Measles (Rubeola) (cont.)
Edmond Hooker, MD, DrPH
Dr. Eddie Hooker is currently an Assistant Professor in the Department of Health Services Administration at Xavier University in Cincinnati, Ohio. He is also an Associate Clinical Professor in the Department of Emergency Medicine at the University of Louisville and at Wright State University. His areas of expertise include emergency medicine, epidemiology, health-services management, and public health.
Melissa Conrad Stöppler, MD
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
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What is the incubation period for measles?
The typical time from exposure to a person infected with measles to development of the initial symptoms (incubation period) is 10-12 days (the range is seven to 21 days). The rash occurs a few days after the initial symptoms (ranges from seven to 18 days from exposure).
What is atypical measles?
Atypical measles occurs in people who received the killed measles vaccine (KMV; only used from 1963 until 1967) and who are exposed to wild-type measles virus. The KMV unfortunately sensitizes the patient to the measles virus but does not offer any protection. The disease is characterized by fever, pleural effusions, pneumonia, and swelling of the extremities. The rash of atypical measles is different from measles in that it may have an urticarial component (hives) and usually appears first on the ankles and wrists.
It is recommended by the U.S. Centers for Disease Control and Prevention (CDC) that people who may have received the KMV should receive revaccination with the live measles vaccine.
What is modified measles?
Modified measles is seen in patients who, because they were unimmunized, received immune globulin after being exposed to a patient with measles. It is also seen occasionally in young infants who have limited immunity from their mothers. The immune globulin prolongs the time from exposure to onset of symptoms (incubation period). When the symptoms do occur, they are much milder than those seen with normal measles and tend to last a shorter period of time.
What types of doctors treat measles?
Any physician (including primary-care physicians and pediatricians) can treat measles; however, most times there will be an infectious-disease doctor consulted to be sure that the diagnosis is correct. Sometimes a dermatologist might also be consulted. Many physicians in current practice have never seen a case of measles, which makes it more difficult for them to diagnose it. If the patient has pneumonia or encephalitis, they may be in the intensive-care unit and treated by critical-care physicians.
How is the diagnosis of measles made?
The diagnosis of suspected measles is mostly clinical, meaning that the appearance and history of the patient suggest the diagnosis. In a person with known exposure to someone with measles or travel to a foreign country, measles should always be considered when faced with a patient who has a high fever and characteristic rash. Until the rash appears, the presence of Koplik's spots should help to suggest the diagnosis. Most cases of suspected measles in the United States turn out not to be measles (see below). It is recommended that the diagnosis be confirmed using a blood test for IgM, a type of antibody against the virus. If the IgM test is positive, viral cultures should be obtained. The state and local health department should be contacted immediately for any suspected case in order to follow the correct procedures for viral culture and isolation of the patient. Further information on laboratory testing of suspected cases is available from the CDC (http://www.cdc.gov/vaccines/pubs/surv-manual/chpt07-measles.html).
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