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An 18-month-old boy, who is visiting family in San Antonio with his parents from Central America, presents with a 3-day history of fever, malaise, conjunctivitis, coryza, and cough. He had been exposed to a child with similar symptoms approximately 2 weeks prior. A day before, he developed a maculopapular rash that blanches under pressure (Figures 126-1 and 126-2). His shot records are unavailable but his mother states that his last vaccine was before age 1 year. He is diagnosed with measles and supportive care is provided.

Figure 126-1

Typical measles rash that began on the face and became confluent. (Courtesy of the University of Texas Health Sciences Center, Division of Dermatology.)

Figure 126-2

The typical measles rash on the trunk. (Courtesy of the University of Texas Health Sciences Center, Division of Dermatology.)

Measles is a highly communicable, acute, viral illness that is still one the most serious infectious diseases in human history. Until the introduction of the measles vaccination, it was responsible for millions of deaths worldwide annually. Although the epidemiology of this disease makes eradication a possibility, the ease of transmission and the low percentage of nonimmunized population that is required for disease survival have made eradication of measles extremely difficult.

  • Last major outbreak in the United States was during 1989 to 1990 and prompted a change in immunization policy in 1991, so that all children are to have two measles, mumps, rubella (MMR) vaccines before starting kindergarten.
  • This practice interrupted the transmission of indigenous measles in the United States by 1993 and reduced incidence of measles to a historic low (<0.5 cases per 1 million persons) by 1997 to 1999.1
  • After an all-time low of 34 cases were reported in 2004, the annual incidence began to increase with most cases linked to international travel of inadequately vaccinated Americans to endemic areas. Incomplete vaccination rates facilitate the spread once the virus is imported to the United States causing clusters of periodic outbreaks.1
  • The worldwide incidence of death from measles was effectively reduced from an estimated 873,000 in 1999 to 164,000 by 2008 with mass vaccination campaigns by the member countries of the World Health Assembly.2 In 2008, approximately 83% of the world's children received one dose of measles vaccine by their first birthday through routine health services—up from 72% in 2000.3

  • Measles is caused by the measles virus, a member of the family paramyxoviridae, genus Morbillivirus (hence the name, morbilliform rash).
  • It is highly contagious, transmitted by airborne droplets, and commonly causes outbreaks.
  • Classic measles infection starts with the incubation phase that is usually asymptomatic and lasts for 10 to 14 days. It starts after entry of the virus into the respiratory mucosa with local viral replication. The infection then spreads to regional lymphatic tissues, and ...

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