Measles: Name 5 Key Signs and Symptoms

Measles outbreak 2019. The CDC reports that from January 1 to May 31, 2019, it has confirmed 981 individual cases of measles, originating in 26 states. This is the largest number of cases in the United States since 1992 and, more importantly, since measles was declared “eliminated” in 2000. Most cases have been reported in New York, Michigan, and Washington State. Cases were concentrated in Orthodox Jewish communities in Brooklyn and Rockland County, NY and then carried to Michigan.

Virus knows no borders. Even if the measles virus were again to be eliminated from the US, the disease is still just a plane ride away from your state. According to the CDC, the 2019 outbreak was triggered by >100 infections acquired by overseas travelers since early 2018, the majority originating in Israel, Ukraine, and the Philippines. The incubation time is fairly long, 8-12 days, so seemingly healthy individuals can be harboring the replicating virus.

Would you recognize measles? Endemic measles was eliminated in the US in 2000 and it's possible that many young practicing US clinicians have never seen an actual case. Does that include you? Can you put the key 5 signs and symptoms of the virus in order of appearance? Fever and malaise; facial rash; body rash; Koplik spots on buccal mucosa; coryza, conjunctivitis, & cough

In order of appearance...1. Fever and malaise appear first and in children may increase rapidly to as high as 105º before rapildy falling. 2. Coryza, conjunctivitis, cough appear within 24 hours of fever onset and peak at day 4. The cough will be the last symptom to resolve.

3. Koplik spots. These tell-tale signs appear first on the buccal mucosa and ~1 day after coryza and cough. Over 3 to 4 days the bright red spots spread to cover the entire buccal and labial mucosa and then fade over another 2 days.

4. Facial rash. The rash appears frist along the hairline of hte face (forehead, behind earlobes, upper neck) ~3 to 4 days after onset of fever.

5. Body rash. The rash moves downward and reaches the feet ~2-3 days after appearance on the head. Upper body lesions are more numerous than lower body lesions and may become confluent. The rash departs as it arrived, starting at the head and moving down.