Opinion

How to identify measles

The rising numbers of cases of measles this year highlights how important it is for nurses in emergency departments to be vigilant for measles to enable early detection.
Measles rash

The rising numbers of cases of measles this year highlight how important it is for nurses in emergency departments (EDs) to be vigilant for measles to enable early detection.

Public Health England (PHE) figures showed that there were four times more measles cases in the second quarter of 2016 167 new confirmed infections than in the same period last year.

Measles rash. Picture: Science Photo Library

Rise in affected adults

There was also a significant increase in the proportion 39% hospitalised in the first half of 2016 compared to 2015 (26%) and 2014 (22%), reflecting the larger proportion of adults affected.

Measles was often not considered as a possible diagnosis and these adults were admitted to open medical wards, increasing risk of disease transmission (PHE 2016) in one of the most contagious of all infectious diseases.

...

The rising numbers of cases of measles this year highlight how important it is for nurses in emergency departments (EDs) to be vigilant for measles to enable early detection.

Public Health England (PHE) figures showed that there were four times more measles cases in the second quarter of 2016 – 167 new confirmed infections – than in the same period last year.

Measles rash
Measles rash.
Picture: Science Photo Library
 

Rise in affected adults

There was also a significant increase in the proportion – 39% – hospitalised in the first half of 2016 compared to 2015 (26%) and 2014 (22%), reflecting the larger proportion of adults affected.

Measles was often not considered as a possible diagnosis and these adults were admitted to open medical wards, increasing risk of disease transmission (PHE 2016) in one of the most contagious of all infectious diseases.

Measles is a notifiable acute viral illness caused by a morbillivirus of the paramyxovirus family. It is spread by airborne or droplet transmission and the incubation period is around 10 days.

Individuals are infectious from the beginning of the prodromal period when the first symptom appears, to four days after a rash appears (PHE, 2013).

Importance of vaccination

Following the MMR and autism controversy in the late 1990s uptake rates for the measles, mumps and rubella vaccine have been below the required 95% in the UK, leading to outbreaks of measles.

Since many cases have been found in people who had not been vaccinated, PHE is urging people to check that they have had the MMR vaccine.

While health professionals working in EDs encounter rashes as one of the most common presentations, they may not consider measles in their differential diagnoses. They may not have seen a patient with measles or consider measles unlikely as vaccination for it has been available for a few decades.

The prodromal phase of measles is characterised by onset of fever, malaise, coryza, aching and feeling unwell, conjunctivitis and cough. Koplik’s spots are typically clustered, small red spots with bluish-white centres (opposite upper 1st and 2nd molars) which appear 2-3 days before a rash. The rash usually appears on day 4 of fever, starting at the head and spreading to the trunk and limbs over 3-4 days.

For a clinical diagnosis of measles, the following features need to be present:

  • Rash (sometimes starting around the ears) for at least three days.
  • Fever for at least one day.
  • At least one of the following: cough, coryza or conjunctivitis.

PHE (2016) recommends sending a saliva swab for a measles test in suspected cases without an epidemiological link. PHE (2016) has also published guidance on administering human normal immunoglobulin to vulnerable groups: immunocompromised contacts, pregnant women with negative measles antibody status and infants (age <1-year). 

It is therefore important that frontline health professionals such as nurses working in EDs remain aware of the signs and symptoms of measles to enable early detection and appropriate management.


References

Public Health England (2013) Measles, the Green Book, chapter 21.

Public Health England (2016) Health Protection Report


About the authors

Siba Prosad Paul is consultant paediatrician at Torbay Hospital in Torquay, Devon

Helen Adams is a fifth year medical student at the University of Bristol, Somerset

Karen Greaves is modern matron in paediatrics, Torbay Hospital, Torquay Devon

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