Measles | Nursing Times

Introduction

Measles is a highly contagious viral disease that is vaccine preventable. While many children will recover, measles can lead to rare, life-changing, complications and even death. Unvaccinated children and infants are at increased risk of severe measles complications. Measles continues to surge across Europe with an increase in cases, a sign that immunisation coverage is breaking down. Uptake of the measles, mumps and rubella (MMR) vaccine in the UK is now below the 95% target recommended by the World Health Organization.

In 2024 there were 2,911 laboratory-confirmed cases of measles in England, the majority of which (61%) were in children aged 10 years and younger.

Causes

Measles is caused by exposure to a virus, morbillivirus, which is of the paramyxovirus family. It spreads when an infected person breathes, sneezes or coughs. Nearly all susceptible people who come into contact with the virus will be infected.

Diagnosis

You should consider a diagnosis of measles in infants and children presenting with a rash, high fever (≥39°C) and at least one of three other suggestive symptoms: cough, a runny nose and conjunctivitis. The rash, which first appears behind the ears and on the face, may be harder to detect on black or brown skin and may be absent entirely in those who are immunocompromised.

Check immunisation history – measles is unlikely in children who have had the MMR vaccine or a previous history of measles. Inequalities in vaccine uptake mean some communities are at increased risk, including the Charedi Orthodox Jewish community, the Traveller community and recent migrants.

Find out whether there has been significant contact with someone who may have measles – this means in the same room for 15 minutes or more, or where there has been face-to-face contact.

The presence of conjunctivitis and the timing of symptoms (see box) can help differentiate measles from other conditions that can resemble it, including streptococcal infection (scarlet fever), fifth disease (slapped cheek syndrome), rubella, Kawasaki disease, and early meningococcal disease.

If you have any suspicion that the illness is measles, you must immediately notify the local health protection team

Prevention

Vaccination coverage is considered the most effective way to prevent measles and associated complications. One dose of the MMR vaccine is at least 95% effective in preventing measles; with two doses, 99% of people will be protected. All deaths due to measles in England and Wales since 2000 have been in people who were not vaccinated.

Treatment/management

If the child is younger than one year of age or immunocompromised, seek immediate advice on management from paediatric services through local rapid access routes.

To alleviate and provide comfort to symptoms, the child should rest and drink adequate fluids. They can also be given paracetamol or ibuprofen for symptomatic relief from three months old, but parents should be advised to always administer as per the guidance on the prescription/packaging and to seek advice from a health professional if the child is taking other medications or has a pre-existing health condition.

Children with measles should stay away from nursery or school for at least four days after the rash first develops, ideally until they are fully recovered, to avoid complications from secondary infections. They should also avoid contact with susceptible people, including pregnant women.

Advise parents that measles usually resolves within about a week but to seek urgent medical advice or go to the emergency department if their child appears very unwell, has difficulty breathing or has a serious complication, such as a seizure.

Complications

In countries such as the UK, around one in every 15 children with measles will develop a serious complication. These include otitis media, pneumonia, convulsions, and encephalitis (brain inflammation, which can cause permanent brain damage).

Infants are more likely to be admitted to hospital with measles than older children and are at higher risk of pneumonia, otitis media and death. They are also more likely to be affected by subacute sclerosing panencephalitis, a degenerative disease of the central nervous system, which can occur decades after measles infection and is fatal.