Measles in adults

Measles is a highly infectious, acute viral disease. It typically manifests itself in characteristic skin rashes and complaints of the upper respiratory tract. Measles is extremely easily transmitted and has a similar infection potential as chickenpox (varicella).

Many people think of measles as a harmless childhood disease, but it is a serious disease that can lead to serious complications such as pneumonia or encephalitis. Adult illnesses are usually more severe and have more complications than childhood illnesses.

Measles causes lifelong immunity against the virus. Newborns whose mothers have survived a measles infection also acquire immunity via the placenta, although this only lasts for the first few months of life. Before a protective vaccination against measles was introduced, measles epidemics usually occurred every two to three years. As a result, many children became ill at a young age and were able to build up lifelong protection.

With the introduction of vaccination, the number of illnesses has been greatly reduced. However, local measles epidemics occur regularly, because nowadays the vaccination protection of children is often neglected by the parents.

Measles is a notifiable disease in Austria. Therefore, already the suspicion of the disease, but of course also the disease as well as the death from measles must be reported to the competent district administrative authority.

Measles is caused by an infection with the measles virus. The virus is usually transmitted through direct contact or as a droplet infection (pathogens are transmitted through the air, for example by coughing, sneezing or talking). Only rarely is the disease transmitted indirectly via healthy people or objects.

The incubation period (time from infection to the appearance of symptoms) is between eight and ten days. The disease is contagious from five days before the rash appears until four days after it appears. Once the rash has subsided, there is no longer a risk of infection.

Measles disease typically progresses in three stages:

Prodromal stage / Initial stage

The incubation period is followed for three to five days by the prodromal stage, which is characterized by the following symptoms:

• Sore throat, fever up to 41°C, cough, cold, bronchitis, nausea, conjunctivitis (eye conjunctivitis).
• Hypersensitivity to light
• In rare cases, occurrence of so-called Koplik spots (white, chalky spots on a reddish background) on the oral mucosa in the area opposite the front molars.

Exanthem stage

This is followed for about three days by the exanthema stage, in which the following symptoms appear:

• First, a typical irritation of the mucous membrane (enanthem) of the soft palate in the throat area is often noticeable.
• This is followed by the characteristic maculo-papular skin rash (exanthem). Typically, the skin behind the ears is affected first, from where the rash spreads over the entire body within 24 hours.
• The rash is accompanied by a renewed rise in fever up to 40°C.
• Occurrence of swelling of the lymph nodes.
• Small skin bleedings may also occur.

Recovery stage

• The rash usually disappears after four to five days.
• After the rash subsides, desquamation of the skin may persist for a short time.
• In the period after a measles infection, the susceptibility to other diseases is temporarily increased due to the weakened immune system.
• If the course of the disease is uncomplicated, a rapid recovery follows, with lifelong immunity to the measles virus.

Untypical courses

mitigated measles: This refers to an attenuated form of measles disease that may occur in newborns with surrogate immunity due to maternal antibodies or in sufferers who have been treated with antibody drugs.

White measles: These can occur in people with immunodeficiency (for example, congenital defects of the cellular immune system, immunosuppressive therapy, AIDS, malignant tumors). In these cases, the typical symptoms such as the skin rash are often absent and there may be a long, severe course of the disease with a higher rate of complications and death than usual.

Atypical measles: This is a severe form of disease progression that occurred in patients vaccinated with formalin-inactivated vaccines when they later came into contact with a wild-type measles virus. However, these vaccines were used in the 1960s and are no longer used today.

Since measles has a relatively characteristic clinical picture, the diagnosis can usually be made on the basis of the symptoms. Laboratory diagnostics can detect antibodies against the measles virus using the ELISA method. The detection of RNA (genetic material) of the measles virus with a PCR is also possible.

If measles causes encephalitis (inflammation of the brain), the cerebrospinal fluid (CSF) is examined for the presence of viruses. The cerebrospinal fluid is taken through a lumbar puncture (the syringe is inserted in the region of the lumbar vertebrae).

In the case of measles, it is important that strict bed rest is observed during the acute phase of the disease. There is no specific therapy against the measles virus.

For symptomatic therapy, antipyretics (fever-reducing drugs) and antitussives (cough suppressants) are available. If there is an additional infection with bacteria (for example, a middle ear infection or pneumonia), these diseases are treated with antibiotics. Since the body has an increased need for fluids due to the fever, it is imperative that the sick drink plenty of fluids. Passive or active immunization after contact with the pathogens can effectively prevent measles outbreaks in previously unvaccinated individuals.

As long as patients are still contagious, they must not visit communal facilities (for example schools, kindergartens, crèches).

Measles is not, as many people assume, a harmless childhood disease, but a serious viral infection that can lead to serious complications:

• Otitis media (inflammation of the middle ear) or pneumonia (inflammation of the lungs) due to an additional infection with bacteria during the course of the disease.
• Meningoencephalitis occurs in about 0.1% of cases. This leads to an inflammation of the brain and the meninges, which is fatal in up to 20% of cases and causes permanent damage to the brain (for example paralysis or speech disorders) in 20-40%.
• Subacute sclerosing panencephalitis is the most feared late complication of measles, with a probability of about 1:100,000. It is a persistent inflammation of the brain in which the nerves are progressively damaged. The first symptoms usually do not manifest themselves until seven years after contracting measles. The disease leads to increasing mental deterioration (mental disorders, dementia, muscle cramps, epileptic seizures) and always to death within up to three years.
• In general, about one in 10,000 to 20,000 cases is fatal.

Vaccination against measles provides safe protection against disease. In this process, the doctor administers an attenuated live vaccine, whereby antibodies against the measles virus are formed in the body, thus creating immunity without prior illness.

In Austria, it is recommended that all children be vaccinated twice between the ages of 11 and 14 months and between the ages of 15 and 23 months. This can guarantee lifelong immunity in 99% of cases. A repeat vaccination (for example, if the second vaccination was forgotten) is offered free of charge in the 7th year of life when the child starts school and in the 13th year of life. To be on the safe side, a blood test can be carried out by the doctor to determine whether there is still sufficient vaccination protection against measles.