Measles - Newcastle Hospitals NHS Foundation Trust

What is measles?

Measles is an extremely infectious viral infection that can cause severe illness, complications or death. Measles can cause serious illness in people who have had organ transplants and who are taking immunosuppressant medicines.

Following the introduction of the measles vaccine in 1968 and the measles, mumps and rubella (MMR) vaccination programme in 1988, transmission of measles in the UK was substantially reduced. In recent years the uptake of the vaccination programme has fallen which has led to an increase in the number of cases of measles being seen across the world, including the UK.

How is measles spread?

Measles is spread by:

Airborne transmission – breathing the air from someone with measles
Droplet transmission – through contact with nasal or throat secretions from someone coughing or sneezing.

How can my child avoid picking up measles?

There is a vaccine available to prevent measles. Unfortunately, this is not suitable for people who have had organ transplants and who are taking immunosuppressant medicines, as it is a live vaccine.

There are some simple measures however, that can be taken to help avoid spreading or picking up measles and other viruses and bacteria.

These include:

Handwashing with soap and water particularly before eating
Avoiding sharing cups and utensils
Use tissues when coughing and sneezing
Throw used tissues in the bin and wash hands afterwards
Avoid contact with known or suspected cases of measles
Vaccination of other household members

How long is the incubation period?

The incubation period is about ten days (ranging between seven and 18 days) between exposure to the virus and developing initial symptoms, with a further two to four days before the rash appears.

What are the symptoms of measles?

Symptoms may vary between different people. Those who have had organ transplants and who are taking immunosuppressant medication may not always develop a rash.

Initial symptoms can include:

Fever
Lethargy
Poor appetite
Cold-like symptoms
Red, itchy, watery eyes (conjunctivitis)
Cough

Later symptoms include:

Koplik spots (small red spots with blueish white centres) which may appear on the inside of the cheeks and lips. These tend to appear one to two days before the rash develops and may be seen for a further one to two days afterwards.
Rash consisting of red spots that are usually not itchy, sometimes are raised and joined together to form blotchy patches. The rash starts three to four days after the initial symptoms. It starts behind the ears, then the face, then spreads to the trunk of the body, and then the limbs.
The rash may look differently with different skin types and colours.
At first the spots fade (blanch) when pressed but become nonâ€blanching by the third or fourth day of the rash.
After five to six days, the rash fades in the same order it appeared in, from face to limbs.
Flaking or peeling of the skin can occur

What complications could my child develop after contracting measles

Measles can lead to serious problems if it spreads to other parts of the body, such as the lungs or brain. These problems are rare but babies and people taking immunosuppressant medicines are more at risk.

Some of the problems that may develop include:

Middle ear infection (Otitis media) is the most common complication of measles. This can lead to permanent hearing loss.
Inflammation of the lung tissue (pneumonitis). This is one of the commonest serious complications and generally develops within around two weeks of symptoms of measles starting.
Infection of the lungs (pneumonia).
Diarrhoea.
Infection of the brain such as encephalitis.
Sight problems including blindness which can be permanent.

What should I do if my child may have been in contact with someone with measles?

If you think your child has been in contact with someone with suspected or confirmed measles, it is very important to contact your transplant team for advice as soon as possible.

Transplant nurse specialists

Monday to Friday, 9am to 5pm

Ward 23

Monday to Friday, 5pm – 9am and Saturday to Sunday

0191 213 7023

Your team will want to know whether there has been close face-to-face contact or your child has spent more than 15 minutes in an enclosed space with someone during the infectious period. For example, this may be being in a room in the same house together or a child in the same class with a confirmed measles case.

Your transplant team will assess and may request a blood test to check for measles immunity and/or advise if intravenous immunoglobulin (IVIG) therapy is needed.

Immunoglobulin is made from donated blood plasma that contains antibodies to protect against certain infections. It is usually given within three days of exposure to measles but can be given up to six days. IVIG will not always prevent your child developing measles but can make the illness less severe.

What tests can be done to diagnose measles?

Your child will be assessed by the medical team who will consider their symptoms and whether they may have measles.

There are a number of other childhood illnesses such as scarlet fever, which may have similar symptoms, and the medical team will try to determine what is making your child unwell.

Some of the tests that may be performed include:

Blood tests to look for signs of infection and inflammation and to check that basic bodily functions are working normally
A swab from the mouth to check for measles and other infections
Chest X-ray if there seems to be any complications affecting the lungs

All cases of suspected measles are reported to the local Health Protection Team who will provide specialist advice and coordinate contact tracing in the community.

Can measles be treated?

We do not have a specific treatment for measles. Ensuring your child takes sufficient fluids, has regular paracetamol and plenty of rest is important.

How long will my child be infectious for?

Your child will be infectious from the time they first develop symptoms (around four days before the rash appears) until four days after the rash develops. People taking immunosuppressant medication may be infectious for longer as their immune systems cannot efficiently clear the virus quickly.

If you are worried that your child is very unwell, has difficulty breathing, is drowsy or difficult to wake, is not feeding or passing urine normally, seek urgent medical advice locally either in the emergency department or by calling 999.

If you would like to speak to someone further about the information in this leaflet, please do not hesitate to talk to a member of staff at your next clinic appointment or you can call the children’s transplant nurse specialists.