Rubeola - Skin in Child
Although measles was declared eliminated in the United States in 2000, outbreaks resulting from imported cases continue to occur. Most cases are associated with importation of measles by unvaccinated international travelers resulting in local outbreaks in communities with clusters of unvaccinated individuals. There were a high number of reported measles cases in the United States in 2011, with 220 cases reported to the CDC. In 2013, 189 cases were reported. In 2014, a record number of 644 cases from 27 states were reported to the CDC. From January 1 to February 13, 2015, 141 cases from 17 states and Washington DC have been reported, most of them part of a large, ongoing multi-state outbreak linked to an amusement park in California. Measles outbreaks can occur in underimmunized communities, such as the 2014 outbreak in in an underimmunized community in 9 counties in Ohio.
Measles is transmitted via respiratory droplets, and it is highly infectious. The incubation period after the measles virus enters the upper respiratory tract and nasal passages is about 10 days (range 7-21 days), with the rash typically appearing about 14 days after a person is exposed. Infected individuals are considered contagious from 4 days before to 4 days after the rash appears.
A prodrome characterized by coryza (nasal congestion), cough, fever (up to 105°F [40.5°C]), and conjunctivitis occurs for about 3-4 days followed by the onset of the rash (sometimes immunocompromised individuals do not develop the rash). The coryza, a "barking" cough, and conjunctivitis will increase in severity until the rash reaches its peak. The CDC reports that approximately 1 of 10 children with measles will also have an ear infection, and up to 1 of 20 will develop a pneumonia. Encephalitis is a complication in about 1 of 1000 cases.
Subacute sclerosing panencephalitis (SSPE) is a late complication, occurring on average 10-11 years after acute infection. This catastrophic sequela is characterized by changes in personality, seizures, coma, and eventuates in death.
B05.9 – Measles without complication
14189004 – Measles
- Before the eruption, it is easy to confuse rubeola with common upper respiratory infections.
- Morbilliform or exanthematous drug eruption
- Other viral exanthems, including rubella, roseola, enterovirus, Epstein-Barr virus, erythema infectiosum (parvovirus B19), HHV-6, and dengue fever
- Rocky Mountain spotted fever
- Kawasaki disease
- Leukocytoclastic vasculitis
- Graft-versus-host disease
- Meningococcemia, especially with atypical measles