Measles (rubeola) is a highly contagious respiratory infection. It is so contagious that 90% of people exposed to it will develop the disease, unless they are immune. Measles is caused by a virus and can be a serious or even fatal illness for young children. However, since vaccinations were introduced in 1963, measles has become rare in developed countries, including the United States. There are still an estimated 30 million cases of measles worldwide each year, resulting in 750,000 deaths.

Measles is associated with the following signs and symptoms:

• Moderate to high fever
• Conjunctivitis (red, irritated eyes)
• Cough
• Sore throat, hoarseness
• Runny nose
• Red spots with bluish-white centers, called Koplik's spots, on the inside of the mouth
• Red, blotchy, itchy rash, which begins on the face and then spreads
• Enlarged lymph nodes
• Rarely (1 in 1000 cases), extreme drowsiness, seizure, or coma, suggesting involvement of the central nervous system

Measles is caused by a virus (paramyxovirus) that is spread through the air or by contact with infectious droplets from the nose, mouth, or throat. It is possible to contract it by merely being in the same room as an infected person. Most people get measles because they were never immunized. Once someone has had measles, that person has immunity for life.

People with the following conditions or characteristics are at risk for developing measles:

• Weakened immune system caused by a congenital immunodeficiency, the human immunodeficiency virus (HIV), or certain drugs that suppress the immune system (for example, chemotherapy medicines)
• Infants less than 1 year of age (too young to be immunized)
• Other children and adults who have not been immunized or who have been insufficiently immunized
• Diminished immunity from vaccination in childhood (occurs rarely but with increasing frequency as adults get older)

Anyone with a fever and unexplained rash should see a health care provider. Your health care provider will do a physical examination, checking for Koplik's spots or the rash that usually appears several days after the spots have disappeared. To help confirm the diagnosis, your health care provider may order a blood test to detect the presence of antibodies against the measles virus.

Prevention

Vaccination is the key to preventing measles. Since the 1980s, the live, weakened measles vaccine, available as the combination vaccine of measles-mumps-rubella (MMR), is administered in two doses -- one at age 12 - 15 months, and the second at age 5 - 12 years. Of those who receive the vaccine, more than 95% have lifelong immunity.

Treatment Plan

Rest, drinking plenty of fluids, and treatment to relieve symptoms are adequate if there are no complications.

Drug Therapies

The following medications may be used in the management of measles:

• Acetaminophen for high fevers. Children under 16 should not be given aspirin because of the danger of developing Reye's syndrome.
• Antibiotics for bacterial complications such as pneumonia and ear infection
• Immune gamma globulin followed by measles vaccination 5 - 6 months later

Complementary and Alternative Therapies

Nutrition and Supplements

• Vitamin A. People who are deficient in vitamin A are more likely to get infections, including measles, and their cases are more likely to be severe. Studies in developing countries have shown that taking high doses of vitamin A reduced the risk of death in children who had measles. It is not clear whether children who do not have a vitamin A deficiency will benefit, although the American Academy of Pediatrics recommends that children who have measles be given a single dose of 200,000 IU vitamin A in oil (100,000 IU in infants). Such a high dose should only be administered by your doctor.

The following nutrients may be used to support the immune system in general. Check with your doctor to determine the proper dose for a child, and do not treat a child without medical supervision.

• Vitamin C
• Vitamin E
• Zinc
• Selenium
• Quercetin, a bioflavonoid that has antiviral effects

Herbs

Flavonoids, plant compounds with potent biologic activity, are believed to help fight viruses. Of those tested in vitro (in test tubes), the following has demonstrated slight benefit against measles:

• Rhusflavanone, from the wax tree (Rhus succedanea L.). Because it has not been tested in humans, there is no established dose.

In addition:

• Calendula flower (Calendula officinalis) has shown antiviral activity in test tubes and is thought to enhance the immune system, although it has not been studied against measles specifically. It is also used to reduce rashes such as the one that is a symptom of measles. Make a tea by steeping 1 - 2 g dried flowers in one cup boiling water, strain, and cool. Drink three cups per day.
• Elderberry (Sambucus nigra) also has shown antiviral properties in studies. Dose will vary with different formulations, so consult a qualified herbal prescriber to determine the right dose.
• Spicebush (Lindera benzoin) is a remedy used by Native Americans of the Cherokee nation for measles, but it has not been studied scientifically.

Herbs that boost the immune system include

• Echinacea (Echinacea spp.)
• Garlic (Allium sativum)
• Goldenseal (Hydrastis canadensis)

To reduce itching from the rash, use witch hazel (Hamamelis virginia) or add oatmeal to a bath.

Homeopathy

Few studies have examined the effectiveness of specific homeopathic remedies. A professional homeopath, however, may recommend one or more of the following treatments for measles based on his or her knowledge and clinical experience. Before prescribing a remedy, homeopaths take into account a person's constitutional type -- your physical, emotional, and intellectual makeup. An experienced homeopath assesses all of these factors when determining the most appropriate remedy for a particular individual.

• Aconitum-- for symptoms that come on suddenly including fever, conjunctivitis, dry cough, and restlessness. It is best used very early in the course of the disease.
• Apis mellifica -- for individuals with swollen lips and eyes and a rash that is not fully developed. Warmth increases itchiness as well as swelling.
• Belladonna -- can be used either during early stages of measles or after the rash has erupted. It is useful for those who have difficulty sleeping and symptoms that include fever, headache, and drowsiness.
• Bryonia -- for individuals with a delayed rash who have a dry, painful cough, headaches, and muscle pain that worsens with movement and warmth. This remedy is most appropriate for people with a rash primarily on the chest, a dry mouth, and a desire for cold drinks.
• Euphrasia -- for nasal discharge, red eyes, and tears associated with measles. This remedy is most appropriate for people who have a strong sensitivity to light.
• Gelsemium -- for the early stages of measles when there is a slow onset of fever and chilliness, cough, headache, weakness, and a watery nasal discharge that burns the upper lip. This remedy is most appropriate for people who are apathetic and have little or no thirst.
• Pulsatilla -- can be used at any stage of the measles but often used after fever has resolved. This remedy is most appropriate for people who may have thick, yellow nasal discharge, a dry cough at night, a productive cough in the daytime, and mild ear pain. Symptoms are frequently mild.
• Sulphur -- for measles in which the skin has a purplish appearance. The individual for whom this remedy is appropriate may have red mucus membranes with a cough and diarrhea that is worse in the mornings.

Measles is most often an uncomplicated childhood illness. However, infants and adults, especially those who are malnourished or whose immune system is weak, may develop complications that involve the respiratory system, central nervous system, or digestive system, and may need to be hospitalized. In a small percentage of cases, measles can be fatal.

Measles in a pregnant woman can result in premature birth, miscarriage, stillbirth, or low-birth-weight babies. Infants of mothers with active measles should receive immune globulin at birth. Pregnant women should not be vaccinated.

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