Measles is an infection of the respiratory system caused by a virus, specifically a
paramyxovirusParamyxoviruses are viruses of the Paramyxoviridae family of the Mononegavirales order; they are negative-sense single-stranded RNA viruses responsible for a number of human and animal diseases.-Genera:*Subfamily Paramyxovirinae**Genus Avulavirus Paramyxoviruses (from Greek para-, beyond, -myxo-,...
of the genus
MorbillivirusMorbillivirus is a genus belonging to the Paramyxoviridae family of viruses in the order Mononegavirales. Many members of the genus cause diseases, such as rinderpest and measles, and are highly infectious.-Species:*Canine distemper virus...
. Morbilliviruses, like other paramyxoviruses, are enveloped, single-stranded, negative-sense RNA viruses. Symptoms include
feverFever is a frequent medical sign that describes an increase in internal body temperature to levels above normal...
,
coughA cough , in medicine, is a sudden and often repetitively occurring defense reflex which helps to clear the large breathing passages from excess secretions, irritants, foreign particles and microbes...
,
runny noseCoryza is a word describing the symptoms of a head cold. It describes the inflammation of the mucous membranes lining the nasal cavity which usually gives rise to the symptoms of nasal congestion and loss of smell, among other symptoms...
,
red eyesConjunctivitis is an inflammation of the conjunctiva , most commonly due to an allergic reaction or an infection...
and a generalized,
maculopapularA maculopapular rash is a medical term used to describe a unique type of rash. It is a compound of the terms macule and papule . It is usually also described as erythematous, or red....
,
erythemaErythema is redness of the skin, which can be caused by several things, including capillary congestion.-Causes:It can be caused by infection, massage, electrical treatment, acne medication, allergies, exercise, solar radiation , cutaneous radiation syndrome, or waxing and plucking of the hairs...
tous rash.
Measles is spread through respiration (contact with
fluidA fluid is a substance that continually deforms under an applied shear stress. All gases are fluids, but not all liquids are fluids. Fluids are a subset of the phases of matter and include liquids, gases, plasmas and, to some extent, plastic solids....
s from an
infectedAn infection is the detrimental colonization of a host organism by a foreign species. In an infection, the infecting organism seeks to utilize the host's resources to multiply, usually at the expense of the host. The infecting organism, or pathogen, interferes with the normal functioning of the...
person's nose and mouth, either directly or through
aerosolParticulates, alternatively referred to as particulate matter or fine particles, are tiny particles of solid or liquid suspended in a gas or liquid. In contrast, aerosol refers to particles and the gas together. Sources of particulate matter can be man made or natural...
transmission), and is highly contagious—90% of people without
immunityAn immune system is a system of biological structures and processes within an organism that protects against disease by identifying and killing pathogens and tumour cells. It detects a wide variety of agents, from viruses to parasitic worms, and needs to distinguish them from the organism's own...
sharing a house with an infected person will catch it. The infection has an average incubation period of 14 days (range 6–19 days) and infectivity lasts from 2–4 days prior, until 2–5 days following the onset of the rash (i.e. 4-9 days infectivity in total).
An alternative name for measles in English-speaking countries is
rubeola, which is sometimes confused with
rubellaRubella, commonly known as German measles, is a disease caused by the rubella virus. The name "rubella" is derived from the Latin, meaning little red. Rubella is also known as German measles because the disease was first described by German physicians in the mid-eighteenth century. This disease is...
(German measles); the diseases are unrelated. In some other European languages,
rubella and
rubeola are synonyms, and
rubeola is not an alternative name for measles.
Signs and symptoms
The classical symptoms of measles include four day fevers, the three
Cs—
coughA cough , in medicine, is a sudden and often repetitively occurring defense reflex which helps to clear the large breathing passages from excess secretions, irritants, foreign particles and microbes...
,
coryzaCoryza is a word describing the symptoms of a head cold. It describes the inflammation of the mucous membranes lining the nasal cavity which usually gives rise to the symptoms of nasal congestion and loss of smell, among other symptoms...
