home Consultations What is measles in children. Symptoms, treatment and prevention of measles in children. Characteristic features of the course of measles in children

What is measles in children. Symptoms, treatment and prevention of measles in children. Characteristic features of the course of measles in children

More recently, measles in a child was considered a typical childhood disease, which was preferable to get sick at preschool age. With the introduction of vaccination, the disease has ceased to be common. However, the problem does not lose its relevance, moreover, today there is a tendency to expand the age range of the disease - more and more adults become infected with measles.

Measles is an airborne viral disease. The infection is highly contagious through direct contact with the carrier - a sick person and is practically not transmitted through objects, third parties or animals. The virus spreads when talking, coughing, sneezing, very quickly invading the mucous membranes of a healthy person. Outside the body, it quickly dies, so the room where the patient has recently been is not dangerous.

The likelihood of infection is also increased by the fact that an infected child becomes contagious even during the incubation period, when there are no signs of the disease yet.

How does measles manifest in children?

Measles in a child with a typical form of the disease goes through several stages:

Incubation;
Premonitory;
The period of the peak of the disease;
convalescence period.

Each of the stages (except for the latent period) has characteristic features that help to accurately diagnose the disease.

Incubation period

It starts from the moment of contact with the carrier of the virus and lasts from 9 to 17 days. If in the first 5 days it becomes known about the source of measles, and at this time the child is injected with immunoglobulin, then the asymptomatic stage is extended to 21 days.

During the incubation period, the virus actively multiplies in the mucous membranes. Then there is its massive release into the blood - viremia.

Important! From this point on, the child becomes contagious. But before the appearance of the first signs of the disease, another 2 to 5 days pass.

Catarrhal stage of measles (prodrome)

How does measles start in children? The disease begins with non-specific signs - the child develops symptoms characteristic of respiratory infections: cough, runny nose, fever. The idea of measles can lead to a sharp onset of the disease and a slight increase in temperature (37.6 - 39 ° C) ahead of other manifestations.

Joining soon:

Signs of inflammation of the mucous eyes - the eyelids turn red, swell, the eyes are watery, bright light irritates and aggravates the condition;
Discharge from the nose, at first transparent, becomes cloudy, when it dries, crusts form, the child sneezes;
The cough goes from mild to rough, barking, painful;
The voice "sits down" or there is hoarseness, pain;
The mucous membranes of the mouth are loosened, but their moisture content is reduced, cracks may appear on the lips;
On the 2nd - 3rd day, on the mucous surfaces of the cheeks (occasionally on the gums and lips), Belsky-Filatov-Kaplik rashes, characteristic only for measles, are observed - bright pink spots with a white dot in the middle;
The measles enanthema is located on the soft and hard palate - red, not bumpy spots.

Important! Catarrhal phenomena increase within 2 to 4 days and reach a peak by the time the rash appears.

Belsky-Filatov-Kaplik rash

Eruption period (height)

The first rash appears at a time when the temperature is highest - up to 40 ° C. Skin manifestations of the disease look like small red pimples that appear in a strictly defined order and tend to merge. The staging of rashes is one of the diagnostic signs:

On day 1, the rash appears behind the ears, on the face, neck, shoulders, upper back, and chest;
On the 2nd day, the rash develops the stomach, back, buttocks and groin;
On the third day, the legs and arms are covered with a rash.

Important! The intensity of the rash can vary from a continuous covering of the skin to rare papules on all parts of the body.

From the 3rd - 4th day, the reverse development of epithelial manifestations begins: the rash turns pale in the same sequence in which it appeared.

At this time, the final stage of the disease begins.

Pigmentation period (reconvalescence)

By 4 - 5 days of rashes, the child's condition improves significantly. By this time, the virus cannot be detected in the blood - antibodies to the infection appear there. This means that the patient no longer poses a danger to others.

Important! But contacts with strangers at this time are extremely undesirable: the body is greatly weakened, the immune system is depleted, and any, even conditionally pathogenic flora, can cause complications.

At this time, cyanosis appears in place of bright rashes, and soon the skin acquires a brownish tint. At the site of the rash, small-lamellar peeling is observed. These signs are temporary, they soon pass without a trace.

The total period of vivid manifestations of the disease lasts, therefore, 7 - 9 days. With proper treatment and a typical course, the medical history ends here, the body acquires lifelong immunity.

Table: Measles in a child: typical course of the disease

Period	Time (days)	Symptoms	Mucous	Danger to others
Incubation	9 – 17 (21)	Missing	Pure	In the last 2 days
Prodrome	3 – 5	Catarrhal phenomena	Inflammation of the eyes, nose, mouth	Infectiousness is high
Razgar	3 – 4	The appearance of a rash	Reducing inflammation	Infectiousness is high
convalescence	From 5	Improving the condition, skin pigmentation, peeling	Disappearance of signs of inflammation	No chance of infection

There is an atypical form with a blurred picture of the disease - mitigated measles. It is characterized by the manifestation of all signs in a reduced form, i.e. not as sharp as in the classical course. This nature of the disease occurs in children who received immunoprophylaxis in the first 5 days after contact with the patient or who became ill in the first year of life, when maternal immune forces are not yet completely exhausted. But, like any other viral disease, measles is dangerous with complications.

Possible effects of measles

In children with stable immunity, developing correctly and living in a favorable environment with good care, complications occur extremely rarely. In weakened children, after being infected with a virus, residual effects may appear:

Attachment of a bacterial infection that causes serious respiratory diseases - laryngotracheitis,;
Damage to individual organs (temporary or chronic) - kidney and intestinal diseases, vision problems;
Persistence of the virus - the preservation of the infectious principle in the body (often in the brain), which leads to severe and encephalitis with unfavorable prospects.

Treatment of measles in children

How to treat measles in children? Specific therapy for the disease has not been developed. Normally, the body itself copes with the viral intervention and acquires stable immunity for life.

In severe cases of the disease, symptomatic assistance is provided:

- preferably the ibuprofen group - they relieve fever, eliminate pain and reduce inflammation;
Washing the mucous eyes, nose and mouth with warm water, a light soda solution, herbal infusions;

Proper care of a sick child is of great importance. It is necessary during the period of acute manifestations of the disease:

Organize bed rest in a clean room;
Restrict contacts;
Create silence, peace, reduce the level of illumination;
Prevent dehydration - ensure sufficient fluid intake in the body (water, juices, herbal decoctions).

Important! With reduced appetite at this time, one should not insist on eating: refusing to eat is one of the protective reflexes of the body. You can offer a light treat of the child's choice.

Prevention of measles in children

The modern vaccination schedule provides for vaccination of children at the age of 12 months, followed by a repeat vaccination at 6 years of age. Now studies are being carried out on the duration of artificial immunity and the need for subsequent revaccinations - in adulthood, the disease is quite difficult. And since not all neighboring countries are held, the likelihood of an epidemic among the unvaccinated or those who have lost their immunity is quite high.

With a medical withdrawal from vaccinations or refusal of parents, prevention consists in separating children. But this method is ineffective, because. infection can occur in the complete absence of signs of the disease. In this case, immunoprophylaxis is recommended - no later than the 5th day after contact, immunoglobulin is administered to the child. This does not always save from the disease, but the disease is much easier.

In adolescence, unvaccinated girls should donate blood for the level of antibodies in the blood - they may need to be vaccinated, because. infection with a viral infection in the first third of pregnancy is fraught with disastrous consequences.

Measles, no longer an obligatory childhood disease, is spreading to other age groups and can strike adults at the most inopportune moment. Therefore, everyone needs to take care of the timely vaccination of children in order to avoid trouble in the future.

Remember that only a doctor can make a correct diagnosis, do not self-medicate without consultation and diagnosis by a qualified doctor.

One of the most contagious and severe diseases in children is measles. The human body is very susceptible to its pathogen, which means that in case of contact with a sick person, the likelihood of developing the disease is extremely high.

Despite the fact that active vaccination against measles has been carried out for a long time, it has not yet been possible to eliminate this disease, and cases of the disease are being recorded.

