Measles cases at 18-year high: what you need to know
The number of cases of measles in England and Wales has reached its highest level for 18 years, the Health Protection Agency (HPA) has announced.
Some 2,016 confirmed cases of measles were reported to the Agency in 2012; the highest annual total since 1994.
There were 56 confirmed cases of measles last year in the East Midlands.
The England and Wales cases identified have been associated with prolonged outbreaks in Merseyside, Surrey and Sussex, as well as several smaller outbreaks in travelling communities across England and Wales.
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The highly infectious viral illness can lead to serious complications including blindness, and it can be fatal.
It is now rare in the UK due to the effectiveness of the MMR vaccination.
Dr Mary Ramsay, head of immunisation at the HPA, said: “Coverage of MMR is now at historically high levels but measles is highly infectious and can spread easily among communities that are poorly vaccinated, and can affect anyone who is susceptible, including toddlers in whom vaccination has been delayed.
“Older children who were not vaccinated at the routine age, who may now be teenagers, are at particular risk of becoming exposed, while at school for example.
“Measles continues to circulate in several European countries that are popular with holidaymakers. Measles is a highly infectious disease so the only way to prevent outbreaks is to make sure the UK has good uptake of the MMR vaccine, and that when cases are reported, immediate public health action is taken to target unvaccinated individuals in the vicinity as soon as possible.
“Measles is often associated with being a disease of the past and as a result people may be unaware that it is a dangerous infection that can lead to death in severe cases. Parents should ensure their children are fully protected against measles, mumps and rubella with two doses of the MMR vaccine.
“Parents of unvaccinated children, as well as older teenagers and adults who may have missed MMR vaccination, should make an appointment with their GP to get vaccinated.
“If you are unsure if you or your child has had two doses of the vaccine, speak to their GP who will have a record.”
Measles is caused by infection with the rubeola virus. The measles virus is contained in the millions of tiny droplets which come out of the nose and mouth when an infected person coughs or sneezes.
The virus spreads very easily, and measles is caused by breathing in these droplets or by touching a surface which has been contaminated and then placing your hands near your nose or mouth. The measles virus can survive on surfaces for a few hours.
Once inside your body, the virus multiplies in the back of your throat and lungs before spreading throughout your body, including your respiratory system and the skin.
What are the symptoms?
The initial symptoms of measles appear around 10 days after you get the infection and usually last for up to two weeks. The measles rash usually appears a few days afterwards.
Initial symptoms include:
- Red eyes and sensitivity to light
- Cold-like symptoms such as watery eyelids, sneezing and a runny nose
- Dry cough
- Aches and pains
- Tiredness and irritability
- Poor appetite
- A mild to severe temperature, which may peak at more than 40.6C (105F) for several days, then fall but go up again when the rash appears
- Tiny greyish-white spots (Koplik's spots) in the mouth and throat
The measles rash appears two to four days after initial symptoms, and lasts for up to eight days.
Spots are initially small but quickly get bigger and often join together. They usually start behind the ears, spread around the head and neck, then spread to the legs and the rest of the body.
See your GP immediately if you suspect you or your child has measles; if your temperature increases to above 38C (100.4F) or stays high after other symptoms have gone; or if your symptoms worsen.
You should also visit your GP without delay if there are signs of complications of measles, which include:
- Inflammation of the voice box
- Eye infection (conjunctivitis)
- Earache or inner ear inflammation
- Fast, difficult breathing, chest pain and deteriorating condition – these are signs of pneumonia
- Drowsiness, headache and vomiting – these are signs of encephalitis (inflammation of the brain)
- A hacking or barking cough – signs of bronchitis and croup (infection of the airways)
- Squint (when one eye turns inwards, outwards, upwards or downwards while the other eye looks forwards) – a sign the virus has affected the nerves and muscles of the eye
Read more about the complications of measles here.
How is measles diagnosed?
Your GP should be able to detect you have measles through a combination of symptoms you may have, such as the characteristic rash and the small spots inside the mouth.
A blood or saliva test can confirm the diagnosis and identify the rubeola virus. They will also notify the local Health Protection Unit, as they have a duty to inform them of all reported and suspected cases of measles.
How is measles treated?
There is no specific treatment for measles, but it is important you rest while your immune system fights off the virus.
You can also relieve some of the symptoms by:
- Closing the curtains or dimming the lights to reduce light sensitivity
- Drinking regularly to prevent dehydration – feverish small children lose water rapidly which will make a cough worse
- Taking ibuprofen or paracetamol to help relieve aches and pains. For children, use liquid paracetamol and don’t give aspirin to children under the age of 16
- Using damp cotton wool to clean away crustiness around the eyes. Use one piece of cotton wool per wipe for each eye, and gently clean the eye from inner to outer lid
- Giving your child (if over 12 months old) a teaspoon of lemon juice and two teaspoons of honey in a glass of warm water. Honey should not be given to babies under the age of 12 months
- Placing a bowl of water in the room to make the atmosphere more humid. This can help relieve a cough
Antibiotics may be prescribed for any secondary bacterial infections that develop, and in severe cases hospitalisation may be required.
Vitamin A supplements may be recommended for children under two years old with severe measles, as it has been shown in some studies to help prevent some of the serious complications arising from a measles infection.
Discuss this with your GP.
My child has measles – now what?
Your GP will notify your child’s school of their illness if necessary. Your child should not return to school or be in contact with other children until at least five days after the appearance of the rash.
You can relieve some of your child’s symptoms – see above.
How can I prevent my child from catching measles?
The most effective way of preventing measles is the measles, mumps and rubella (MMR) vaccine. Vaccinated children and anyone who has already had measles are extremely unlikely to catch measles.
The first dose of the MMR vaccine should be given to babies who are between 12 and 13 months old.
Children are given a second dose (the booster dose) before they start school, usually between the ages of three and five. The second dose can be given three months after the first, however.
A child aged between six and 13 months who is exposed to the measles virus will normally be given the MMR vaccination to protect them from developing measles.
However, if a child is given the vaccine before their first birthday, they should still be given two further doses as part of the childhood vaccination programme. These doses should be given at around 13 months of age and before the child begins school.
If a child under the age of six months is exposed to the virus, the treatment will be dictated by whether the mother has had measles in the past.
If the child's mother has previously had measles the child will usually be immune to the infection because the mother's protective antibodies will have been passed to the baby in the womb.
However, if the mother has not had measles the child may be given an injection of human normal immunoglobulin (HNIG).
HNIG is not a vaccine, but a concentration of antibodies which can give short-term but immediate protection against measles.
I’m hoping to get pregnant but I haven’t had the MMR vaccine – what should I do?
Arrange with your GP to have the MMR vaccine.
If you catch measles during pregnancy it can be passed on to your baby, which can be very dangerous or even fatal for your baby.
Measles in pregnancy can cause miscarriage, premature labour or a baby with low birthweight. The MMR jab cannot be given during pregnancy.
You should not become pregnant for at least a month after having the MMR jab, as the vaccination contains a live virus which could cause infection in the baby.
I’m pregnant and I’ve come into contact with someone with measles – what do I do?
If you're pregnant and you think you've come into contact with someone with measles, and you know you're not immune, you should see your GP immediately. Your GP may treat you with human normal immunoglobulin (HNIG).
This may reduce the severity of your measles, but there is no evidence it prevents miscarriage, stillbirth or pre-term delivery.