(runny nose) and
conjunctivitisConjunctivitis is an inflammation of the conjunctiva , most commonly due to an allergic reaction or an infection...
(red eyes). The fever may reach up to 40°
CelsiusCelsius is a temperature scale that is named after the Swedish astronomer Anders Celsius , who developed a similar temperature scale two years before his death...
(104°
FahrenheitFahrenheit is the temperature scale proposed in 1724 by, and named after, the physicist Daniel Gabriel Fahrenheit . Today, the scale has been replaced by the Celsius scale in most countries; it is still in use for non-scientific purposes in the United States and a few other nations, such as...
).
Koplik's spotsKoplik spots are a viral enanthem of measles manifesting on the first day of rash. They are characterized as clustered, white lesions on the buccal mucosa near Stensen ducts and are pathognomonic for measles...
seen inside the mouth are
pathognomonicPathognomonic is a term, often used in medicine, that means characteristic for a particular disease...
(diagnostic) for measles but are not often seen, even in real cases of measles, because they are transient and may disappear within a day of arising.
The characteristic measles rash is classically described as a generalized,
maculopapularA maculopapular rash is a medical term used to describe a unique type of rash. It is a compound of the terms macule and papule . It is usually also described as erythematous, or red....
,
erythemaErythema is redness of the skin, which can be caused by several things, including capillary congestion.-Causes:It can be caused by infection, massage, electrical treatment, acne medication, allergies, exercise, solar radiation , cutaneous radiation syndrome, or waxing and plucking of the hairs...
tous rash that begins several days after the fever starts. It starts on the head before spreading to cover most of the body, often causing
itchItch is an unpleasant sensation that evokes the desire or reflex to scratch. Itch has resisted many attempts to classify it as any one type of sensory experience. Modern science has shown that itch has many similarities to pain, and while both are unpleasant sensory experiences, their behavioral...
ing. The rash is said to "stain", changing colour from red to dark brown, before disappearing.
Complications
Complications with measles are relatively common, ranging from relatively mild and less serious
diarrheaIn medicine, diarrhea , also spelled diarrhoea , is the condition of having frequent loose or liquid bowel movements. Acute diarrhea is a common cause of death in developing countries and the second most common cause of infant deaths worldwide...
, to
pneumoniaPneumonia is an inflammatory illness of the lung. Frequently, it is described as lung parenchyma/alveolar inflammation and abnormal alveolar filling with fluid ....
and
encephalitisEncephalitis is an acute inflammation of the brain.Encephalitis with meningitis is known as meningoencephalitis.-Bacterial and other:It can be caused by a bacterial infection such as bacterial meningitis spreading directly to the brain , or may be a complication of a current infectious disease...
(
subacute sclerosing panencephalitisSubacute sclerosing panencephalitis is a rare chronic, progressive encephalitis that affects primarily children and young adults, caused by a persistent infection of immune resistant measles virus . 1 in 100,000 people infected with measles develop SSPE...
),
corneal ulcerA corneal ulcer, or ulcerative keratitis, is an inflammatory condition of the cornea involving loss of its outer layer. It is very common in dogs and is sometimes seen in cats...
ation leading to
corneal scarringCorneal abrasion is a medical condition involving the loss of the surface epithelial layer of the eye's cornea.-Etiology:Corneal abrasions are generally a result of trauma to the surface of the eye. Common causes include jabbing a finger into an eye, walking into a tree branch, getting grit in the...
. Complications are usually more severe amongst adults who catch the virus.
The fatality rate from measles for otherwise healthy people in developed countries is 3 deaths per thousand cases, or .3%.