Therefore, it is very important for parents to be able to recognize the signs of measles in a child in order to start treatment on time.

What is measles and how is it transmitted

Measles is an infectious viral disease characterized by an acute course. The measles virus is very small and round in shape. The source of the spread of the pathogen is a sick person, his mucous secretions contain a lot of viral particles, which are transmitted by airborne droplets when sneezing, coughing, talking.

It is assumed that the virus can be carried by air currents through ventilation ducts in a room where an infected person is present, although the pathogen dies quickly enough in the environment.

Viral particles enter the body of a healthy child through the respiratory organs and mucous membranes, and then they are carried by the blood throughout the body. But most of all, the disease affects the skin and respiratory system.

Newborns in the first 3 months of life have passive natural immunity to measles: antibodies during fetal development are transmitted through the placenta from the mother (if she is vaccinated or has previously had this infection).

Measles is most common in children 2 to 5 years of age. Adults get sick much less often, but their manifestations are more severe.

In case of infection with the measles virus, the incubation period in children lasts from 8 days to 2-2.5 weeks, and in the last two days the sick child already becomes contagious. After that, the symptoms of the disease begin to appear.

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Measles: symptoms in children

Parents should be alert to such signs that appear in the initial stage of measles in a child:

1 The child becomes lethargic, his appetite disappears (children up to a year old may even lose weight). Insomnia, photophobia, headache can develop, the baby is naughty.

2 There are signs of a respiratory infection: runny nose (purulent-mucous discharge), dry cough. The voice due to swelling of the mucous membrane of the larynx becomes more hoarse. The temperature rises to 38-40 degrees.

3 The baby's eyes turn red, the eyelids swell, lacrimation is observed. Conjunctivitis may appear with purulent discharge, due to which the child's cilia stick together in the morning.

3 weeks after the manifestation of these signs, whitish small spots characteristic of measles (Belsky-Filatov-Koplik spots) appear in the child's mouth. They are located on the inside of the cheek opposite the molars. After 5 days, a rash appears on the skin. 3 days after the first rash, the temperature rises even more - up to 40.5 degrees.

The rash persists for about a week, and then disappears, leaving behind brown pigment spots (they disappear within two weeks).

To accurately establish the diagnosis, the doctor prescribes blood tests, urine tests, and studies to detect the virus in the child's blood and antibodies to it. With the development of complications, it is necessary to make a chest x-ray and an electroencephalogram.

Rash with measles in children

In order to identify this disease in time and distinguish it from other infections, you need to know exactly what measles looks like in children.

The elements of the rash are bright, pink, up to 10 mm in diameter and slightly convex. They quickly increase and merge, forming continuous patches of irregular shape.

This distinguishes measles from rubella, because with it the elements of the rash always remain separate from each other and do not merge (read more about rubella on our website).

The first spots appear on the baby's forehead and behind the ears. Then the rash spreads over the entire surface of the face, passes to the neck and torso. Last of all, rashes appear on the arms and legs of the child.

The pattern of spread of the rash is another important feature by which measles can be distinguished from other diseases.

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The presence of characteristic rashes on the mucous membrane of the mouth helps to distinguish measles from respiratory infections and flu before spots appear on the skin.

Consequences and complications after measles in children

In children, complications may occur after the disease. They affect the respiratory organs (otitis, laryngitis, tracheobronchitis, bronchopneumonia), the nervous system (polyneuritis, encephalitis). Sometimes stomatitis develops (read about this disease on the site site), inflammation of the cervical lymph nodes, blindness.

In many cases, complications are associated with a secondary infection, when pathogenic bacteria begin to multiply in a weakened body. Serious consequences can be avoided only with the timely detection of the disease and its adequate treatment.

After the transfer of measles in the human body, a strong immunity to this disease is formed. The second time she gets sick only people with impaired immunity.

It is important to remember that measles is highly contagious and is accompanied by dangerous symptoms, so a sick child needs qualified medical care, and healthy children need to be isolated so that they do not get sick.

Measles- an acute infectious disease, which is manifested by a temperature above 39 degrees, severe intoxication, sore throat, cough and a characteristic rash. The disease is caused by a virus that enters the body through the mucous membranes of the mouth, nose, and eyes. You can only get measles once in a lifetime, after which a strong immunity is produced in the body.

General blood analysis

With measles in the blood, the following changes are detected:

decrease in the level of lymphocytes, leukocytes, monocytes and neutrophils;
decrease in the level of eosinophils (may be completely absent);
the erythrocyte sedimentation rate (ESR) is moderately increased.

ELISA for antibodies to measles virus

For research, blood is taken from a vein, its serum is separated and processed using special enzymes. To study the antibody titer is widely used - the hemagglutination inhibition reaction (RTGA) and the neutralization reaction (RN), less often the reaction of radial hemolysis (RRH) and the immunofluorescence reaction (RIF).

Immunoglobulins M (IgM)- substances that are produced in the body to fight the measles virus from 3-4 days of illness. The diagnosis of measles is confirmed by the following results:

0.12 - 0.18 IU / ml - a questionable result. Antibodies have not yet developed, perhaps not enough time has passed since the onset of the disease. It is necessary to repeat the analysis after 10 days.
>0.18 IU/ml - positive result. The body recognized the measles virus and began to fight it.

If the antibody titer is less than 0.12 IU / ml, then the body has never met with the measles virus and another microorganism has become the cause of poor health.

Immunoglobulins G (IgG)- antibodies to fight the measles virus, which begin to stand out from the second day of the rash or 10-14 days after infection. They last for life, providing protection from reinfection.

When infected with measles, the following results are possible:

0 - 0.12 IU / ml - no antibodies to measles were detected. The disease is caused by another virus.
0.12 - 0.18 IU / ml - a questionable result.
>0.18 IU/ml - positive result. The body has developed enough antibodies to protect against the virus.

Additional tests although they cannot identify the cause of the disease, they talk a lot about the state of the body and the complications that have arisen.

General urine analysis

With measles in the urine is observed:

protein impurity (microproteinuria);
an increase in the level of leukocytes (leukocyturia).

X-ray of the chest

Shadows corresponding to areas of inflammation in the lungs indicate that measles was complicated by pneumonia.

measles treatment

Is hospital treatment necessary?

Measles is usually treated at home. The doctor will visit you periodically during this period and monitor the course of the disease. He will prescribe you the necessary medicines, recommend eating well and drinking plenty of fluids, and taking vitamins A and C.

Treatment in the infectious diseases department of the hospital is required in such cases:

if there are serious complications;
severe course of the disease, severe poisoning of the body (intoxication);
it is impossible to isolate the patient from other members of the team (in a boarding school or in the army).

Daily routine for measles

A patient with measles needs bed rest while the temperature persists. If possible, give him a separate room. Wet cleaning should be carried out at least 2 times a day. It is very important that the air always remains fresh, so ventilate the room more often.

If bright light causes discomfort, then close the curtains, and in the evening, turn on a table lamp instead of a chandelier.

Follow the daily routine. Although sleep is disturbed and insomnia has appeared, try to go to bed on time. This is especially true for children.

If it is difficult to keep the child in bed, then allow them to play quiet games, watch a little TV, read together. But it is desirable that after dinner he sleeps.

Diet for measles

The diet for measles should be light so as not to irritate the intestines and high in calories to maintain the strength of the body. It is very important to take enough vitamins A and C, which will improve the condition and speed up recovery.
If there are digestive disorders, then doctors prescribe diet number 2. When the work of the intestines returned to normal, then diet number 15 will help restore strength.

