The infection is droplet spread - by the airborne route, or by direct contact with the nasal or oral secretions of an infected person, and less commonly, by articles freshly soiled with nasal or oral secretions.

Measles is one of the most highly communicable infectious diseases.

On average, ten days (7 to 18 days from date of exposure, usually 14 days until rash appears, but rarely 19 to 21 days).

Early symptoms (prodromal phase) start at 2 to 4 days with fever, conjunctivitis, coryza and Koplik spots inside the mouth. A characteristic rash appears on the body (starting on the forehead and spreading downwards over the face, neck and body) between the third and seventh day; it takes four days to spread and lasts one week.

There can also be symptoms of diarrhoea, vomiting and abdominal pain.

Saliva testing can confirm initial diagnosis (refer to your local policy / Health Protection Team for further information).

There is no specific treatment for measles, treatment is based on alleviating symptoms. Encourage patients to drink lots of clear fluids to replace body water lost through fever. Paracetamol can be used to reduce the fever. (Aspirin should not be given to children, as its use is associated with Reye’s Syndrome - a severe neurological disorder.)

Children should be kept away from school/nurseries/childminders for five days after the rash appears.

Click here for guidance by the Health Protection Agency on infection control in schools and other childcare settings.

Yes, refer to your local policy/infection control team for further information.

Complications of measles are common and include otitis media, pneumonia, croup or diarrhoea. Other complications may include bronchiolitis, sinusitis, myocarditis, corneal ulceration, mesenteric adenitis, hepatitis and thrombocytopaenic purpura.

Severe complications of measles are encephalitis and subacute sclerosing panencephalitis (SSPE); a rare but fatal late complication of measles that occurs many years after the initial illness.

Infection during pregnancy can result in the loss or early birth of the baby. Severe disease and complications are most likely in infants under 12 months, those with weakened immune systems, the malnourished and children with vitamin A deficiency.

This is through immunisation.

Measles vaccine is one of the components of the MMR vaccine introduced in 1988. There are two licensed MMR vaccines: Priorix (GSK) using attenuated Schwarz measles strain, and MMR II (Aventis Pasteur) using attenuated Enders line of the Edmonston strain.

Note: do not confuse MMR II vaccine with a 2^nd dose of the vaccine.

MMR vaccine contains three live attenuated viruses, each vaccine virus will not replicate to a significant level in a host who has pre-existing immunity to that infection as a result of either vaccination or natural disease.

There is no upper age limit, and where necessary, two doses can be given separated by a three-month interval.

There is no single antigen measles vaccine licensed in the UK.

MMR is not given if the patient:

• has had a severe reaction to MMR
• is pregnant (women should avoid pregnancy for one month after MMR)
• has had an injection of immunoglobulin or other blood product in the previous three months
• reacts severely to neomycin or kanamycin
• has an untreated malignant disease or altered immunity.

Severe reactions should be reported via the yellow card scheme (www.yellowcard.gov.uk).