Measles

Measles

Profile

Measles is a highly contagious viral disease. Infections are characterized by flu-like symptoms and a characteristic skin rash. In some cases, life-threatening complications such as inflammation of the lungs and brain can occur. Vaccination offers the best protection against infection; there is no specific therapy. The virus is only transmitted from person to person. The World Health Organization (WHO) aims to eliminate measles (and also rubella). Austria also supports the goal of measles and rubella elimination. In order to be able to quickly interrupt chains of infection, immunity of more than 95 percent in the population is considered a prerequisite.

Occurrence

The measles virus is widespread worldwide. Since the use of vaccination, cases have declined significantly, but outbreaks continue to occur, particularly in areas with lower vaccination coverage and generally inadequate health care. Cases also occur repeatedly in Europe, with vaccination coverage rates declining in some cases.

Pathogen reservoir

Humans are the only reservoir for the measles virus.

Infection route

Measles is a highly contagious droplet infection. When sick people cough or sneeze, infectious virus particles are excreted in the form of droplets. These can circulate in the air for several hours. The virus can also be transmitted through direct contact with nasal or throat secretions or with contaminated surfaces. On surfaces, the virus can survive for up to two hours.

Incubation period

Between 8-14 days (in rare cases up to 21 days) until the appearance of first symptoms

Symptomatology

Typical initial symptoms are fever, cough, rhinitis, inflammation of the conjunctiva and bronchioles, the smallest branches of the respiratory tract. In addition, there are typically Koplik spots, bright red spots with white or bluish-white centers in the oral pharynx, which appear one or two days before the rash typical of measles.

The rash itself usually appears three to four days after symptom onset, starting on the head and spreading from there over the entire body. It is described as maculopapular exanthema, which means a patchy nodular rash, usually with single and converging reddish spots. Itching is common. Diarrhea may also occur. After 4-5 days, the exanthema usually subsides.

Therapy

There is no specific antiviral therapy for the treatment of measles infection. Supportive therapy with adequate hydration and antipyretic drugs can alleviate the symptoms. Antibiotics are used in the event of a bacterial superinfection.

Prevention

The best prevention against measles is vaccination. This is a live vaccine, which is available in combination with components against mumps and rubella. From the completed 9th month of life, a total of two vaccination doses are generally recommended. Vaccination is part of the vaccination program of the federal government, the provinces and the social insurance institutions and is available free of charge at public vaccination centers for all age groups. If necessary, the vaccination can also be administered in a certain time window after contact with measles.

Ministry of Health: details on vaccination recommendations, vaccination program and vaccination coverage rates.

Situation in Austria

Since 01.01.2024, 446 confirmed measles cases have been recorded in the epidemiological reporting system (EMS) (EMS status 11.06.2024, 07:00). Information on hospitalisation is available for 438 measles cases: 87 people (19.9 %) were treated in hospital, four of them in an intensive care unit. Further measles cases are to be expected.

For comparison: In 2023, a total of 186 measles cases were recorded in the reporting system. Of these, 49 people were treated in hospital.

Ministry of Health: Statistics on notifiable communicable infectious diseases since 1990

Cases of measles 2024

Number of measles cases by calendar week of exanthema onset (or date of diagnosis/reporting/entry). Only cases that are considered confirmed as of the data status are shown. The number of confirmed measles cases from previous weeks may change as more information is received

Specialized information

The measles virus is a highly contagious single-stranded RNA virus that belongs to the paramyxovirus family.

Infected individuals are considered contagious from about four days before to four days after the appearance of the characteristic measles exanthema. The highest risk of infection occurs during the prodromal phase, the phase before the rash appears, which lasts 2-4 days and is characterized by severe coughing.

Possible complications of measles infection include bacterial superinfections with middle ear and lung infections or inflammation of the larynx. Susceptibility to tuberculosis is also increased.

In 1-2 out of 1,000 cases, life-threatening inflammation of the brain occurs, which is fatal in 10-20% of cases and associated with permanent damage to the nervous system in 20-40%. In addition, there is a risk of generalized encephalitis, in which the brain gradually disintegrates. This late consequence is called subacute sclerosing panencephalitis (SSPE). The risk of contracting it is greater the younger the child is at the time of infection. Children infected during birth or in the first year have a risk of 1:600. There is no treatment for this complication. The course is always fatal.

Diagnostic

The diagnosis is made on the basis of the typical symptoms and course of the disease. To confirm the diagnosis, measles-specific antibodies can be detected in a blood test. Direct virus detection by RT-PCR from a nasopharyngeal swab, conjunctival swab, bronchial secretion, urine or cerebrospinal fluid is also possible, but only after the onset of the rash.

National reference center for measles-mumps-rubella viruses: Medical University of Vienna, Center for Virology. Samples from justified suspected measles cases are analyzed free of charge at the National Reference Laboratory.

Last updated: 11.06.2024

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