Drink plenty of fluids. The norm for an adult is 2.5-3 liters per day, and for a child, 100-150 ml / kg per day. Compliance with this rule helps to remove harmful waste products of viruses from the body, reduce the allergization of the body and prevent complications. You can drink clean water, compotes, juices, fruit drinks, teas.
Ready-made solutions for dehydration Regidron help restore water and mineral reserves, Humana Electrolyte. You can prepare a similar solution yourself by dissolving 1 tbsp in a liter of boiled water. sugar, 1/2 tsp baking soda and 1 tsp. salt.
The menu should have a lot of vegetables and fruits, both raw and stewed and boiled. Vegetable soups with cereals in a low-fat meat broth are well suited.
Food should be warm, but not hot, so as not to irritate the sore throat. For the same reason, it is desirable that the dishes are mashed and semi-liquid (mashed soups or milk porridges). Such food is easy to swallow without irritating the mucous membrane of the mouth.
To strengthen the immune system, protein dishes from lean mashed meat and fish (steam cutlets, pate or soufflé) are needed. As well as omelettes, cottage cheese in its natural form or in a casserole with cereals and berries.
As a side dish, any semi-liquid cereals are suitable: rice, buckwheat, millet.
Fermented milk products, especially kefir, narine and homemade yoghurts, raise immunity well.
Exclude from food:
1. hard, fatty and sinewy meat;
2. animal fats (lard, cooking oil);
3. fried foods;
4. hot spices: hot red and black pepper, horseradish, mustard.

Treatment of measles with medicines

There is no specific medicine to fight the measles virus. Treatment is aimed at eliminating symptoms and preventing the development of a bacterial infection.

Cytokines

Protein-based immunotherapy drugs are used for treatment and emergency prevention if you have been in contact with a person with measles. They help create immune defenses and have an antiviral effect, preventing the virus from multiplying.

Leukinferon dry is used for injections of 1000 IU / m. Injections are made daily for 3-5 days.

Anti-measles γ-globulin. 5 ml of the drug is administered intramuscularly once.

Antihistamines

By blocking sensitive receptors, these drugs reduce the manifestations of an allergic reaction. The rash becomes less abundant, the general condition improves.

Suprastin- 1 tablet 3-4 times a day.

Loratadine (Claritin) 1 tablet 1 time per day. Children 2-12 years old: 5 ml of syrup or 1/2 tablet 1 time per day for a week

Diazolin 1 tablet 3 times a day.

Antipyretics

Non-steroidal anti-inflammatory drugs reduce fever, help get rid of headaches and sore throats, and reduce inflammation.

Paracetamol (Panadol, Efferalgan) 1 tablet 2-3 times a day, depending on the temperature.

Ibuprofen (Nurofen) 400 mg 3 times a day. Take as long as the temperature persists.
For children, these same drugs are prescribed in the form of syrups. The dosage depends on the age and weight of the child.

vitamins

The measles virus disrupts vitamin metabolism in the body and destroys vitamin A, which increases the risk of complications. Therefore, an additional intake of vitamin preparations is necessary to protect against free radicals and normalize the work of cells damaged by the virus.

Vitamin A. For children older than a year and adults, 200,000 IU is administered once a day with an interval of a day. For the course, 2 doses are enough. For children under one year old, the dose is 100,000 IU.

Vitamin C take daily. Children 0.2 g and adults 0.6-0.8 g. The course of treatment is 7-10 days. After that, to strengthen the immune system, it is necessary to take a vitamin complex for a month.

Symptomatic remedies

eye drops for conjunctivitis sodium sulfacyl solution. Use 2-3 times a day, 1-2 drops in each eye. The duration of treatment is 5-7 days. This sulfanilamide the drug destroys bacteria that multiply on the eyelids.

When coughing Ambroxol (Lazolvan, Halixol) 1 tablet 3 times a day. Continue treatment for 7-10 days. For children, these same drugs are prescribed in syrup, 5-10 ml, depending on age. These drugs thin the mucus, making it less viscous and easier to pass.

Antibiotics

The doctor will prescribe antibiotics if a secondary bacterial infection has joined the measles. They inhibit the growth and reproduction of bacteria.

Sumamed (azithromycin) tablets (500 mg) are taken 1 time per day for 5-7 days.

Clarithromycin 500 mg 2 times a day intravenously drip. The course of treatment is 7-10 days.

Folk remedies for measles

Raspberry tea. Brew 1 tablespoon of dry raspberries with a glass of boiling water, wrap and let it brew for half an hour. Drink 150 ml 2-3 times a day, preferably add honey. The tool helps to reduce the temperature and strengthen the immune system.

A decoction of linden flowers. 1 tbsp dried linden flowers pour 200 ml of boiling water and heat in a water bath for 10 minutes. Take half a glass before meals in the morning and evening. Flavonoids, phytoncides and essential oils lower the temperature, treat cough, and eliminate intoxication.

Infusion of violet tricolor. Pour 2 tbsp into a thermos. dried violet flowers and 400 ml of boiling water. Insist 1-2 hours. Strain the infusion and drink on an empty stomach in small portions throughout the day. Violet helps to limit the spread of a rash, cleanses the blood of the virus, relieves stomach pain and reduces fever.

Tea from viburnum ordinary. 1 tablespoon of dried viburnum berries pour 200 ml of boiling water and insist in a thermos for 4-5 hours. You can use fresh berries: mash 2 tablespoons of raw materials and pour a glass of hot water. Take 4 tbsp. 3 times a day. Kalina has an anti-inflammatory effect. Therefore, keep the infusion in your mouth as long as possible. And the high content of vitamin C helps to speed up recovery.

Infusion of parsley roots. Grind fresh or dry root and brew with boiling water at the rate of 1 tbsp. raw materials in a glass of water. Wrap and leave for 4 hours. Drink an infusion of 100 ml 4 times a day before meals. Such an infusion helps to reduce the rash and prevent the merging of its elements. And thanks to the diuretic effect, it is possible to get rid of toxins.

Measles prevention

Is the measles vaccine effective?

The measles vaccine has been used worldwide for over 50 years. It is safe, effective and after its application the risk of serious complications is almost zero. Mass vaccination has turned measles from a deadly disease into an ordinary childhood infection.

Single vaccines are available that contain only a weakened measles virus. It cannot cause disease, but introduces the body to measles. After that, the immune system begins to produce antibodies. And if a person later meets with a measles patient, then infection does not occur. The three-component vaccine against measles, rubella and mumps (MMR) works on the same principle.

The first MMR vaccination at 12 months is given to all children who have no contraindications. But in 15% of children, immunity after this may not develop. Therefore, the second vaccination is done at 6 years before school. If the vaccination was not done in childhood, then it can be done in adulthood.
In 5-10% of children, a reaction to the vaccine that resembles a mild form of measles is possible: These reactions may appear 5-15 days after vaccination and disappear without treatment in 2-3 days. During this period, the child is not contagious and can visit the children's team.

a slight increase in temperature;
runny nose;
cough;
conjunctivitis;
mild rash on the face.

How to protect yourself if someone in the family has measles?

If you are vaccinated against measles, then you are practically not at risk. But it is still better to consult a doctor. He or she may recommend administering measles immunoglobulin to prevent infection. This must be done within the first 5 days of contact with the patient.

Measures to limit the spread of the measles virus. In conclusion, we recall once again that if you or your baby has a fever, runny nose, cough and rash, then immediately consult a doctor. Timely treatment of measles will save you from dangerous complications.

The patient should remain in his room until the 4th day from the onset of the rash.
If the patient has a need to go out, then a cotton-gauze or disposable mask should be worn that covers the mouth and nose.
It is desirable that a sick or vaccinated family member take care of the patient.
Give the patient separate dishes and a towel.
There is no need to disinfect the apartment, as the virus dies on its own after 2 hours. But wet cleaning 2 times a day is required.
All family members should take vitamins, especially A and C.
If the family has a child who has not been sick or vaccinated, then he cannot visit the children's team from 8 to 17 days from contact with the patient.

Measles is a highly contagious infectious disease that is transmitted by airborne droplets and manifests itself in the form of a rash on the skin, as well as damage to the upper respiratory tract, eyes, and is accompanied by symptoms of general intoxication of the body.

Measles is more common in children of preschool and school age, so this disease is classified as a childhood infectious disease.

By itself, measles is not dangerous for the life of a child, but it often leads to complications such as pneumonia, purulent otitis, meningitis or meningoencephalitis, which, if not treated in time, can lead to death.

Therefore, we want to tell you in detail how measles manifests itself in children and adults and how to treat it, what effective methods of preventing this disease exist. In addition, we will analyze the symptoms and treatment of measles in adults.