In
underdeveloped nationDeveloping country is a term generally used to describe a nation with a low level of material well being. There is no single internationally-recognized definition of developed country, and the levels of development may vary widely within so-called developing countries, with some developing...
s with high rates of
malnutritionMalnutrition is the insufficient, excessive or imbalanced consumption of nutrients.A number of different nutrition disorders may arise, depending on which nutrients are under or overabundant in the diet....
and poor healthcare, fatality rates have been as high as 28%. In
immunocompromisedImmunodeficiency is a state in which the immune system's ability to fight infectious disease is compromised or entirely absent. Most cases of immunodeficiency are acquired but some people are born with defects in the immune system, or primary immunodeficiency...
patients (e.g. people with
AIDSAcquired immune deficiency syndrome or acquired immunodeficiency syndrome is a disease of the human immune system caused by the human immunodeficiency virus ....
) the fatality rate is approximately 30 percent.
Cause
The measles virus is a highly contagious airborne pathogen which spreads primarily via the respiratory system. The virus is transmitted in respiratory secretions, and can be passed from person to person via aerosol droplets containing virus particles, such as those produced by a coughing patient. Once transmission occurs, the virus infects and replicates in the
lymphatic systemThe lymphatic system in vertebrates is a network of conduits that carry a clear fluid called lymph. It also includes the lymphoid tissue through which the lymph travels. Lymphoid tissue is found in many organs, particularly the lymph nodes, and in the lymphoid follicles associated with the...
, urinary tract,
conjunctivaThe conjunctiva is a clear mucous membrane consisting of cells and underlying basement membrane that covers the sclera and lines the inside of the eyelids...
e,
blood vesselThe blood vessels are the part of the circulatory system that transport blood throughout the body. There are three major types of blood vessels: the arteries, which carry the blood away from the heart, the capillaries, which enable the actual exchange of water and chemicals between the blood and...
s and
central nervous systemThe central nervous system is the part of the nervous system that functions to coordinate the activity of all parts of the bodies of bilaterian animals—that is, all animals more advanced than sponges or jellyfish. In vertebrates, the central nervous system is enclosed in the meninges. It contains...
of its new host. The role of epithelial cells is uncertain, but the virus must infect them to spread to a new individual.
Patients with the measles should be placed on
droplet precautions.
Humans are the only known natural host of measles, although the virus can infect some non-human primate species.
Diagnosis
Clinical diagnosis of measles requires a history of fever of at least three days together with at least one of the three Cs (cough, coryza, conjunctivitis). Observation of
Koplik's spotsKoplik spots are a viral enanthem of measles manifesting on the first day of rash. They are characterized as clustered, white lesions on the buccal mucosa near Stensen ducts and are pathognomonic for measles...
is also diagnostic of measles.
Alternatively, laboratory diagnosis of measles can be done with confirmation of positive measles
IgMIGM might be an acronym or abbreviation for:* The polymeric immunoglobulin, IgM* International Grandmaster, a chess ranking* intergalactic medium* Intragroup medium - see: Intracluster medium* IG Metall - the dominant German metalworkers' union...
antibodies or isolation of measles virus RNA from respiratory specimens. In cases of measles infection following secondary vaccine failure IgM antibody may not be present. However, in the rare case of a secondary vaccine failure, other external symptoms may be present, including nausea, headaches, or a feeling of slight dizziness when turning one's head to the left. In these cases serological confirmation may be made by showing IgG antibody rises by enzyme immunoassay or complement fixation. In children, where
phlebotomyPhlebotomy may refer to:* Venipuncture, the practice of collecting blood samples* The main practice of a phlebotomist, an individual trained to draw blood* Bloodletting, the ancient medical practice* Phlebotomy...
is inappropriate, saliva can be collected for salivary measles specific
IgAIga or IGA may stand for:-Places :* Iga, a city in Mie Prefecture, Honshū island, Japan** Iga Ueno Castle, a castle located in the above city...
test. Adults are recommended to seek medical help right away.
Positive contact with other patients known to have measles adds strong
epidemiologicalEpidemiology is the study of factors affecting the health and illness of populations, and serves as the foundation and logic of interventions made in the interest of public health and preventive medicine...
evidence to the diagnosis. The contact with any infected person in any way, including semen through sex, saliva, or mucus can cause infection.
