jul 2019. https://www.chp.gov.hk/tc/healthtopics/content/24/31.html [ONLINE] Accessed 15 Mar 2021.

 

MAT-HK-2100318-1.0-03/2021