The causative agent of measles is a small spherical virus (120-230 nm) belonging to the Paramyxovirus family.

The measles virus consists of a single strand of RNA and a shell, which is built from lipoproteins. Also, the pathogen has a set of antigens such as hemolysin, hemagglutinin, nucleocapsid and membrane protein. Hemolysin is able to cause hemolysis of red blood cells.

This paramyxovirus is unstable in the external environment, as it instantly dies under the influence of disinfectants, high temperatures and direct sunlight. But, at the same time, at room temperature, the pathogen can exist for 1-2 days, and when frozen - 2 weeks.

The source of the measles virus is a sick person with an overt or latent infection. The patient becomes contagious at the end of the incubation period, that is, 3 days before the rash appears, and remains contagious for 4-5 days after the rash.

The transmission mechanism of measles is aerogenic (through the air), and direct infection occurs by airborne droplets.

This requires that particles of mucus that contain the virus, when coughing or sneezing, get on the mucous membrane of the upper respiratory tract of a healthy person.

In addition to the aerogenic mechanism of spread of the measles virus, in rare cases, a contact mechanism of transmission through household items or children's toys is observed.

The entrance gate of infection is the mucous membrane of the upper respiratory tract and eyes.

Measles outbreaks are mainly recorded in the winter-spring season with a cyclical pattern of once every 2-4 years.

Since the measles virus is not prone to mutation, those who have been ill develop strong immunity.

There is also an effective measles vaccine, which is part of a comprehensive vaccination - MMR (measles, rubella, mumps). Vaccination provides active immunization of children, which has significantly reduced the incidence of measles.

The mechanism of the development of the disease

The causative agent enters the mucous membrane of the upper respiratory tract and with the flow of lymph is sent to the lymph nodes of the neck, where it begins to actively multiply. After that, the virus enters the bloodstream and spreads through tissues and organs, forming small inflammatory seals with multinucleated giant cells.

With the appearance of a rash, the number of viral bodies in the blood of a sick person begins to decrease.

On the fifth day from the appearance of rashes, the patient becomes harmless to others, since the virus is no longer in the body.

It is also known that the causative agent of measles has a slight immunosuppressive activity, as a result of which bacterial complications are often observed.

The course of measles can be typical and atypical.

In a typical course of the disease, a sequence of periods is noted.

Atypical measles is common in vaccinated children and adults. In turn, this form is subdivided downstream into several types, namely:

abortive flow. The onset of the disease is manifested by typical symptoms, but after 24-48 hours the patient's condition improves dramatically. Eruptions on the body are insignificant, pale and pass quickly;
a mitigated course is observed in contact children who were injected with anti-measles gamma globulin. This type of measles is characterized by a mild course, with a small single rash that quickly passes;
the erased course differs from other types of measles by the presence of only individual symptoms of the disease;
asymptomatic course of symptoms resembles a cold.

Despite the mild course of atypical forms of measles, patients also often develop complications, as in the typical course of the disease.

In the clinical course of typical measles, four stages are distinguished. Consider them:

The initial stage of measles, or the incubation period, is characterized by the absence of manifestations. At this stage of the infectious process, the virus actively multiplies in the lymph nodes of the neck. The duration of the initial stage is 1-2 weeks.
The catarrhal stage takes 3 to 5 days. The first symptoms of measles appear acutely at the end of the incubation stage. Children develop catarrhal symptoms from the upper respiratory tract and eyes, as well as signs of intoxication of the body.

A pathognomic symptom of measles is enanthema (Filatov-Koplik-Belsky spots), which appears on the inner surface of the cheeks opposite the premolars and looks like semolina.

The characteristic symptoms of the catarrhal stage are:

general weakness;
headache;
capriciousness and irritability;
loss of appetite;
sleep disturbance;
an increase in body temperature of 38 ° C;
swelling of the nasal mucosa and runny nose;
dry cough;
noisy breathing;
hoarseness of voice;
hyperemia of the mucous membrane of the eyes;
swelling of the eyelids;
the appearance of discharge from the palpebral fissure of a mucopurulent nature;
pain in the eyes in bright light;
swelling of the face;
hyperemia of the mucous throat;
lymphadenopathy (enlargement of the lymph nodes of the neck);
loosening of the stool and others.

The rash stage lasts about five days and is characterized by an increase in symptoms of intoxication and catarrhal phenomena from the upper respiratory tract.

The recovery stage begins with the subsidence of the exanthema and the appearance of pigmentation. The rash first turns pale, in its place light brown pigment spots form, which disappear within 7-8 days.

Rashes with measles in children: photo

Measles is characterized by the appearance on the skin of the face, upper limbs, trunk and lower limbs of bright maculopapular rash elements that merge with each other.

Measles exanthema can be identified according to the following features:

pours out in stages - from top to bottom. First, pimples appear on the head, neck and upper chest, then on the back, abdomen, shoulders and forearms, and only then on the lower limbs and arms;
rashes also subside in stages;
temporary pigmentation remains in place of measles exanthema.

Measles in infants: features

Measles is rare in infants under one year of age because infants have antibodies against measles that they received in their mother's milk. But this is only possible if the woman has been vaccinated against measles or has been ill with it.

If the baby is fed with artificial milk mixtures or the mother did not have measles, then, accordingly, the child does not receive protection against this infection and may turn white even at such an early age.

In newborns and infants, measles is severe and often accompanied by complications that can lead to death of the patient.

How does measles start in vaccinated children?

Measles in vaccinated children begins 9-10 days after infection with the measles virus and is mild. Catarrhal and intoxication symptoms of the disease are not expressed, rashes of a single nature, which quickly turn pale and disappear.

Children who are vaccinated are more likely to develop atypical measles, which we talked about earlier.

In adults, the symptoms of measles are more severe.

Patients may show the following signs of the disease:

Strong headache;
severe general weakness;
high body temperature;
nausea, up to vomiting;
insomnia;
the appearance of Belsky-Filatov-Koplik spots;
profuse rashes on the skin;
lymphadenopathy;
enlargement of the spleen, and sometimes the liver.

Despite the severe course of measles, complications of the disease are rare in adults.

Complications of measles

As we said earlier, the measles virus slightly depresses the patient's immunity, as a result of which the risk of attaching a secondary bacterial flora increases.

Measles is characterized by the addition complications such as:

bacterial pneumonia;
bacterial laryngitis and laryngotracheobronchitis;
false croup;
stomatitis;
inflammation of the meninges;
inflammation of the brain tissue;
purulent inflammation of the middle ear and others.

There is no etiotropic treatment for measles, so the treatment of the disease is aimed at alleviating its symptoms.

Mild measles is treated mainly at home under the supervision of a local pediatrician.

Indications for hospitalization in an infectious diseases hospital are states such as:

moderate and severe measles;
the presence of complications of measles;
accommodation of a child in a family where there are persons with measles, infants and pregnant women.

The treatment of measles is guided by the following principles:

bed or semi-bed rest;
airing and wet cleaning of the room or ward where the patient with measles is located is carried out several times a day;
the windows of the ward or the patient's room should be covered with dark curtains;
a diet that should consist of easily digestible and hypoallergenic foods containing a sufficient amount of vitamins and trace elements;
oral hydration to reduce the manifestations of intoxication. For this, both ordinary water, compotes, juices, fruit drinks, and electrolyte solutions of the Regidron type are suitable;
the patient's eyes are washed with a warm, weak solution of Furacilin;
the patient's lips are lubricated with vaseline oil to avoid drying out;
rinse the mouth with warm boiled water, weak solutions of potassium permanganate, Furacilin or soda, as well as decoctions of chamomile, string or oak bark;
the appointment of antiallergic drugs, such as Loratadin, Tavegil, Claritin, L-cet and others, which will reduce catarrhal symptoms and the severity of rashes;
the appointment of antipyretic drugs (Nurofen, Efferalgan) at a body temperature above 38.5 ° C;
the appointment of antiviral drugs in the first three days of the disease, which will increase the body's defenses and prevent the development of complications (human interferon, Viferon, Laferon and others);
the appointment of antibiotics with a wide spectrum of action in order to prevent purulent complications;
the appointment of infusion therapy in severe cases with severe intoxication syndrome (physiological sodium chloride solution, Disol, Rheosorbilact and others);
the appointment of hormonal drugs for measles complicated by meningitis or meningoencephalitis (Prednisolone, Dexamethasone) in combination with antibiotics.

