Rubeola

Airborne Precautions

Rubeola, also known as measles or morbilli, is an acute, highly contagious paramyxovirus infection that may be one of the most common and most serious of all communicable childhood diseases. Vaccine use has reduced its occurrence during childhood. In the United States, the prognosis is usually excellent; however, rubeola is a major cause of death in children in underdeveloped countries.

Generally, one bout of rubeola provides immunity (a second infection is extremely rare and may indicate a misdiagnosis); infants younger than age 4 months may be immune because of circulating maternal antibodies. Under normal conditions, rubeola vaccine isn’t administered to children younger than age 15 months. However, during an epidemic, infants as young as 6 months may receive the vaccine and then be re-immunized at age 15 months. An alternative preventive approach calls for administering gamma globulin to infants between ages 6 and 15 months who are likely to be exposed to rubeola.

Causes

Rubeola is spread by direct contact or by contaminated airborne respiratory droplets. The portal of entry is the upper respiratory tract.

Complications

Complications of rubeola include otitis media, cervical adenitis, laryngitis, pneumonia, and encephalitis.

Assessment Findings

Incubation is from 10 to 12 days. Initial symptoms begin and greatest communicability occurs during the prodromal phase, about 11 days after exposure to the virus. This phase lasts from 4 to 5 days; signs and symptoms include fever, photophobia, malaise, anorexia, conjunctivitis, coryza, hoarseness, and a hacking cough.

At the end of the prodrome, Koplik spots—the hallmark of the disease—appear. These spots, which resemble tiny, bluish white specks surrounded by a red halo, are found on the oral mucosa opposite the molars and occasionally bleed. About 5 days after Koplik spots appear, temperature rises sharply, spots slough off, and a slightly pruritic rash appears. This characteristic rash starts as faint maculae behind the ears and on the neck and cheeks. The maculae become papular and erythematous, rapidly spreading over the entire face, neck, eyelids, arms, chest, back, abdomen, and thighs. When the rash reaches the feet 2 to 3 days later, it begins to fade in the same sequence in which it appeared, leaving a brownish discoloration that disappears in 7 to 10 days.

The disease climax occurs 3 to 4 days after the rash appears and is marked by a fever of 103° to 105° F (39.4° to 40.6° C), severe cough, puffy red eyes, and rhinorrhea. About 5 days after the rash appears, other symptoms disappear and communicability ends. More severe symptoms and complications are more likely to develop in young infants, adolescents, adults, and patients who are immunocompromised than in young children.

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