|Classification and external resources|
A child showing a classic 4-day measles rash.
|eMedicine||derm/259 emerg/389 ped/1388|
Measles, also known as morbilli, English measles, or rubeola (and not to be confused with rubella or roseola) is an infection of the respiratory system, immune system and skin caused by a virus, specifically a paramyxovirus of the genus Morbillivirus. Symptoms usually develop 7–14 days (average 10–12) after exposure to an infected person and the initial symptoms usually include a high fever (often > 40 °C [104 °F]), Koplik's spots (spots in the mouth, these usually appear 1–2 days prior to the rash and last 3–5 days), malaise, loss of appetite, hacking cough (although this may be the last symptom to appear), runny nose and red eyes. After this comes a spot-like rash that covers much of the body. The course of measles, provided there are no complications, such as bacterial infections, usually lasts about 7–10 days.
Measles is spread through respiration (contact with fluids from an infected person's nose and mouth, either directly or through aerosol transmission), and is highly contagious—90% of people without immunity sharing living space with an infected person will catch it. An asymptomatic incubation period occurs nine to twelve days from initial exposure. The period of infectivity has not been definitively established, some saying it lasts from two to four days prior, until two to five days following the onset of the rash (i.e., four to nine days infectivity in total), whereas others say it lasts from two to four days prior until the complete disappearance of the rash. The rash usually appears between 2–3 days after the onset of illness.
Signs and symptomsEdit
The classic signs and symptoms of measles include four-day fevers [ the 4 D's ] and the three Cs—cough, coryza (head cold), and conjunctivitis (red eyes)—along with fever and rashes. The fever may reach up to 40 °C (104 °F). Koplik's spots seen inside the mouth are pathognomonic (diagnostic) for measles, but are not often seen, even in confirmed cases of measles, because they are transient and may disappear within a day of arising. Their recognition, before the affected person reaches maximum infectivity can be used to reduce spread of epidemics.
The characteristic measles rash is classically described as a generalized, maculopapular, erythematous rash that begins several days after the fever starts. It starts on the back of the ears and, after a few hours, spreads to the head and neck before spreading to cover most of the body, often causing itching. The measles rash appears two to four days after the initial symptoms and lasts for up to eight days. The rash is said to "stain", changing color from red to dark brown, before disappearing.
Complications with measles are relatively common, ranging from mild and less serious complications such as diarrhea to more serious ones such as pneumonia (either direct viral pneumonia or secondary bacterial pneumonia), otitis media, acute encephalitis (and very rarely SSPE—subacute sclerosing panencephalitis), and corneal ulceration (leading to corneal scarring). Complications are usually more severe in adults who catch the virus. The death rate in the 1920s was around 30% for measles pneumonia.
Between 1987 and 2000, the case fatality rate across the United States was 3 measles-attributable deaths per 1000 cases, or 0.3%. In underdeveloped nations with high rates of malnutrition and poor healthcare, fatality rates have been as high as 28%. In immunocompromised persons (e.g., people with AIDS) the fatality rate is approximately 30%.
|Measles virus electron micrograph|
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Measles is caused by the measles virus, a single-stranded, negative-sense, enveloped RNA virus of the genus Morbillivirus within the family Paramyxoviridae. The virus was first isolated in 1954 by Nobel Laureate John F. Enders and Thomas Peebles, who were careful to point out that the isolations were made from patients who had Koplik's spots. Humans are the natural hosts of the virus; no other animal reservoirs are known to exist. This highly contagious virus is spread by coughing and sneezing via close personal contact or direct contact with secretions.
Risk factors for measles virus infection include the following:
- Children with immunodeficiency due to HIV or AIDS, leukemia, alkylating agents, or corticosteroid therapy, regardless of immunization status
- Travel to areas where measles is endemic or contact with travelers to endemic areas
- Infants who lose passive antibody before the age of routine immunization
Risk factors for severe measles and its complications include the following:
Clinical diagnosis of measles requires a history of fever of at least three days, with at least one of the three C's (cough, coryza, conjunctivitis). Observation of Koplik's spots is also diagnostic of measles.
Alternatively, laboratory diagnosis of measles can be done with confirmation of positive measles IgM antibodies or isolation of measles virus RNA from respiratory specimens. In patients where phlebotomy is not possible, saliva can be collected for salivary measles-specific IgA testing. Positive contact with other patients known to have measles adds strong epidemiological evidence to the diagnosis. The contact with any infected person in any way, including semen through sex, saliva, or mucus, can cause infection.