Measles Prevention Methods

In order to prevent measles, two scheduled vaccinations of children are carried out with the introduction of the MMR vaccine (measles, rubella, mumps).

Vaccination is given to healthy children at 12 months and 6 years of age, as well as adults who have not been ill and have not been vaccinated before or have no history of vaccinations, every 12 years until the age of 35.

All contacts who have not previously had measles are injected with anti-measles gamma globulin.

If you or your child has symptoms of measles, we strongly recommend that you seek medical help in order to start timely treatment and avoid serious complications. In addition, the importance of measles vaccination should be understood and should not be abandoned, since the disease in vaccinated individuals is much milder than in unvaccinated individuals.

The content of the article

Measles- an acute infectious disease of a viral nature, occurring with a characteristic fever, generalized lesions of the mucous membranes of the respiratory tract, mouth, pharynx and eyes, a kind of rash and frequent complications, mainly from the respiratory system.

Historical data

Measles was first described in the 10th century, but a detailed description of it is given in the 17th century (Sydenham). Measles was long mixed with many diseases accompanied by a rash, and only in the 18th century was it singled out as an independent nosological unit.
At the beginning of the 20th century, the viral nature of measles was established. In 1916, a prophylaxis method was proposed using the serum of convalescents: in 1920, Degkwitz proposed a prophylaxis method by administering normal human serum to children in the incubation period, which played a large role in reducing mortality. In the 1950s, the measles virus (Enders. Peebles) was isolated. Fundamental changes occurred after the measles vaccine for active immunization 1A was developed. A. Smorodintsev. Enders). which made it possible to reduce the incidence by tens and even hundreds of times. In the study of the clinic, the pathogenesis of measles, the studies of M. G. Danilevich played an important role. A. I. Dobrokhotova. A. A. Skvortsova. V. D. Tsinzerling and others.

Etiology of measles in children

The causative agent of measles belongs to the group of microviruses, contains RNA, is passaged on chicken embryos and in human tissue culture. After long passages, attenuated, non-pathogenic strains with high antigenic activity are obtained from some strains. They are used for active immunization against measles.
The measles virus is isolated from the mucus of the nasopharynx and from the blood of the patient in the catarrhal period and at the very beginning of the rash. It can also be isolated from the blood during the incubation period. The measles virus is pathogenic for humans and some breeds of monkeys. It is unstable in the external environment, in the air in daylight, in droplets of saliva it dies within half an hour; when dried, it dies immediately, when heated to 50 ° C - within 15 minutes, at 60 ° C and above - immediately.
At low temperatures and in the dark, it can be stored for a long time, at +4 ° C - up to several weeks, and at -15 ° C or lower - up to several months.

Epidemiology of measles in children

The source of infection are patients with any form of measles, including the weakened form resulting from passive immunization, as well as patients who fell ill with measles, despite active immunization. Virus carrier has been denied so far. A patient with measles is contagious in the last 1-2 days of incubation, in the catarrhal period, in the first 3 days of the rash; from the 2nd day of the rash, the infectivity begins to decrease and disappears by the 5th day.
The route of transmission is airborne. The measles virus during a conversation, coughing, sneezing of a patient with droplets of mucus enters the air. Around the patient, a kind of cloud is formed, containing a large amount of live virus. It is carried by a stream of air over considerable distances, into neighboring rooms, and can penetrate through cracks even to other floors.
Transmission of infection through objects and a third person due to the low resistance of the virus can be carried out in exceptional, casuistic cases, only with a direct transition from a sick person to a healthy person.
Susceptibility to measles is very high, the contagiousness coefficient is close to 100%. Children of the first 3 months have innate immunity, transmitted from mothers who have had measles.
After 3 months, immunity decreases and is lost by 6-8 months. Further susceptibility remains high; after measles of any form, the body becomes immune for life; corresponding antibodies remain in the blood. Recurrent cases of measles are rare, probably no more than 1-2%. Currently, immunity and associated resistance to measles are also observed after immunization due to the presence of antibodies in the blood serum. Antibody titers in blood serum in children immunized against measles are usually somewhat lower than in children who have had measles, however, their minimum values also protect against measles (L. M. Boychuk, E. S. Shikina, L. V. Bystryakova ).
Morbidity. Children under 3 months do not get measles; diseases at this age occur only when the mother of the child did not have measles. Transplacental infection and simultaneous disease of the newborn and mother are possible if the mother becomes ill with measles before childbirth. At the age of 3 to 6 months, the disease is rare. The incidence of measles is highest between the ages of 2 and 7 years, then it decreases rapidly, and after 14 years only isolated cases are recorded.
Like all airborne infections, measles is characterized by seasonal fluctuations and frequency of incidence. The maximum of diseases falls on the winter-spring months - from December to May; rises in incidence are repeated every 2-4 years. These patterns are observed in large cities with a wide communication of the population. In some places where there has been no measles for many years, in the event of its drift, everyone who has not been ill before, regardless of age, falls ill. The situation is changing dramatically with the introduction of active immunization. With a wide coverage of vaccinations, diseases occur in the form of sporadic cases and the above patterns are eliminated.
Mortality in measles has been high in the past. In recent years, it has been reduced everywhere. There are no deaths in Leningrad and a number of other cities.

Pathogenesis and pathological anatomy of measles in children

The pathogenesis of measles has been studied for many decades. In recent years, measles has been experimentally induced in monkeys (I. Schroit). The study showed that damage to the lymphoid tissue and the reticuloendothelial system, which occurs shortly after the introduction of the virus, continues throughout the disease with the characteristic formation of giant cells.
The measles virus enters the body through the mucous membranes of the upper respiratory tract and possibly through the conjunctiva. From the first day of incubation, it is found in the blood, multiplies in epithelial cells and regional lymph nodes. By the end of the incubation period, the virus generalizes, it is fixed in many organs (central nervous system, lungs, intestines, tonsils, bone marrow, liver, spleen), where it further multiplies with the formation of small inflammatory infiltrates with the proliferation of reticular elements and the formation of multinuclear giant cells. With a significant accumulation of the virus in the organs, secondary generalization (viremia) occurs, corresponding to the clinical onset of the disease (catarrhal period).
In the catarrhal period there is a catarrhal inflammation of the pharynx, nasopharynx, larynx, trachea, a widespread lesion of the bronchi, often bronchioles, as well as focal pneumonia; in lung tissue, multinucleated giant cells are often found. The digestive tract, oral cavity, tonsils, small and large intestines are involved in the process. In lymphoid follicles, Peyer's patches, giant cells are often also determined. Measles is characterized by damage to the mucous membranes with areas of plethora, focal edema with vacuolization, superficial focal necrosis of epithelial cells, with desquamation of the epithelium. As a result of the inflammatory process, Velsky-Filatov-Koplik spots appear on the mucous membranes of the lips and cheeks.
In the future, a skin lesion specific to measles develops in the form of an exanthema - a large maculopapular rash on the skin. It is a foci of perivascular inflammation, consisting of histiocytic and lymphoid elements. Foci of destruction appear in the epidermis, subsequently they are desquamated (peeling). At the beginning of the rash, all the changes inherent in measles reach a maximum, which is expressed clinically by intoxication, catarrh of the upper respiratory tract, tonsillitis, bronchitis, bronchiolitis, often diarrhea, etc.
In the lung tissue, there is a disorder of blood and lymph circulation, cellular infiltration of the interstitial tissue, and a productive-infiltrative reaction of the interlobular peribronchial connective tissue.
With the end of the rash, the virus disappears from the body, pathological changes are gradually reversed. In recent years, there have been reports of the possibility of long-term persistence of the measles virus in the human body. Connoly, Baublis, Payne isolated measles antigen from the brain tissue of patients with sclerosing panencephalitis using immunofluorescence.
Research in this direction is ongoing.
Damage to the central nervous system.
myelondal pre-reticular tissues bring! to severe anergy, which is a significant pathogenetic factor characterizing measles. Simultaneous extensive damage to the epithelial cover, mucous membranes, respiratory and digestive organs (as if an extensive wound surface is formed) creates exceptionally favorable conditions for the penetration and vital activity of the microbial flora. Therefore, with measles, microbial processes develop extremely often. They can occur in any period of measles and are one of the main causes of death. In addition, measles can exacerbate chronic diseases. In the past, measles was a great danger for tuberculosis patients, contributing to the development of tuberculous meningitis, miliary tuberculosis.
Recovery in measles occurs due to immune processes. In the blood serum of patients, antibodies are determined in the reaction of neutralization of the cytopathic action of the measles virus, in RSK. hemagglutinacin inhibition reaction (HTGA). In the first days of the disease, antibodies are absent, they appear during the rash, and subsequently, within 7-10 days, their titers reach a maximum. In the coming months, there is a slight decrease in antibody titers and subsequently their content is fairly stable.

