bubble_chart Overview

Measles is an acute respiratory infectious disease caused by the measles virus. It is highly contagious and mostly occurs in winter and spring. It is characterized by fever, catarrhal symptoms, mucosal spots, rash, and pigmentation.

bubble_chart Clinical Manifestations

It is divided into four types: typical, severe, mild, and atypical.

1. Typical measles, also known as the common type, is the most frequently seen clinical form. The incubation period is 10–11 days (6–18 days), which can extend to 21 days in vaccinated individuals. The clinical course is further divided into the following stages. (1) **Prodromal stage**: 3–4 days. Symptoms include fever, which can reach 39–40°C, fatigue, loss of appetite, vomiting, diarrhea, and may be accompanied by febrile seizures. Concurrently, respiratory catarrhal symptoms appear, such as runny nose, sneezing, cough, tearing, photophobia, and conjunctival congestion. On days 2–3 of fever, measles mucous membrane spots (Koplik spots) may appear—grayish-white dots resembling ground pepper, 0.5–1 mm in diameter, surrounded by a red halo—on the buccal mucosa, which may also extend to the lips. These spots are diagnostically significant. (2) **Stage of full eruption**: 3–5 days. Typically, the rash appears on day 4 of fever when the temperature is highest. The eruption sequence is behind the ears, hairline, face, neck, trunk, limbs, and palms/soles (complete eruption). The rash consists of congestive maculopapules, initially light red and gradually turning dark red, sometimes merging into irregular patches with unaffected skin between them. Systemic symptoms worsen during eruption, including lethargy, anorexia, aggravated cough, vomiting, and diarrhea. Within 1–2 days after the rash appears, the oral mucosa becomes more congested and rough, and the mucous membrane spots gradually fade. (3) **Stage of convalescence**: If no complications occur, the rash gradually fades in the order of its appearance after complete eruption, leaving brownish pigmentation and fine bran-like desquamation, which resolves in 2–3 weeks. As the rash subsides, the fever also drops to normal, and other systemic symptoms diminish and disappear.
2. **Severe measles** presents with persistent high fever above 40°C, dense and confluent dark red rashes, sometimes hemorrhagic or abruptly fading. Complications such as pneumonia or laryngitis are often present.
3. **Mild measles** features relatively lower fever (mostly below FGH), a shorter course (less than 6 days), milder respiratory catarrhal symptoms, and sparse, atypical rashes that fade within 1–2 days. Only 1–2 Koplik spots may be seen or none at all. Mild measles is observed in children Neijing who have received passive immunity. Occasionally, symptoms are even milder after measles vaccination.
4. **Atypical measles** is rare and mostly seen in older children. It presents with sudden high fever, headache, and myalgia, without Koplik spots. After 2–3 days, a rash appears, starting on the limbs and spreading to the trunk and face. The rash is polymorphic, including macules, papules, purpura, and urticaria, often accompanied by edema on the hands and feet, pneumonia, and eosinophilia. This occurs 6 months to 6 years after receiving inactivated measles vaccine, followed by revaccination or reinfection with measles virus. The cause is unknown but may involve a delayed hypersensitivity reaction. This presentation is also called atypical measles syndrome.
5. **Complications**: During the acute phase, complications such as pneumonia (primary interstitial or secondary bacterial pneumonia), laryngitis, myocarditis, or encephalitis may manifest with corresponding symptoms and signs. Much later (even years after infection), subacute sclerosing panencephalitis (SSPE) may develop, characterized by neuropsychiatric symptoms, extremely high measles antibody titers in cerebrospinal fluid and serum, and isolation of measles virus from brain tissue.

bubble_chart Auxiliary Examination

1. The total white blood cell count in the blood picture decreases, and the proportion of lymphocytes increases.
2. Multinucleated giant cells can be observed in smears of secretions from the eyes, nose, and throat of the child during the prodromal period up to one day after the rash appears, stained with Wright's stain, which aids in diagnosis.
3. Virus isolation involves collecting nasopharyngeal secretions, blood, and urine from the child during the prodromal period and the stage of full eruption to isolate the measles virus.
4. A fourfold or greater increase in paired serum antibody titers and the presence of measles-specific IgM have diagnostic significance.

bubble_chart Diagnosis

Epidemiological history: Contact with measles 8 days to 2 weeks before onset.

