Measles

Symptoms

• High fever
• Cough
• Running nose (coryza)
• Red, watery eyes (conjunctivitis)
• Tiny white spots (Koplik spots) inside the mouth
• Rash as flat red spots that first appear on the face (3-4 days after the fever) and spreads to the rest of the body

Transmission

• Person-to-person through direct contact with infectious droplets or by small particle aerosols that remain suspended in the air for up to 2 h when an infected person breathes, coughs, or sneezes
• A patient with measles may infect ~12-18 susceptible persons within close contact
• The infectious period spans from several days before to several days after appearance of rash

Vaccination

• Measles can be prevented through measles vaccination
• Measles vaccines are available as combined vaccines with those for rubella (MR), mumps (MMR), or varicella (MMR-V)
• In India, the following measles vaccination programmes have been implemented:
  • Routine immunization with the first dose of measles containing vaccine (MCV1) for children aged 9 months-12 months was introduced in 1985
  • Routine immunization with the second vaccine dose (MCV2) for children aged 16 months-24 months was introduced in 2011
  • Mass vaccination campaigns or supplemental immunization campaigns were introduced in a phased manner for children aged 9 months-10 years between 2010 to 2013 and for measles and rubella between 2017 to 2019
  • In 2017, the routine immunization schedule with MCV1 and MCV2 was replaced by measles- and rubella-containing vaccine (MRCV)

Incidence

• India made considerable progress in its measles and rubella immunization programme resulting in a 62% decrease in the annual incidence of measles - from 10.4 to 4.0 cases per million population - during 2017-2021.
• Despite the progress made in measles immunization, routine MRCV1 and MRCV2 coverages decreased during the COVID-19 pandemic causing recent outbreaks in some states. Therefore, meeting the measles and rubella elimination goals by 2023 remains a challenge.