Clinic of measles in children

The incubation period is 9-10) days, occasionally it can be extended up to 17 days. In children who received y-globulin or transfused blood plasma during the incubation period, it can be delayed up to 21 days.
In the Chechen measles, 3 periods are distinguished: the initial, or catarrhal, period of the rash and the period of pigmentation.
catarrhal period begins with a runny nose, cough, conjunctivitis, symptoms of general intoxication. The runny nose is characterized by more or less copious mucous secretions: the cough is rough, barking, sometimes there is a hoarseness of voice. Conjunctivitis is expressed by hyperemia of the conjunctiva, barely leaking. photophobia. The face becomes puffy, the eyelids and lips swell. Symptoms of general intoxication are manifested by an increase in temperature up to 38 - 39 ° C. Headache, general malaise, lethargy, loss of appetite, more frequent stools can be observed, sometimes abdominal pain occurs
Catarrhal changes in the next 2 - 3 days the couple will melt. On the 2nd - 3rd day, an enanthema appears in the form of irregularly shaped red spots on the mucous membrane of the hard and soft palate. On the mucous membrane of the cheeks against small molars, sometimes on the mucous membrane of the lips and conjunctiva, a pathognomonic symptom specific to measles appears, described by Velsky, and then independently by Filatov and Koplik. This is small, the size of a poppy seed, spots rising under the mucous membrane, surrounded by a halo of hyperemia, not merging with each other and firmly soldered to the underlying tissue (not removed with a spatula). They persist for 2-4 days and disappear on the 1st, less often on the 2nd day of the rash; after their disappearance, the mucous membrane remains hyperemic and loose for several days. The duration of the catarrhal period is most often 2-3 days, but can vary from 1-2 to 5-6 days. The temperature all these days usually remains high, and before the appearance of the rash it often decreases, sometimes to normal numbers.
Rash period begins with a new rise in temperature and an increase in other symptoms of general intoxication, catarrh of the upper respiratory tract and conjunctivitis; these changes reach a maximum. Characterized by stages of rash. The first elements of the rash appear behind the ears, on the bridge of the nose, then during the first day the rash spreads to the face, neck and upper chest. Within 2 days it spreads to the trunk and upper limbs, on the 3rd day - to the lower limbs. The rash is usually profuse, merging in places, especially on the face, somewhat less on the trunk, and even less on the legs. When it appears, it looks like pink roseolas or small papules, then it becomes bright, enlarges and merges in places, which creates polymorphism in the size of roseolas, after another day they lose their papularity, change color - they become brown, do not disappear under pressure and turn into age spots in TQM in the same order in which the rash appeared - first on the face, gradually on the trunk, and finally on the legs. Therefore, the staging of the rash is visible even with a single examination, for example, there is already pigmentation on the face, and there is still a bright rash on the legs.
Rash with measles almost always typical, varieties are rare. These include hemorrhagic changes, when the rash acquires a purple-cherry hue. When the skin is stretched, it does not disappear, and when it passes into pigmentation, it first acquires a greenish and then brown color. Often, against the background of a normal rash, petechiae, or hemorrhages, appear in places subject to pressure. The hemorrhagic nature of the rash with measles can also be observed in mild forms.
IN the height of the illness(at the end of the catarrhal period and at the beginning of the rash) there are changes in the nervous, excretory, cardiovascular systems, gastrointestinal tract and lungs.
Changes in the central nervous system are manifested in increased headaches, loss of appetite, lethargy, drowsiness. In older children, excitation, delirium, hallucinations are sometimes observed. At the same time, oliguria develops and protein and casts appear in the urine. On the part of the cardiovascular system, tachycardia, a decrease in blood pressure, deafness of heart tones, and arrhythmias are noted. ECG reveals dystrophic processes in the myocardium. In the respiratory tract, there are phenomena of tracheobronchitis with a large number of dry whistling rales. On radiographs, an increase in the shadow of the pulmonary roots is determined as a result of hyperplasia of the lymph nodes, vein expansion and lymphostasis. Bronchography and bronchoscopy revealed hyperemia of the mucous membrane, edema and narrowing of the lumen of the bronchi. In young children, dyspeptic disorders are not uncommon; in older children, symptoms of acute appendicitis are sometimes observed. In the blood at the end of the incubation and the beginning of the catarrhal period, leukocytosis, neutrophilia with a shift to the left are noted, at the height of the disease - leukopenia, often with relative neutrophilia.
Period of pigmentation lasts 5-6 days and in the absence of microbial complications usually proceeds with normal temperature. Most children have asthenic phenomena for many more days: increased irritability, fatigue, weakness, headaches, insomnia, memory loss is often observed, and sometimes endocrine disorders occur.
Depending on the degree of intoxication, mild, moderate and severe forms of measles are distinguished. Severe forms occur with pronounced symptoms of intoxication in the form of hyperthermia, mental disorders, adynamia and cardiovascular insufficiency. In the past, severe hemorrhagic forms were sometimes noted, in which, along with symptoms of intoxication, multiple hemorrhages into the skin and mucous membranes, hematuria, etc. were observed. An extremely mild form sometimes occurs in infants. It proceeds with a slight fever, mild catarrhal phenomena and a scanty rash.
Measles in children after gamma globulin prophylaxis proceeds in the form of a mitigated form. The incubation period may be lengthened, catarrhal phenomena are mild or absent, as well as Filatov's symptom. The rash is scanty, up to single elements. There are no intoxication phenomena or they are insignificant, the temperature for 1-2 days can rise to subfebrile figures; complications usually do not occur. With a delayed introduction of γ-globulin (on the 8th - 9th day of incubation) or with an insufficient dosage of its measles symptoms weaken less and it may differ from the usual form only by greater ease.
Measles in vaccinated children(despite active immunization) does not differ from the usual, there is only a slight decrease in the frequency of complications. The measles clinic is fully consistent with immunological data. Just like in measles patients who have not previously been immunized, antibodies are absent at the onset of the disease, and their further increase occurs at the same time and in similar titers.
recurrent measles also proceeds without any deviations both in clinical manifestations and in immunological parameters. Antibodies at the onset of the disease, as in children who have not had measles (and are not immunized), are absent. In these cases, despite the disease, immunity for some reason did not develop, which caused the subsequent typical measles disease with a new infection.

