It has been in the news everywhere. Two children and an adult in NSW have recently been diagnosed with measles.
Having presented at a number of health facilities prior to receiving their diagnosis, it would seem hundreds of fellow patients may now be at risk. The alarmist headlines follow similar cases being diagnosed in Victoria and Western Australia in recent months.
But how would you know? Back in 2014, the WHO declared measles had been eliminated in Australia. And unless you’re at least 50 years old, chances are you’ve never personally experienced the disease or known anyone who has.
What’s more, while some of the recent measles cases have been in returned travellers, some have been in people who have been unfortunate enough to have caught it from the returned traveller, There’s not even a history of recent travel to give you a clue.
So what are the signs of measles and how would you distinguish it from say a drug reaction or an allergy?
Well firstly people with measles look sick – they have a high fever, cough and commonly red, watery eyes which will be present for at least a few days before the patient develops a red rash. The rash which consists of red, raised, flat topped spots typically starting on the face at the hairline and extending to cover the entire body. It is not especially itchy but can be uncomfortable.
A characteristic feature of measles that most doctors will be aware of but probably never have seen is the presence of Koplik spots on the buccal mucosa. These white spots usually appear before the more widespread measles rash appears on the body and are pathognomonic of the disease.
The fever and the rash usually persist for a few days prior to subsiding.
Diagnosis of measles requires serum testing for antibodies – either an IgM antibody or rising IgG antibody levels. Measles is a notifiable disease.
In addition, there is no specific antiviral treatment available for this disease. Management tends to revolve around supportive therapies and restricting contact with other people to minimise the potential spread. Once someone has been identified as having measles, anyone who has been in contact with that person and may be vulnerable to contracting the disease because they are not immunised or are immunocompromised should be quarantined at least 18 days from last contact, as the incubation period for measles is between 7-18 days.
According to the Department of Health (1), there have been 22 reported cases of measles this year (to early March) already. Early detection is obviously the key to curtailing potential outbreaks.