Measles

In 2008, more measles cases were reported than in any other year since 1997 (CDC, 2010). Measles is the "first disease" of childhood from the history of medicine. In adults, measles infection may be acquired in the face of waning immunity from remote immunization. A booster dose of MMR vaccine is recommended before college entry.

Clinically, measles presents with cough, coryza (nasal irritation and congestion), and conjunctivitis. Fever is common several days before the onset of the rash. The rash of measles typically spreads from head to toe and has an erythematous, papular appearance with a "sandpaper" feeling. Koplik's spots are erythematous papules with a bluish center on the oral mucosa and appear early in measles. Measles is highly contagious through droplets.

Lymphopenia and neutropenia are common laboratory findings with measles infection. Complications of measles include primary infections such as pneumonia, gastroenteritis, encephalitis, and the rare subacute sclerosing panenceph-alitis. Secondary infections such as otitis media, pneumonia, and adenitis may also occur.

Treatment is supportive, and the implications of measles infection are primarily in the public health realm. Patients with measles should be isolated for at least 4 days after the appearance of the rash. It is important to recognize that patients are contagious for 2 days before the development of symptoms. Careful verification of immunization status for close contacts is essential.

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