Complications of measles in children

The following complications of measles are distinguished.
1. Actually measles complications caused directly by the measles virus. These include laryngitis, tracheitis, bronchitis, tracheobronchitis, becoming more pronounced; in the midst of measles, in addition, there may be pneumonia. Physical changes in measles pneumonia are not pronounced, some shortening of the percussion tone in the posterior lower sections of the lungs, harsh breathing, rough dry rales, a small amount of medium bubbling rales can be determined. An x-ray examination determines changes due to impaired lymph and blood circulation, increased shadow of the pulmonary roots, infiltration of the surrounding tissue, enhanced pulmonary pattern, and sometimes meager focal changes are observed.
A distinctive feature of the actual measles complications is the synchronism of their development with the phenomena of intoxication, catarrhal changes, rash. Simultaneously with the mitigation of measles intoxication, with the end of the rash, the changes caused by these complications also weaken. Along with these more benign complications, encephalitis can occur. More often, encephalitis develops already at the decline of intoxication, at the end of the rash period, during the transition to the stage of pigmentation. This disease is observed rarely, mainly in older children, it is extremely dangerous, is severe, can lead to the death of the patient or leave severe changes (paralysis, mental disorders, epilepsy). The question of the pathogenesis of measles encephalitis has not been finally resolved; most likely, it arises as a result of direct damage to brain cells by the measles virus. This theory is confirmed by experimental observations by I. Schroit. With measles in monkeys at different stages of the disease, the author often observed morphological changes in the brain, similar to those that appear in children with measles encephalitis.
2. Complications due to secondary, predominantly microbial, infection, occur mainly in the respiratory system, then in the digestive tract. M. G. Danilevich figuratively compares sick coryos with a sponge that draws in any pathological beginnings from the environment. For them, unhygienic content, contact with children and adults with inflammatory processes, and staying in the general ward of the measles department among children with complications are dangerous. Patients with measles can easily become infected with AVRI, which increases the possibility of microbial complications. The frequency of complications is inversely proportional to the age of patients, their maximum occurs in children of the first 3 years of life. The condition of the patient also matters. Complications occur more often and are more severe in debilitated children. Therefore, they are usually identified in the group of so-called measles-at risk children.
Secondary complications can occur at any stage of measles. Appearing in the early stages, they "weigh" the measles and themselves are more difficult. For proper treatment, it is very important to identify complications in a timely manner, which is often difficult in the early stages of measles due to masking by severe manifestations of the underlying disease. At a later date, the diagnosis of complications is facilitated, as the symptoms of measles smooth out, the temperature decreases.
Respiratory complications include the entire range of possible inflammatory processes in this system (rhinitis, laryngitis, tracheitis, bronchitis, bronchiolitis, pleurisy, pneumonia).
In past years, pneumonia in measles was most often pneumococcal etiology, streptococcal was in second place, and staphylococcal pneumonia was more rare. In the 40s of the XX century, after the introduction of sulfanilamide preparations into practice, streptococci became dominant in the etiology of pneumonia. Since the 50s, in connection with the use of penicillin, and later other antibiotics, streptococcal processes have gradually given way to staphylococcal ones, which still retain their dominant position.
Secondary pneumonia in patients with measles is often severe, become extensive, may be accompanied by abscess formation, the development of pleurisy.
Among the secondary complications, laryngitis is quite common, often caused in the past by diphtheria bacilli, recently, as well as pneumonia, caused mainly by staphylococci.
Complications from the digestive system proceed more favorably. In some cases, stomatitis is observed, currently predominantly catarrhal, aphthous. Gangrenous forms (noma) have been noted in the past.
Patients with measles often still have otitis, mainly catarrhal, due to the spread of an inflammatory, usually microbial, process from the pharynx. For the same reason, cervical lymphadenitis may occur. Purulent lesions of the ears, lymph nodes are now very rare.
Sometimes there are blepharitis, keratitis.
Frequent pustular lesions of the skin.
Of the secondary complications of measles, there may be purulent meningitis of microbial etiology, which developed as a result of generalization of the infection by the hematogenous route or its spread from the middle ear in the presence of otitis media. In recent years, they are exceptionally rare.
Forecast in measles at the present time, as a rule, favorable.
Mortality with measles, even among children of a threatened group, it can be practically eliminated, but subject to proper timely treatment. Rare deaths have been observed in older children with measles complicated by encephalitis.

Diagnosis, differential diagnosis of measles in children

The diagnosis is made on the basis of the presence of a catarrhal period with severe conjunctivitis, pharyngitis, laryngitis, bronchitis, enanthema and the Velsky-Filatov-Koplik symptom, later on the basis of a staged rash of a characteristic rash and subsequent pigmentation. Information about contact with a patient with measles is essential. A blood test helps in the diagnosis.
Specific diagnostic methods.
1. Determination of measles virus in nasopharyngeal swabs both in tissue culture and by immunofluorescence. The latter is quite simple and more accessible than virus isolation. The antigen is determined from the onset of the disease to the 3-4th day of the rash.
2. Determination of titers of antiviral antibodies using a neutralization reaction, RTGA, RSK.
A method for diagnosing measles by the presence of characteristic giant cells in scrapings from the buccal mucosa, nasopharyngeal mucus, and conjunctival discharge is described. They are determined in the early stages of the disease (G V. Pimonova, Naeke).
Blood for a serological reaction is taken twice. Diagnostic is the increase in titer in the terms indicated above. In the absence of measles, antibodies are either not detected, or they are detected from the onset of the disease, subsequently remaining in the same titers (L. V. Bystryakova).
It is necessary to differentiate measles in the catarrhal period from OVRI, in the period of the rash - from rubella, scarlet fever, enterovirus exanthems and various variants of the drug disease.
OVRI is suspected of measles with severe catarrhal symptoms and conjunctivitis. The difference is the different dynamics of the disease, the absence of the Filatov-Koplik symptom, rash. Sometimes for Filatov-Koplik spots they take thrush on the mucous membrane of the cheeks. The thrush is characterized by larger sizes of individual elements that can be easily removed with a spatula.
Rubella in the rash stage, it sometimes resembles measles. However, unlike measles, it is characterized by less pronounced symptoms of intoxication, the absence of a catarrhal period of the disease (catarrhal phenomena occur simultaneously with a rash and are very minor). The mucous membranes of the oral cavity are not changed, there is no conjunctivitis. A rubella rash appears within the next few hours, counting from the onset of the disease. There is a difference in the nature and localization of the rash: with rubella, it is pale, more pink in color, smaller and less diverse in shape. The elements of the rash are almost the same size and do not merge with each other. With rubella, the rash is located mainly on the extensor surfaces of the body, most often on the outer surfaces of the thighs and buttocks.
It lasts 1-2 days and disappears without leaving any pigmentation. Rubella is characterized by systemic enlargement of the lymph nodes, especially the posterior cervical and occipital. In the blood with rubella, the number of plasma cells is often increased.
Scarlet fever little like measles. Suspicion of scarlet fever in patients with measles sometimes occurs at the end of the catarrhal period, when a small prodromal rash appears on the body before the measles rash begins, and in a later period, when a confluent measles rash creates a general hyperemia of the body, reminiscent of scarlet fever. Differences from measles: the absence of catarrh of the upper respiratory tract, conjunctivitis, Filatov-Koplik spots, the presence of tonsillitis, changes in the tongue. A rash with scarlet fever does not appear in stages, as with measles, but almost simultaneously, it is absent on the face. The rash is not maculopapular, but punctate on a hyperemic background. Instead of leukopenia characteristic of measles, scarlet fever causes leukocytosis, neutrophilia, and eosinophilia.
Enteroviral diseases very similar to measles. With ECHO infection, a bright spotted rash may appear, as with measles, after a 2 to 3-day catarrhal period. The difference is the absence of pronounced catarrhal changes, Filatov-Koplik spots, the staging of the spread of the rash and pigmentation. In addition, enterovirus diseases are characterized by frequent enlargement of the liver and spleen, which is usually not observed with measles.
medicinal disease occurs in different clinical variants. It can appear after taking various drugs (antipyrine, synthomycin, streptomycin, etc.).
Its feature is the absence of any patterns in the rash; the rash is usually polymorphic, rarely covering the entire body. In addition, there are no other symptoms of measles. Some similarities with measles have Stevens-Johnson syndrome. This syndrome is described by a number of authors as a toxic-allergic reaction to certain drugs; other authors consider this syndrome a manifestation of mycoplasma infection. Its similarity with measles is manifested in the fact that it proceeds with damage to the mucous membranes and a rash against the background of intoxication. The disease begins with fever, runny nose, cough, then conjunctivitis and inflammatory changes in the mucous membranes develop around the natural openings - the anus, genitals, mucous membranes of the mouth and nose.
The rash appears on the 4-5th day, begins on the face and spreads to the trunk and limbs within a few hours, then new rashes appear within a few days.
The elements of the rash at first look like measles and are spots of bright red color, irregular shape, of different sizes. After a day, the central areas of the spots turn into flaccid blisters, similar to burns. The mucous membrane of the cheeks and tongue is at first loose, hyperemic, then ulcers appear on it, covered with a yellow film; they are sometimes mistaken for Filatov-KoPlik spots and patients are sent to measles departments. The condition of patients is usually severe, the temperature is high. Changes in the skin and mucous membranes can last for several weeks, recovery is slow, and deaths are observed. In the peripheral blood, patients usually have leukopenia and lymphocytosis; staphylococcal infection often joins, neutrophilic leukocytosis develops and ESR rises sharply.
The difference from measles is a violation of the patterns in the development of the disease characteristic of measles, an ulcerative process on the mucous membranes of the mouth, genital organs and around the anus, a vesicular rash, and the absence of Filatov-Koplik spots.
Serum sickness sometimes accompanied by a measles-like rash. The difference between this rash and measles is the absence of a cyclic course, catarrhal changes and Filatov-Koplik spots. The rash appears around the injection site of the serum, the rash occurs without any order, is accompanied by itching, urticarial elements are found, the symmetrical location of the rash, blisters or ring-shaped elements, skin itching, etc.