Histologically, a unique cell can be found in the paracortical region of hyperplastic lymph nodes in patients affected with this condition. This cell, known as the
Warthin-Finkeldey cellA Warthin-Finkeldey cell is a small multinucleated cell, found in the paracortical region of hyperplastic lymph nodes in some patients of measles and AIDS. It consists of fused lymphocytes and can be seen in a lymph node biopsy after a measles vaccination....
, is a multinucleated giant with eosinophilic cytoplasmic and nuclear
inclusionsInclusion bodies are nuclear or cytoplasmic aggregates of stainable substances, usually proteins. They typically represent sites of viral multiplication in a bacterium or a eukaryotic cell and usually consist of viral capsid proteins...
.
Prevention
In developed countries, most children are immunized against measles by the age of 18 months, generally as part of a three-part
MMR vaccineThe MMR vaccine is a mixture of three live attenuated viruses, administered via injection for immunization against measles, mumps and rubella . It is generally administered to children around the age of one year, with a second dose before starting school...
(measles,
mumpsMumps or epidemic parotitis is a viral disease of the human species, caused by the mumps virus. Prior to the development of vaccination and the introduction of a vaccine, it was a common childhood disease worldwide, and is still a significant threat to health in the third world.Painful swelling...
, and
rubellaRubella, commonly known as German measles, is a disease caused by the rubella virus. The name "rubella" is derived from the Latin, meaning little red. Rubella is also known as German measles because the disease was first described by German physicians in the mid-eighteenth century. This disease is...
). The vaccination is generally not given earlier than this because children younger than 18 months usually retain anti-measles immunoglobulins (antibodies) transmitted from the mother during pregnancy. A second dose is usually given to children between the ages of four and five, in order to increase rates of immunity. Vaccination rates have been high enough to make measles relatively uncommon. Even a single case in a college dormitory or similar setting is often met with a local vaccination program, in case any of the people exposed are not already immune.
In developing countries where measles is highly endemic, the
WHOThe World Health Organization is a specialized agency of the United Nations that acts as a coordinating authority on international public health...
recommend that two doses of vaccine be given at six months and at nine months of age. The vaccine should be given whether the child is HIV-infected or not. The vaccine is less effective in HIV-infected infants, but the risk of adverse reactions is low.
Unvaccinated populations are at risk for the disease. After vaccination rates dropped in northern
NigeriaNigeria , officially the Federal Republic of Nigeria, is a federal constitutional republic comprising thirty-six states and one Federal Capital Territory. The country is located in West Africa and shares land borders with the Republic of Benin in the west, Chad and Cameroon in the east, and Niger...
in the early 2000s due to religious and political objections, the number of cases rose significantly, and hundreds of children died. A 2005 measles outbreak in
IndianaIndiana is a U.S. state, the 19
th admitted to the Union. It is located in the Great Lakes region, and with approximately 6.3 million residents, is ranked 16
th in population and 17
th in population density. Indiana is ranked 38
th in land area, and is the...
was attributed to children whose parents refused vaccination. In the early 2000s the
MMR vaccine controversyThe MMR vaccine controversy refers to claims that autism can be caused by the MMR vaccine, a vaccine against measles, mumps, and rubella. The scientific consensus is that no credible scientific evidence links the vaccine to autism, and that the vaccine's benefits greatly outweigh its risks.Claims...
in the
United KingdomThe United Kingdom of Great Britain and Northern Ireland is a sovereign state located off the northwestern coast of continental Europe. It is an island country, spanning an archipelago including Great Britain, the northeastern part of Ireland, and many small islands...
regarding a potential link between the combined MMR vaccine (vaccinating children from mumps, measles and rubella) and
autismAutism is a disorder of neural development that is characterized by impaired social interaction and communication, and by restricted and repetitive behavior. These signs all begin before a child is three years old. Autism involves many parts of the brain; how this occurs is not well understood...
prompted a reemergence of the "measles party", where parents deliberately expose their child to measles in the hope of building up the child's immunity without an injection. This practice poses many health risks to the child, and has been discouraged by the public health authorities.