In developed countries, children are immunized against measles by the age of 18 months, generally as part of a three-part MMR vaccine (measles, mumps, and rubella). The vaccination is generally not given earlier than this because sufficient antimeasles immunoglobulins (antibodies) are acquired via the placenta from the mother during pregnancy may persist to prevent the vaccine viruses from being effective. A second dose is usually given to children between the ages of four and five, to increase rates of immunity. Vaccination rates have been high enough to make measles relatively uncommon. Adverse reactions to vaccination are rare, with fever and pain at the injection site being the most common. Life-threatening adverse reactions occur in less than one per million vaccinations (<0.0001%).
In developing countries where measles is highly endemic, WHO doctors recommend two doses of vaccine be given at six and nine months of age. The vaccine should be given whether the child is HIV-infected or not. The vaccine is less effective in HIV-infected infants than in the general population, but early treatment with antiretroviral drugs can increase its effectiveness. Measles vaccination programs are often used to deliver other child health interventions, as well, such as bed nets to protect against malaria, antiparasite medicine and vitamin A supplements, and so contribute to the reduction of child deaths from other causes.
Unvaccinated populations are at risk for the disease. Traditionally low vaccination rates in northern Nigeria dropped further in the early 2000s when radical preachers promoted a rumor that polio vaccines were a Western plot to sterilize Muslims and infect them with HIV. The number of cases of measles rose significantly, and hundreds of children died. This could also have had to do with the aforementioned other health-promoting measures often given with the vaccine.
Claims of a connection between the MMR vaccine and autism were raised in a 1998 paper in The Lancet, a respected British medical journal. Later investigation by Sunday Times journalist Brian Deer discovered the lead author of the article, Andrew Wakefield, had multiple undeclared conflicts of interest, and had broken other ethical codes. The Lancet paper was later fully retracted, and Wakefield was found guilty by the General Medical Council of serious professional misconduct in May 2010, and was struck off the Medical Register, meaning he could no longer practise as a doctor in the UK.
The GMC's panel also considered two of Wakefield's colleagues: John Walker-Smith was also found guilty and struck off the Register; Simon Murch "was in error" but acted in good faith, and was cleared. Walker-Smith was later cleared and reinstated after winning an appeal; the appeal court's finding was based on the panel's conduct of the case, and gave no support to the MMR-autism hypothesis, which the official judgement described as lacking support from any respectable body of opinion. The research was declared fraudulent in 2011 by the BMJ. Scientific evidence provides no support for the hypothesis that MMR plays a role in causing autism.
The autism-related MMR study in Britain caused use of the vaccine to plunge, and measles cases came back: 2007 saw 971 cases in England and Wales, the biggest rise in occurrence in measles cases since records began in 1995. A 2005 measles outbreak in Indiana was attributed to children whose parents refused vaccination, as was another outbreak in 2008 in San Diego. Centers for Disease Control and Prevention (CDC) reported that the three biggest outbreaks of measles in 2013 are attributed to clusters of unvaccinated people due to their philosophical or religious beliefs. As of August 2013, three pockets of outbreak, New York City; North Carolina and Texas contributed to 64% of the 159 cases of measles occurred in 16 states. This high number makes it on track to be the most cases since measles was considered eliminated in USA in 2000.
There is no specific treatment for measles. Most patients with uncomplicated measles will recover with rest and supportive treatment. It is, however, important to seek medical advice if the patient becomes more unwell, as they may be developing complications.
Some patients will develop pneumonia as a sequel to the measles. Other complications include ear infections, bronchitis, and encephalitis. Acute measles encephalitis has a mortality rate of 15%. While there is no specific treatment for measles encephalitis, antibiotics are required for bacterial pneumonia, sinusitis, and bronchitis that can follow measles.
All other treatment addresses symptoms, with ibuprofen or paracetamol to reduce fever and pain and, if required, a fast-acting bronchodilator for cough. As for aspirin, some research has suggested a correlation between children who take aspirin and the development of Reye syndrome. Some research has shown aspirin may not be the only medication associated with Reye, and even antiemetics have been implicated, with the point being the link between aspirin use in children and Reye's syndrome development is weak at best, if not actually nonexistent. Nevertheless, most health authorities still caution against the use of aspirin for any fevers in children under 16.
The use of vitamin A in treatment has been investigated. A systematic review of trials into its use found no significant reduction in overall mortality, but it did reduce mortality in children aged under two years. A specific drug treatment for measles ERDRP-0519 has shown promising results in animal studies, but has not yet been tested in humans.