Features of measles in modern conditions

For many centuries, measles was rightly called the childhood plague. The incidence was almost universal, mortality was at least 2-3%, and hospital mortality was up to 30-40% or more, which determined its large role in the mortality of the population: losses from measles in Europe alone amounted to hundreds of thousands of people a year.
The situation began to change only in the 30s of the XX century, when seroprophylaxis was introduced into practice, and subsequently, y-globulin prophylaxis of children in contact with sick children at the beginning of incubation. This limited the spread of the disease to a certain extent and eased the severity of the course of measles, especially among the threatened contingents (young age, weakened children). From the same time, the improvement of the regimen of measles departments aimed at the prevention of cross-infection began, which made it possible to somewhat reduce hospital mortality. The use of sulfanilamide drugs reduced the incidence of complications of pneumococcal etiology, the introduction of antibiotics expanded the range of etiotropic therapy, affected streptococcal and then staphylococcal complications, which, along with the development of nonspecific therapy, led to a sharp decrease in mortality, and in cities with a well-organized medical service to its elimination.

Measles prognosis in children

The prognosis for uncomplicated measles is usually good. It is aggravated in weakened children, young children in the event of pneumonia. However, even in these cases, with the early complex use of modern means, lethal outcomes can be avoided or reduced to negligible numbers. A serious complication is encephalitis, which can lead to the death of a child, and in survivors to changes in the psyche, sensory organs and respiratory organs.

Treatment of measles in children

Most children with measles are treated at home. Hospitalization is subject to children with severe forms of the disease, with complications, for epidemic (from dormitories, boarding schools, etc.) and everyday (impossibility of care, poor conditions, etc.) indications.
The patient is provided with bed rest during the entire febrile period, the position in the bed should be comfortable, bright light should not fall into the eyes. Indoors carry out regular wet cleaning, aeration. It is necessary to observe the rules of personal hygiene (regular washing, cleanliness of the mouth, eyes, nose). It is very important to limit the communication of a measles patient to only 1-2 people caring for him.
Medical treatment uncomplicated measles is either not used, or very limited. With significantly pronounced conjunctivitis, the eyes are washed with a solution of boric acid. With an obsessive cough, they give pertussin, at an older age - codeine, dionine. Treatment of complications should correspond to their character. Due to the fact that they are usually microbial in nature, the earliest possible use of antibiotics in sufficient dosage is required. Timely antibiotic treatment is necessary for severe forms of measles, pronounced bronchitis, measles laryngitis. Penicillin is used provided that the dosage is sufficient (at least 100,000 IU / kg) and semi-synthetic preparations of penicillin (oxacillin, ampicillin, methicillin sodium, etc.) in the usual age dosages. In severe cases, combinations of antibiotics are needed. Stimulating therapy (hemotransfusion, plasma transfusion, injections of y-globulin, etc.), physiotherapeutic procedures are also important.
The nutrition of the patient is organized depending on his desires, appetite, without any restrictions, according to age. At the height of the disease, appetite is sharply reduced;
you can give jelly, kefir, soups, mashed potatoes, cereals, meat, cottage cheese, etc. If possible, plentiful drinking is shown (fruit drink, tea with lemon, etc.). Food and drink are fortified by adding fruits, fruit and berry juices.
Recovery from measles is slow. For several weeks, the child may have weakness, fatigue, memory loss, increased irritability, so they are discharged to school, kindergarten, depending on his condition.

Prevention of measles in children

Currently, the main place in the prevention of measles is occupied by active immunization, carried out by live attenuated (attenuated) measles vaccine.
Vaccinate children from 15-18 months. Vaccination is carried out once by subcutaneous or intradermal injection of live attenuated vaccine L-16. Clinical reactions to vaccination occur in less than 10-11% of cases. They represent an infectious process that has retained the basic pathogenetic patterns of measles, but is very light; its advantage is that it is absolutely devoid of contagiousness; the child in the presence of any reaction to the vaccination may be in the children's team.
Clinical reactions to vaccination may occur from days 6 to 20, most often on days 13-17 after vaccination. They are divided into weak, medium and strong. When using the L-16 vaccine, predominantly weak reactions occur, expressed in an increase in temperature to 37.2-37.5 ° C; with moderate reactions, the temperature ranges from 37.5 to 38 ° C. Strong reactions rarely occur (less than 1%). They are characterized by an increase in temperature up to 38-38.5 ° C, headache, sometimes lethargy, anorexia. Vaccination reactions last no more than 2-3 days.
In addition to fever, children may have minor catarrhal phenomena (cough, runny nose, conjunctivitis), individual elements of a small-spotted, sometimes papular rash. With vaccination reactions, there are no patterns in the development of symptoms of the disease observed with measles.
Catarrhal phenomena and rash often appear with strong reactions, sometimes the changes resemble mitigated measles, but, as already indicated, with a perverted, erratic dynamics. Complications from vaccine reactions are very rare. Severe reactions, not only with an increase in temperature, but also with other phenomena of intoxication, are usually due to the occurrence of other diseases during the period of reactions.
In some cases (about 2%), children, despite being vaccinated, subsequently become ill with measles with the same typical symptoms as in unvaccinated.
Passive immunization consists in the introduction of y-globulin to children who have been in contact with measles patients (before not having measles), y-globulin contains antibodies, due to which measles does not develop or occurs in a milder form, depending on the dose of the drug and the time of its administration.
According to the current instructions, y-globulin prophylaxis is carried out for unvaccinated (who did not receive the measles vaccine) children aged 3 months to 4 years and debilitated children without age restrictions (sick and convalescents after various diseases, with tuberculosis intoxication, etc.). γ-globulin is administered intramuscularly on the 4-6th day after contact with the patient; to prevent measles, you need to enter 3 ml of the drug. Passive immunity is short-lived, no more than 2 weeks; therefore, upon repeated contacts, γ-globulin is administered repeatedly. In some cases, a half dose of γ-globulin is administered, it does not prevent the disease, but helps to alleviate measles, while the children develop a strong active immunity that protects them from measles in the future.
A patient with measles is isolated until the 5th day from the onset of the rash, in the presence of complications, this period is extended to 10 days. The room where the patient was located is ventilated; disinfection due to the instability of the virus in the external environment is not needed. Among the vaccinated children in contact with the patient, preventive measures are not carried out. Unvaccinated children under 2 years of age (debilitated older children) are given 7-globulin; healthy children older than 2 years are urgently vaccinated. Children who had contact with the patient, unvaccinated and not sick with measles, are subject to quarantine from the 8th day after contact: those who did not receive 7-globulin - for 17 days, those who received 7-globulin - for 21 days. Students older than 2nd grade are not subject to quarantine.