by Tsu Dho Nimh

Created on: January 26, 2009

The effects of red measles (rubeola) haven't been widely experienced for over a generation because the vaccine introduced in 1963 and the improved vaccines introduced over the next 46 years brought the number of cases in the USA to near zero. Unfortunately, the current generation of parents has no direct experience with measles and may learn the hard way why measles was considered significant enough to develop a vaccine to prevent it. Despite what the critics say, measles is not just a rash and a fever. It can be diarrhea, pneumonia, and even brain injury and death.

Like most of my generation, I had natural measles. I was not seriously ill, but I vividly remember my sister being cared for because my sister was extremely ill. Her bedroom room was darkened because she screamed in pain at bright light, she had round the clock home nursing care from my grandmother, my mom or one of the neighbors. In addition, she was on antibiotics for the pneumonia and IV fluids for the dehydration. Why wasn't she in the hospital? Our county was in the middle of a measles outbreak, hospital beds were in short supply, and the hospital was only accepting children who were sicker than my sister! If the child didn't need an oxygen tent, they weren't admitted to the hospital. It was up to family, friends and neighbors to handle what we now assume a hospital will take care of.

Here's what to expect, if your child gets the measles, translated from the medicalese, for a case of measles that does not end in encephalitis or death. After a 7- to 14-day incubation period, the child will appear to have a cold. They will first have a hacking cough, a runny nose (coryza), and red eyes (conjunctivitis). If you know where to look a couple of days later, you may see "Koplick's spots" in their mouth, looking like tiny white dots inside a larger red circle. Then your child will complain of a sore throat

During this time, while your child is still rash-free and you have no idea they might have measles, they are shedding virus freely into the air wherever they go. The virus can stay in the air and infect people who enter the room as long as a couple of hours after the infected child has gone. The next one in the chain of infection doesn't have to touch or even see the source of the virus. Just breathing the air in a classroom or pizza parlor where a measles victim has been recently can be enough.

A few days after the illness begins you will see the rash starting to form. The pattern of the spreading is diagnostic: it almost always begins on the face and spreads to the trunk and then the arms and legs over the next day or two, including the palms of the hands and the soles of the feet. The measles rash starts out flat and blotchy (macular), then develops distinct bumps (papules). In some cases when the rash is heavy capillary blood vessels can break and leak into the skin, making petechia and the larger bruise-like ecchymoses. At the peak of the measles, your child may have a temperature near 104F, a rash-covered body,"prostration" (extremely weak and listless), diarrhea, extreme sensitivity to light, a persistent hacking cough, and itching. That will last for 3 to 5 days, then the fever falls and the child improves. The rash will fade, leaving a brownish shadow of itself, and in many cases the child's skin "desquamates" (the top layer comes off in large sheets).

A virus that causes a predictable couple weeks of misery to your child, probably with a couple weeks of constant home nursing on your part, isn't exaclty a "mild childhood disease" is it? And that's just the uncomplicated cases. Some people, like this man, weren't that lucky. I don't know if his experience gave him his interest in epidemiology or not.

Learn more about this author, Tsu Dho Nimh.
Click here to send this author comments or questions.