Given the increasing incidence of measles outbreaks in Europe and the United Kingdom, these slides represent a clinical refresher on this condition for medical professionals in Ireland. Slides for educational purposes only, and should not replace clinical judgement. No monetary gain was made for this work. Image sources credited in references. Information presented based on interpretation of published material. Uploading to SlideShare causes disruption of slide layout. Original layout visible on download.

1. Measles
Dr. Robert Ferris

2. Measles
 Also known as English measles, rubeola or morbilli
 Causes by measles virus
 UK declared free of measles in 2016, bus cases rapidly climbing as
of January 2024
Mainly due to incomplete vaccine coverage
 Alert issued by ICGP 26/01/2024
 MMR uptake <90% nationwide over last 7 consecutive quarters
As low as 77.3% in one region
 Represents a risk to large numbers of children, vulnerable adults,
as well as general practice and paediatric services
 First confirmed case in Ireland in 2024 was in an adult, who
subsequently died

3. Transmission
 Airborne/droplet
 Also contact with droplets on surfaces
 Infectious window typically 10-12 days between exposure
and symptom onset
 May vary from 7 to 21 days in rare cases
 Virulence: 1 infected person can affect approx.
18 other contacts (COVID-19 is 1-1.5 others)
 Typically progresses to the “Three Cs”:
Cough
Coryza
Conjunctivitis
with further symptoms following

4. Transmission Risks
 Very elderly
 Very young
 Immunocompromised
 Low socio-economic backgrounds
 Close-quartered living
 Young people aged mid-late 20s (M>F)

5. Disease Stages, per NCBI (2023)
I. Incubation: largely asymptomatic. Typically 10-12 days, may be longer.
II. Prodromal: onset of fever, coryza, respiratory sx., general malaise. Koplik spots on oral
mucosa are typical. 4-6 days.
III. Eruptive: appearance of maculopapular rash, typically beginning on the head and
progressing downward. 3-4 days.
IV. Convalescent: fever and malaise begin to lift 2-3 days following rash, which itself starts
to fade after 3-4 days from appearance

6. Management
Treatment is primarily supportive. Patients should be isolated,
where possible, and managed with appropriate hydration and
analgaesics/antipyretics. Good safety netting is important,
especially for parents of young children, to enable early
recognition of signs of complications.
Measles is a notifiable disease in Ireland.

7. Complications
(in addition to the aforementioned)
Common:
Acute OM
Bronchopneumonia
GI upset
Febrile convulsions
Uncommon:
Meningitis
Encephalitis
Immunosuppression

8. Consider onward referral in
 The Very Unwell Child
 Immunocompromised patients
 Very young/premature
 Very elderly
 Unvaccinated (if very unwell)
 Sx. of concern for IC involvement
 Atypical presentation

9. Prevention
Per ICGP Clinical Notification 09/02/2024, individuals may be
considered immune if:
They have received to MMR vaccines, both given after the
person’s first birthday, at least four weeks apart
They were born before 1978 (this cohort almost certainly have
had prior measles infection)

10. Prevention
MMR (Measles, Mumps, Rubella) is among the most effective
vaccinations. Two doses are recommended for best protection.
Childhood schedule in Ireland is at 12 months and again at
Junior Infants (4-5 years old).
Older children who have missed doses should receive catch-
up vaccination as soon as possible.
There is no upper-age limit for vaccination with MMR.
First dose offers approx. 95% protection. Second dose offers
close to 99% protection and lifelong coverage in most people.

11. Who Should Not Receive MMR?
Confirmed vaccine allergy
Personal or strong family hx. of immunocompromise
Bleeding disorder
Active TB
Recent (≤3/12) recipient of blood products
Acute illness
Other live vaccine (including prior MMR) in past 4/52
<1 year old
Pregnant

12. Measles Exposure in Pregnancy
 No evidence of congenital defects from measles during pregnancy
 Higher risk of both maternal and foetal mortality in unvaccinated
patients
 HPSC recommends use of human normal immunoglobulin (HNIG) in
susceptible (e.g. unvaccinated, serological evidence of lack of immunity,
ethnic/disadvantaged background) woman who have been subject to
significant exposure
 All such women should be referred promptly to a local High-Risk
Antenatal Clinic

13. Thank you.
Any questions?
References:
1. ‘Measles Clinical Alert’, ICGP January 2024, accessed at
https://www.icgp.ie/go/about/news/C1061A16-C75D-4629-B66D2C93A364EDF5.html on
31/01/2024
2. ‘Measles’, Red Whale January 2024, accessed at https://www.gp-
update.co.uk/SM4/Mutable/Uploads/pdf_file/GP_Child_Health_Measles_January2024.pdf on
31/01/2024
3. ‘Measles (morbilli)’, DermNet October 2020, accessed at https://dermnetnz.org/topics/measles
on 31/01/2024
4. ‘Measles’, World Health Organisation (WHO) August 2023, accessed at
https://www.who.int/news-room/fact-
sheets/detail/measles#:~:text=Measles%20infects%20the%20respiratory%20tract,body%20fight
%20off%20the%20virus on 31/01/2024
5. ‘National measles guidelines’ UK Health Security Agency, February 2024
6. ‘Measles’, GP Notebook, February 2024, accessed at https://gpnotebook.com/pages/infectious-
disease/measles on 07/02/2024
7. ‘Clinical Notification Measles’ ICGP update 9th February 2024

14. References (contd.):
8. Coughs and Sneezes Spread Diseases’ poster (c. 1918), attributed to the U.S. Public Health Service
9. ‘Rubeola (Measles)’, National Centre for Biotechnology Information (NCBI) 2023, accessed at
https://www.ncbi.nlm.nih.gov/books/NBK557716/#:~:text=The%20clinical%20picture%20of%20measles,coug
h%2C%20conjunctivitis%2C%20and%20coryza on 07/02/2024
10. ‘Measles’, Health Protection Surveillance Centre (HSPC) January 2024, accessed at https://www.hpsc.ie/a-
z/vaccinepreventable/measles/factsheet/measlesfrequentlyaskedquestions/ on 07/02/2024
11. ‘Measles’, Health Services Executive (HSE) April 2021, accessed at https://www2.hse.ie/conditions/measles/
on 07/02/2024
12. ‘Measles’, NHS Inform February 2024, accessed at https://www.nhsinform.scot/illnesses-and-
conditions/infections-and-poisoning/measles/ on 07/02/2024
13. ‘Adult with confirmed case of measles dies, HSE says’, RTE News February 2023, accessed at
https://www.rte.ie/news/ireland/2024/0207/1431067-measles-death/ on 12/02/2024
14. ‘Measles exposure during pregnancy – guidance document’, HSPC July 2018, accessed at
https://www.hpsc.ie/a-
z/vaccinepreventable/measles/guidance/20180719_measles%20exposure%20during%20pregnancy%20v1.1.p
df on 12/02/2024