Scientific evidenceEvidence-based medicine aims to apply the best available evidence gained from the scientific method to medical decision making. It seeks to assess the quality of evidence of the risks and benefits of treatments ....
provides no support for the hypothesis that MMR plays a role in causing autism. However, the MMR scare in Britain caused uptake of the vaccine to plunge, and measles cases came back: 2007 saw 971 cases in England and Wales, the biggest rise in occurrence in measles cases since records began in 1995.
The joint press release by members of the
Measles InitiativeMeasles Initiative , launched in 2001, is a long-term commitment and partnership among leaders in public health and supports the goal of reducing measles deaths globally by 90% by 2010 compared to 2000 estimates.-Impact:...
brings to light another benefit of the fight against measles: "Measles vaccination campaigns are contributing to the reduction of child deaths from other causes. They have become a channel for the delivery of other life-saving interventions, such as bed nets to protect against malaria, de-worming medicine and vitamin A supplements. Combining measles immunization with other health interventions is a contribution to the achievement of Millennium Development Goal Number 4: a two-thirds reduction in child deaths between 1990 and 2015."
Treatment
There is no cure for measles. Most patients with uncomplicated measles will recover with rest and supportive treatment.
Some patients will develop
pneumoniaPneumonia is an inflammatory illness of the lung. Frequently, it is described as lung parenchyma/alveolar inflammation and abnormal alveolar filling with fluid ....
as a sequel to the measles.
Epidemiology
According to the
World Health OrganizationThe World Health Organization is a specialized agency of the United Nations that acts as a coordinating authority on international public health...
(WHO), measles is a leading cause of vaccine-preventable childhood mortality. Worldwide, the fatality rate has been significantly reduced by partners in the
Measles InitiativeMeasles Initiative , launched in 2001, is a long-term commitment and partnership among leaders in public health and supports the goal of reducing measles deaths globally by 90% by 2010 compared to 2000 estimates.-Impact:...
: the
American Red CrossThe American Red Cross is a humanitarian organization that provides emergency assistance, disaster relief and education inside the United States, and is the designated U.S...
, the United States Centers for Disease Control and Prevention (CDC), the United Nations Foundation, UNICEF and the World Health Organization (WHO). Globally, measles deaths are down 60 percent, from an estimated 873,000 deaths in 1999 to 345,000 in 2005. Africa has seen the most success, with annual measles deaths falling by 75 percent in just 5 years, from an estimated 506,000 to 126,000.
History
The
Antonine PlagueThe Antonine Plague, AD 165-180, also known as the Plague of Galen, who described it, was an ancient pandemic, whether of smallpox or measles, brought back to the Roman Empire by troops returning from campaigns in the Near East...
, 165-180 AD, also known as the Plague of
GalenAelius Galenus or Claudius Galenus , better known as Galen of Pergamum , was a prominent Greek physician and philosopher and probably the most accomplished medical researcher of the Roman period. His theories dominated and influenced Western medical science for well over a millennium...
, who described it, was probably
smallpoxSmallpox is an infectious disease unique to humans, caused by either of two virus variants, Variola major and Variola minor. The disease is also known by the Latin names Variola or Variola vera, which is a derivative of the Latin varius, meaning spotted, or varus, meaning "pimple"...
or measles. Disease killed as much as one-third of the population in some areas, and decimated the
RomanThe Roman Empire was the post-Republican phase of the ancient Roman civilization, characterised by an autocratic form of government and large territorial holdings in Europe and around the Mediterranean. The term is used to describe the Roman state during and after the time of the first emperor,...
army. The first scientific description of measles and its distinction from smallpox and
chickenpoxChickenpox or chicken pox, also known as varicella, is a highly contagious illness caused by primary infection with varicella zoster virus...
is credited to the Persian physician, Muhammad ibn Zakariya ar-Razi (860-932), known to the West as "Rhazes", who published a book entitled The Book of Smallpox and Measles
(in ArabicArabic is a Central Semitic language, thus related to and classified alongside other Semitic languages such as Hebrew and the Neo-Aramaic languages. In terms of speakers, the Arabic macrolanguage is the largest member of the Semitic language family. It is spoken by more than 280 million people as...