bubble_chart Treatment Measures

﹝Treatment﹞

(1) Strengthening Nursing Care

1. Maintain room temperature at 18–20°C and humidity at 60–70%. Ensure the indoor environment is well-ventilated, fresh, and avoid direct sunlight on the child.
2. Provide adequate fluids, liquid or semi-liquid foods, and light, easily digestible meals with sufficient vitamins, especially large amounts of vitamins A and C. During the convalescence stage, add nutrient-rich, high-calorie foods. 3. Skin, oral, and eye care: Gently cleanse the skin, clean the mouth and nose, and wash the eyes with saline or 2% boric acid solution. (2) Symptomatic Treatment
   1. For high fever, avoid or minimize the use of antipyretics. Instead, use lukewarm water sponge baths while keeping the child warm to reduce body temperature to around [target temperature], preventing febrile seizures. Excessive cooling may lead to poor circulation and worsen the condition.
   2. For severe cough, administer phlegm-resolving and cough-relieving agents. 3. For severe measles, use coffee bean extract (caffeine), 0.3–0.5 ml per dose subcutaneously, or camphor, 0.3–0.5 ml per dose subcutaneously, to improve circulation and promote thorough rash eruption. (3) Traditional Chinese Medicine Treatment Use Chinese herbal remedies such as "rash-promoting" formulas, e.g., Five-Pearl Revival Pills, twice daily, two pills each time. Alternatively, boil cilantro or Spirodela in water for oral administration. (4) Treatment of Complications 1

． For secondary measles pneumonia, select antibiotics based on bacterial type and sensitivity tests. 2． For measles laryngitis, in addition to appropriate antibiotics, administer adrenal corticosteroids to reduce subglottic edema, which is highly effective. Options include: (1) Prednisone, 1 mg/(kg·d) orally. For severe cases, use dexamethasone, 0.2 mg/(kg·d), intravenously. In cases of severe respiratory obstruction, tracheostomy may be necessary.

bubble_chart Prevention

(1) Active Immunization

1. Measles Vaccination Target Population (1) The initial vaccination age is 8 months after birth. Vaccination earlier than this may reduce the vaccine's efficacy because antibodies from the mother can still neutralize the live attenuated measles vaccine in the infant's body. The immunity period lasts 4–6 years, and a booster is recommended at 5–7 years of age. (2) For susceptible children, emergency vaccination with the measles vaccine should be administered on the first day of exposure to measles, enabling the body to produce specific antibodies during the incubation period, which can prevent the disease or alleviate symptoms.
2. Contraindications or Temporary Deferral of Vaccination (1) Children with active subcutaneous nodules or those currently on hormone or immunosuppressant therapy. (2) Children who have taken the polio vaccine within the past 4 weeks or received gamma globulin injections within the past 8 weeks should temporarily defer vaccination, as it may otherwise affect immunization efficacy. (2) Passive Immunization Can prevent the disease or alleviate symptoms, with immunity lasting 3–4 weeks. 1

． Objective: To prevent the disease. Administer one of the following preparations within 5 days of measles exposure: (1) Measles immune globulin, 0.25 ml/kg, intramuscular injection. (2) Placental globulin, 5–10 ml per dose, intramuscular injection. (3) Adult plasma, 10–15 ml per dose, intramuscular injection. 2． Objective: To alleviate symptoms. Administer the above preparations to individuals exposed to measles for 5–9 days.

bubble_chart Differentiation

(1) Rubella presents with mild systemic symptoms, followed by the appearance of light red rashes within half a day to one day after onset. No rashes appear on the palms or soles. The rashes fade within 1 to 3 days without leaving pigmentation. Swollen lymph nodes are observed behind the ears and at the back of the head. (2) Roseola infantum is more common in infants under 6 months old. After 3 to 4 days of fever, the rash appears as the body temperature drops, leaving no marks. It is not difficult to differentiate from measles. (3) Scarlet fever has a short prodromal period with no obvious catarrhal symptoms. The pharynx and tonsils are significantly red and swollen. The rash is fine, with no normal skin between the lesions. A "strawberry tongue" is present, and significant desquamation occurs after the rash subsides. (4) Drug rash is associated with a history of medication use and lacks the prodromal symptoms of measles. The rash varies in appearance, being less prominent on the trunk and more so on the limbs. It resolves after discontinuing the medication. (5) Thrush presents with larger, uneven white spots in the mouth that are easily scraped off, with no systemic symptoms.