The majority of patients survive measles, though in some cases, complications may occur, which may include bronchitis, and—in about 1 in 100,000 cases—panencephalitis, which is usually fatal. The patient may spread the disease to an immunocompromised patient, for whom the risk of death is much higher, due to complications such as giant cell pneumonia. Acute measles encephalitis is another serious risk of measles virus infection. It typically occurs two days to one week after the breakout of the measles exanthem and begins with very high fever, severe headache, convulsions and altered mentation. A patient may become comatose, and death or brain injury may occur.
Measles is extremely infectious and its continued circulation in a community depends on the generation of susceptible hosts by birth of children. In communities which generate insufficient new hosts the disease will die out. This concept was first recognized in measles by Bartlett in 1957, who referred to the minimum number supporting measles as the Critical community size. Analysis of outbreaks in island communities suggested that the CCS for measles is c. 250,000.
In 2011, the WHO estimated that there were about 158,000 deaths caused by measles. This is down from 630,000 deaths in 1990. In developed countries,death occurs about 1 in 1,000 cases (0.1%). In populations with high levels of malnutrition and a lack of adequate healthcare, mortality can be as high as 10%. In cases with complications, the rate may rise to 20–30%. Increased immunization has led to a 78% drop in measles deaths which made up 25% of the decline in mortality in children under five.
|Region of the Americas||257,790||218,579||1,755||19||3,100|
|Eastern Mediterranean Region||341,624||59,058||38,592||15,069||2,214|
|South-East Asia Region||199,535||224,925||61,975||83,627||1,540|
|Western Pacific Region||1,319,640||155,490||176,493||128,016||34,310|
Even in countries where vaccination has been introduced, rates may remain high. In Ireland, vaccination was introduced in 1985. There were 99,903 cases that year. Within two years, the number of cases had fallen to 201, but this fall was not sustained. Measles is a leading cause of vaccine-preventable childhood mortality. Worldwide, the fatality rate has been significantly reduced by a vaccination campaign led by partners in the Measles Initiative: the American Red Cross, the United States Centers for Disease Control and Prevention (CDC), the United Nations Foundation, UNICEF and the WHO. Globally, measles fell 60% from an estimated 873,000 deaths in 1999 to 345,000 in 2005. Estimates for 2008 indicate deaths fell further to 164,000 globally, with 77% of the remaining measles deaths in 2008 occurring within the Southeast Asian region.
In 2006–07 there were 12,132 cases in 32 European countries: 85% occurred in five countries: Germany, Italy, Romania, Switzerland and the UK. 80% occurred in children and there were 7 deaths.
Five out of six WHO regions have set goals to eliminate measles, and at the 63rd World Health Assembly in May 2010, delegates agreed a global target of a 95% reduction in measles mortality by 2015 from the level seen in 2000, as well as to move towards eventual eradication. However, no specific global target date for eradication has yet been agreed to as of May 2010.
On January 22, 2014, the World Health Organization and the Pan American Health Organization declared and certified Colombia free of the measles while becoming the first Latin American country to abolish the infection within its borders.
In Vietnam, in the Measles Epidemic in the beginning of 2014, unto April 19 had 8,500 measles cases, 114 fatalities.
History and cultureEdit
The Antonine Plague, 165–180 AD, also known as the Plague of Galen, who described it, was probably smallpox or measles. The epidemic may have claimed the life of Roman emperor Lucius Verus. Total deaths have been estimated at five million. Estimates of the timing of evolution of measles seem to suggest this plague was something other than measles. The first scientific description of measles and its distinction from smallpox and chickenpox is credited to the Persian physician Rhazes (860–932), who published The Book of Smallpox and Measles. Given what is now known about the evolution of measles, this account is remarkably timely.
Measles is an endemic disease, meaning it has been continually present in a community, and many people develop resistance. In populations not exposed to measles, exposure to the new disease can be devastating. In 1529, a measles outbreak in Cuba killed two-thirds of the natives who had previously survived smallpox. Two years later, measles was responsible for the deaths of half the population of Honduras, and had ravaged Mexico, Central America, and the Inca civilization.
Between roughly 1855 to 2005 measles has been estimated to have killed about 200 million people worldwide. Measles killed 20 percent of Hawaii's population in the 1850s. In 1875, measles killed over 40,000 Fijians, approximately one-third of the population. In the 19th century, the disease decimated the Andamanese population. In 1954, the virus causing the disease was isolated from an 11-year old boy from the United States, David Edmonston, and adapted and propagated on chick embryo tissue culture. To date, 21 strains of the measles virus have been identified. While at Merck, Maurice Hilleman developed the first successful vaccine. Licensed vaccines to prevent the disease became available in 1963. An improved measles vaccine became available in 1968.