: Kitab fi al-jadari wa-al-hasbah).
Measles is an endemic disease, meaning that it has been continually present in a community, and many people develop resistance. In populations that have not been exposed to measles, exposure to a new disease can be devastating. In 1529, a measles outbreak in
CubaThe Republic of Cuba is an island country in the Caribbean. It consists of the island of Cuba, the Isla de la Juventud, and several archipelagos. Havana is the largest city in Cuba and the country's capital. Santiago de Cuba is the second largest city. Cuba is home to over 11 million people and is...
killed two-thirds of the natives who had previously survived smallpox. Two years later measles was responsible for the deaths of half the population of
HondurasHonduras is a republic in Central America. It was formerly known as Spanish Honduras to differentiate it from British Honduras...
, and had ravaged
MexicoThe United Mexican States , commonly known as Mexico , is a federal constitutional republic in North America. It is bordered on the north by the United States; on the south and west by the Pacific Ocean; on the southeast by Guatemala, Belize, and the Caribbean Sea; and on the east by the Gulf of...
,
Central AmericaManagua
Guatemala City
San Salvador
San Pedro Sula
Panama City
San José, Costa Rica
Santa Ana, El Salvador
León
San Miguel|-|}...
, and the
IncaThe Inca civilization began as a tribe in the Cuzco area, where the legendary first Sapa Inca, Manco Capac founded the Kingdom of Cuzco around 1200. Under the leadership of the descendants of Manco Capac, the Inca state grew to absorb other Andean communities. In 1442, the Incas began a...
civilization.
In roughly the last 150 years, measles has been estimated to have killed about 200 million people worldwide. During the 1850s, measles killed a fifth of
HawaiiHawaii is the newest of the 50 U.S. states, and is the only state made up entirely of islands. It is located on an archipelago in the central Pacific Ocean, southwest of the continental United States, southeast of Japan, and northeast of Australia. The state was admitted to the Union on August...
's people. In 1875, measles killed over 40,000
FijiFiji , officially the Republic of the Fiji Islands , is an island nation in the South Pacific Ocean east of Vanuatu, west of Tonga and south of Tuvalu. The country comprises an archipelago of about 322 islands, of which 106 are permanently inhabited, and 522 islets...
ans, approximately one-third of the population. In the 19th century, the disease decimated the
AndamaneseThe Andamanese is a collective term to describe the adivasi peoples who are the aboriginal inhabitants of the Andaman Islands, which is the northern district of the Andaman and Nicobar Islands union territory of India, located in the southeastern part of the Bay of Bengal. The term includes the...
population. In 1954, the virus causing the disease was isolated from an 11-year old boy from the
United StatesThe United States of America is a federal constitutional republic comprising fifty states and a federal district...
, David Edmonston, and adapted and propagated on
chickChick may refer to:-Birds:* A chicken * A young bird * A day-old cockerel in falconry* A young bird of prey at the fluffy downy stage-People:* A slang word for women...
embryoAn embryo is a multicellular diploid eukaryote in its earliest stage of development, from the time of first cell division until birth, hatching, or germination...
tissue cultureTissue culture is the growth of tissues and/or cells separate from the organism. This is typically facilitated via use of a liquid, semi-solid, or solid growth medium, such as broth or agar...
. To date, 21 strains of the measles virus have been identified. Licensed
vaccineA vaccine is a biological preparation that improves immunity to a particular disease. A vaccine typically contains a small amount of an agent that resembles a microorganism...
s to prevent the disease became available in 1963.
Recent outbreaks
On February 19, 2009, 505 measles cases were reported in twelve provinces in the North of
VietnamVietnam , officially the Socialist Republic of Vietnam , is the easternmost country on the Indochina Peninsula in Southeast Asia. It is bordered by China to the north, Laos to the northwest, Cambodia to the southwest, and the South China Sea to the east...
