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The measles virus is a type of paramyxovirus. It contains 2 proteins on the outer membrane. The first is the fusion protein (F), which is responsible for the fusion of the virus to the host cell membranes, viral penetration, and the destruction of red blood cells. The second is the hemagglutinin protein (H), which helps in the absorption of the virus into cells. The core contains single-stranded RNA (ribonucleic acid).1
Environmental factors such as heat, sunlight, acidic conditions, ether, and trypsin may inactivate the virus. The virus typically survives in the air or on objects and surfaces for less than 2 hours.1
Measles is highly contagious. Transmission occurs primarily by direct contact via respiratory droplets from an infected person to a susceptible individual from coughing, sneezing, or close personal contact. The virus is still active and contagious for up to 2 hours in the air or on infected surfaces. The virus can be transmitted several days before to several days after development of a rash from an infected individual.2
Measles infection affects the entire body. Although the first site of infection is the lining of the nasopharynx, after viral invasion and replication in the respiratory epithelium and regional lymph nodes, the infection enters the bloodstream, which is known as primary viremia. Further infection and replication at regional and distal sites can lead to a second viremia and subsequent infection of other body organs.1
General Clinical Features of Measles Infection by Phases1
Days 10–12 duration from exposure
Prodrome Phase (early signs and symptoms of disease)
Days 12–16 from exposure
Stepwise fever (which may peak at 103°F–105°F)
Conjunctivitis (pink eye)
Coryza (cold symptoms: runny nose and congestion)
Koplik spots (characteristic blue and white spots on the inner lining of cheeks, mouth, and lips that may be bright red; appear 1–2 days before and 1–2 days after the measles rash)
Days 14–21 from exposure
Commonly forms a rash
First appears around the hairline approximately 2–4 days after onset of symptoms
Spreads down to cover the face, trunk, limbs, and hands and feet over a few days
The rash is initially maculopapular (flat red area) and tends to become confluent (appearing together) as it spreads, especially on the face and neck
Although identification of the measles virus is not routinely recommended, identification and verification are helpful for geographic tracking or epidemiologic surveillance.1
A measles diagnosis can be made through analyzing samples from urine, nasal passages, blood, and throat. For every suspected case, samples for virus culture should be collected and sent to state public health laboratories or the Centers for Disease Control and Prevention (CDC). Samples should be collected within 7–10 days after rash onset.1
In regions with warmer summers and cooler winters, measles is usually seen in the late winter and early spring.1
In tropical climates, higher incidences occur after the rainy season.4
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Centers for Disease Control and Prevention (CDC). Measles. In: Hamborsky J, Kroger A, Wolfe S,
eds. Epidemiology and Prevention of Vaccine-Preventable Diseases. 13th ed. Washington, DC: Public Health Foundation; 2015:209–230. http://www.cdc.gov/vaccines/pubs/pinkbook/ index.html. Accessed August 17, 2018.
World Health Organization (WHO). Measles. http://www.who.int/en/news-room/fact-sheets/detail/measles. Accessed August 17, 2018.
Gershon AA. Measles virus (rubeola). In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. Vol 2. 8th ed. Philadelphia, PA: Elsevier Saunders; 2015:1967–1973.
World Health Organization (WHO). International travel and health. http://www.who.int/ith/diseases/measles/en/. Accessed October 12, 2018.
Centers for Disease Control and Prevention (CDC). Measles cases and outbreaks. https://www.cdc.gov/measles/cases-outbreaks.html. Accessed October 12, 2018.