Causative agent
Measles virus
Clinical description
Measles is a highly infectious acute viral disease resulting from infection with measles
virus (also known as Rubeola virus). It is transmitted via respiratory droplets. Symptoms include prodromal fever, malaise, conjunctivitis, coryza, cough
and Koplik spots. A maculopapular rash spreads from the head to the
body and limbs. Complications of measles occur for around one in 15
notified cases and include otitis media, pneumonia, convulsions, encephalitis and death. A rare complication of measles is subacute sclerosing
panencephalitis (SSPE), a fatal degenerative neurological disorder. The case
fatality ratio is approximately one to two deaths per 1000 cases. The
case fatality ratio is highest for children under one year of age.
Transmission
The measles virus is transmitted via respiratory droplets from infected individuals. The incubation
period is about 10 days and usually 14 days until the appearance of
rash. A measles case is infectious from five days before the appearance
of rash (i.e. one day before prodromal phase) to four days after its appearance.
Surveillance in Scotland
- Statutory notification of measles by clinical diagnosis
- Laboratory reports for measles virus
- Laboratory confirmation of notified cases by salivary testing
Clinical case definition
Any person with:
fever and
- maculopapular (i.e. non-vesicular) rash and at least one of the following three:
- cough, coryza (i.e. runny nose) or conjunctivitis (i.e. red eyes)
Laboratory criteria for diagnosis
- Isolation of measles virus from a clinical specimen
- Detection of measles virus nucleic acid in a clinical specimen
- Measles virus specific antibody response in serum or saliva
- Detection of measles virus antigen by direct fluorescent antibody (DFA) in a clinical specimen using measles specific monoclonal antibodies.
(EUVAC.NET. A Surveillance Community Network for Vaccine Preventable Infectious Diseases)
Incidence
Vaccination has led to a dramatic decrease in the number of confirmed
cases of measles with 17 confirmed cases in 2009. This is in comparison with 536 confirmed cases in 1994 and over 25,000 notifications for measles in 1970. Generally, there are low levels of measles cases, which are often imported or in high risk groups. There are occasional outbreaks which are usually unvaccinated individuals, with linked chain of transmission.
Notification and Laboratory confirmation
Most cases of suspected measles (notifications) turn out not to be geniunely measles after a laboratory test is done. Enhanced surveillance for notifications of measles is in place, with salivary specimens invited from all notified cases and sent out to the laboratory for confirmation.
Measles Notifications and Laboratory reports
Scotland 2000-2010
Year |
Vaccine Uptake* (%) |
Notification (all ages) |
Laboratory
Confirmation |
2000 |
93.2 |
395 |
3 |
2001 |
88.5 |
315 |
0 |
2002 |
87.8 |
399 |
4 |
2003 |
86.8 |
181 |
15 |
2004 |
88.3 |
257 |
2 |
2005 |
89.9 |
186 |
1 |
2006 |
92.1 |
259 |
27 |
2007 |
92.1 |
168 |
4 |
2008 |
92.6 |
219 |
54** |
2009 |
93.6 |
172 |
17 |
2010 |
93.2 |
93 |
10*** |
* Uptake of one dose of MMR by age 24 months
** There were an additional 18 probable cases in 2008
*** There was an additional 1 probably case in 2010 |
Prevention
Vaccination against measles was introduced in 1968. The measles antigen
was combined with mumps and rubella with the introduction of the combined
MMR vaccine in 1988. Increased incidence of measles in 1994 prompted,
later that year, mass schools vaccination with measles and rubella (MR)
vaccine for all children aged five to 16 years, as mathematical modelling
predicted more cases in the future. A second dose of MMR was introduced
for pre-school children in 1996, as a one dose programme would not support
eventual measles elimination. The second dose protects children who
may not have responded to the first dose, and offers some boosting
to those who did respond to the first dose.
MMR vaccine is included in the UK childhood immunisation schedule,
with routine vaccination recommended at around 13 months, with a second dose from age three years and four months.
Further Information
Historic data
Vaccine Uptake
Vaccine update data is compiled by Information Services Division (ISD). Further information can be found on their website:
European Centre for Disease Prevention and Control
ECDC is the public health surveillance network for vaccine preventable infectious diseases in Europe. Previously this work was carried out by EUVAC.NET.
Images of Measles Infection
General Information about Measles
Immunisation Against Infectious Diesase (The Green Book) provides background information and vaccination details about all vaccine preventable diseases. This is regularly updated. It is written and maintained by the UK Department of Health, but is used throughout the UK.
NHS Inform provides information about measles including symptoms, causes, complications and prevention.
Last reviewed: 2 February 2012
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