, with
HanoiHanoi , estimated population 6.232.940 , is the capital and second-largest city of Vietnam. From 1010 until 1802, with a few brief interruptions, it was the political centre of an independent Vietnam. It was eclipsed by Huế during the Nguyen Dynasty as the capital of Vietnam, but Hanoi served as...
accounting for 160 cases. A high rate of complications including
meningitisMeningitis is inflammation of the protective membranes covering the brain and spinal cord, known collectively as the meninges. The inflammation may be caused by infection with viruses, bacteria, or other microorganisms, and less commonly by certain drugs...
&
encephalitisEncephalitis is an acute inflammation of the brain.Encephalitis with meningitis is known as meningoencephalitis.-Bacterial and other:It can be caused by a bacterial infection such as bacterial meningitis spreading directly to the brain , or may be a complication of a current infectious disease...
has worried health workers and the U.S. CDC recommended that all travelers be immune to measles.
On The 1st April 2009, an outbreak has happened in two schools in North Wales.
Ysgol John BrightYsgol John Bright is a secondary school on Maesdu Road, Llandudno. It serves the state secondary education sector in the Llandudno area and has around 1200 pupils. The school was recently rebuilt and opened in September 2004. The school’s name is derived from John Bright MP who helped set up the...
and Ysgol Ffordd Dyffryn in
WalesWales is a country that is part of the United Kingdom, bordered by England to its east, and the Atlantic Ocean and Irish Sea to its west. It is also an elective region of the European Union...
have had the outbreak and are making sure every pupil has had the
MMRMMR may stand for:*measles, mumps and rubella, as in MMR vaccine*MagnetoMetric Resistivity, a type of survey to find ore bodies*Main Machinery Room, in reference to the nuclear reactors of an aircraft carrier...
vaccine.
In 2007, a large measles outbreak in
Japanis an island country in East Asia. Located in the Pacific Ocean, it lies to the east of the Sea of Japan, People's Republic of China, North Korea, South Korea and Russia, stretching from the Sea of Okhotsk in the north to the East China Sea and Taiwan in the south...
caused a number of universities and other institutions to close in an attempt to contain the disease.
Approximately 1000 cases of the disease were reported in
IsraelIsrael officially the State of Israel , is a developed state in Western Asia located on the eastern shore of the Mediterranean Sea. It borders Lebanon in the north, Syria in the northeast, Jordan in the east, and Egypt on the southwest, and contains geographically diverse features within its...
between August 2007 and May 2008 (in sharp contrast to just some dozen cases the year before). Many children in ultra-Orthodox Jewish communities were affected due to low vaccination coverage. As of 2008 the disease is
endemicIn epidemiology, an infection is said to be endemic in a population when that infection is maintained in the population without the need for external inputs. For example, chickenpox is endemic in the UK, but malaria is not...
in the
United KingdomThe United Kingdom of Great Britain and Northern Ireland is a sovereign state located off the northwestern coast of continental Europe. It is an island country, spanning an archipelago including Great Britain, the northeastern part of Ireland, and many small islands...
with 1,217 cases diagnosed in 2008
and epidemics have been reported in
AustriaAustria , officially the Republic of Austria , is a landlocked country of roughly 8.3 million people in Central Europe. It borders both Germany and the Czech Republic to the north, Slovakia and Hungary to the east, Slovenia and Italy to the south, and Switzerland and Liechtenstein to the west...
,
ItalyItaly , officially the Italian Republic , is a country located on the Italian Peninsula in Southern Europe and on the two largest islands in the Mediterranean Sea, Sicily and Sardinia. Italy shares its northern, Alpine boundary with France, Switzerland, Austria and Slovenia...
and
SwitzerlandSwitzerland , officially the Swiss Confederation , is a federal republic consisting of 26 states named cantons, with Bern as the seat of the federal authorities...
. Low vaccination rates are responsible.
The Americas
Indigenous measles were declared to have been eliminated in North, Central, and South America; the last endemic case in the region was reported on November 12, 2002, with only Northern
ArgentinaArgentina, officially the Argentine Republic , is the second largest country in South America, constituted as a federation of 23 provinces and an autonomous city, Buenos Aires. It is the eighth largest country in the world by land area and the largest among Spanish-speaking nations, though Mexico,...
and rural
CanadaCanada is a country occupying most of northern North America, extending from the Atlantic Ocean in the east to the Pacific Ocean in the west and northward into the Arctic Ocean...
, particularly in the provinces of Ontario, Quebec, and Alberta having minor endemic status. Outbreaks are still occurring, however, following importations of measles viruses from other world regions. In June 2006, an outbreak in
BostonBoston is the capital and largest city of the Commonwealth of Massachusetts, and is one of the oldest cities in the United States. The largest city in New England, Boston is considered the economic and cultural center of the region and is sometimes regarded as the unofficial "Capital of New England"...
resulted after a resident became infected in
IndiaIndia, officially the Republic of India , is a country in South Asia. It is the seventh-largest country by geographical area, the second-most populous country, and the most populous democracy in the world. Bounded by the Indian Ocean on the south, the Arabian Sea on the west, and the Bay of Bengal...
, and in October 2007, a
MichiganMichigan is a Midwestern state of the United States of America. It was named after Lake Michigan, whose name is a French adaptation of the Ojibwe term mishigama, meaning "large water" or "large lake"....
girl who had been vaccinated contracted the disease in
SwedenSweden , officially the Kingdom of Sweden , is a Nordic country on the Scandinavian Peninsula in Northern Europe...
.
Between January 1 and April 25, 2008, a total of 64 confirmed measles cases were preliminarily reported in the United States to the Centers for Disease Control and Prevention, the most reported by this date for any year since 2001. Of the 64 cases, 54 were associated with importation of measles from other countries into the United States, and 63 of the 64 patients were unvaccinated or had unknown or undocumented vaccination status.
By July 9, 2008, a total of 127 cases were reported in 15 states (including 22 in
ArizonaThe State of Arizona is a state located in the southwestern region of the United States. The capital and largest city is Phoenix. The second largest city is Tucson, followed in size by the four Phoenix metropolitan area cities of Mesa, Glendale, Chandler, and Scottsdale.Arizona was the 48th and...
), making it the largest U.S. outbreak since 1997 (when 138 cases were reported). Most of the cases were acquired outside of the United States and afflicted individuals who had not been vaccinated.
By July 30, 2008, the number of cases had grown to 131. Of these, about half involved children whose parents rejected vaccination. The 131 cases occurred in 7 different outbreaks. There were no deaths, and 15 hospitalizations. 11 of the cases had received at least one dose of the measles vaccine. 122 of the cases involved children who were unvaccinated or whose vaccination status was unknown. Some of these were under the age of one year old and below the age when vaccination is recommended, but in 63 cases the vaccinations had been refused for religious or philosophical reasons.
See also
- Infectious disease
An infectious disease is a clinically evident disease resulting from the presence of pathogenic microbial agents, including pathogenic viruses, pathogenic bacteria, fungi, protozoa, multicellular parasites, and aberrant proteins known as prions...
- List of epidemics
- MMR vaccine
The MMR vaccine is a mixture of three live attenuated viruses, administered via injection for immunization against measles, mumps and rubella . It is generally administered to children around the age of one year, with a second dose before starting school...
- Rubella (German measles)
Rubella, commonly known as German measles, is a disease caused by the rubella virus. The name "rubella" is derived from the Latin, meaning little red. Rubella is also known as German measles because the disease was first described by German physicians in the mid-eighteenth century. This disease is...
- Roseola ("baby measles")
Exanthem subitum , also referred to as roseola infantum , sixth disease and baby measles, or three-day fever, is a disease of children, generally under two years old, whose manifestations are usually limited to a transient rash that...
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