Many children in ultra-Orthodox Jewish communities were affected due to low vaccination coverage. As of 2008, the disease is endemic in the United Kingdom, with 1,217 cases diagnosed in 2008, and epidemics have been reported in Austria, Italy and Switzerland.
On February 19, 2009, 505 measles cases were reported in twelve provinces in northern Vietnam, with Hanoi accounting for 160 cases. A high rate of complications, including meningitis and encephalitis, has worried health workers, and the U.S. CDC recommended all travelers be immunized against measles.
Beginning in April 2009 there was a large outbreak of measles in Bulgaria, with over 24,000 cases including 24 deaths. From Bulgaria, the strain was carried to Germany, Turkey, Greece, Macedonia, and other European countries.
Beginning in September 2009, Johannesburg, South Africa reported about 48 cases of measles. Soon after the outbreak, the government ordered all children to be vaccinated. Vaccination programs were then initiated in all schools, and parents of young children were advised to have them vaccinated. Many people were not willing to have the vaccination done, as it was believed to be unsafe and ineffective. The Health Department assured the public that their program was indeed safe. Speculation arose as to whether or not new needles were being used. By mid-October, there were at least 940 recorded cases, and four deaths.
As of May 2011, over 17,000 cases of measles have so far been reported from France between January 2008 and April 2011, including 2 deaths in 2010 and 6 deaths in 2011. Over 7,500 of these cases fell in the first three months of 2011, and Spain, Turkey, Macedonia, and Belgium have been among the other European countries reporting further smaller outbreaks. The French outbreak has been specifically linked to a further outbreak in Quebec in 2011, where 327 cases have been reported between January and June 1, 2011, and the European outbreaks in general have also been implicated in further small outbreaks in the USA, where 40 separate importations from the European region had been reported between January 1 and May 20.
Some experts stated that the persistence of the disease in Europe could be a stumbling block to global eradication. It has proven difficult to vaccinate a sufficient number of children in Europe to eradicate the disease, because of opposition on philosophical or religious grounds, or fears of side-effects, or because some minority groups are hard to reach, or simply because parents forget to have their children vaccinated. Vaccination is not mandatory in some countries in Europe, in contrast to the United States and many Latin American countries, where children must be vaccinated before they enter school.
In March 2013, an epidemic was declared in Swansea, Wales, UK with 1,219 cases and 88 hospitalizations to date. A 25-year-old male had measles at the time of death and died from giant cell pneumonia caused by the disease. There have been growing concerns that the epidemic could spread to London and infect many more people due to poor MMR uptake, prompting the Department of Health to set up a mass vaccination campaign targeted at one million school children throughout England.
In late 2013, it was reported in the Philippines that 6,497 measles cases occurred which resulted in 23 deaths.
In 2014 many unvaccinated US citizens visiting the Philippines, and other countries, contracted measles, resulting in 288 cases being recorded in the United States in the first five months of 2014, a twenty year high.
Indigenous measles was declared to have been eliminated in North, Central, and South America; the last endemic case in the region was reported on November 12, 2002, with only northern Argentina and rural Canada, particularly in Ontario, Quebec, and Alberta, having minor endemic status. Outbreaks are still occurring, however, following importations of measles viruses from other world regions. In June 2006, an outbreak in Boston resulted after a resident became infected in India.
Between January 1 and April 25, 2008, a total of 64 confirmed measles cases were preliminarily reported in the United States to the CDC, the most reported by this date for any year since 2001. Of the 64 cases, 54 were associated with importation of measles from other countries into the United States, and 63 of the 64 patients were unvaccinated or had unknown or undocumented vaccination status. By July 9, 2008, a total of 127 cases were reported in 15 states (including 22 in Arizona), making it the largest U.S. outbreak since 1997 (when 138 cases were reported). Most of the cases were acquired outside of the United States and afflicted individuals who had not been vaccinated. By July 30, 2008, the number of cases had grown to 131. Of these, about half involved children whose parents rejected vaccination. The 131 cases occurred in seven different outbreaks. There were no deaths, and 15 hospitalizations. Eleven of the cases had received at least one dose of measles vaccine. Children who were unvaccinated or whose vaccination status was unknown accounted for 122 cases. Some of these were under the age when vaccination is recommended, but in 63 cases, the vaccinations had been refused for religious or philosophical reasons.
In March 2014, there was an outbreak in British Columbia's Fraser Valley.
- Chen, SSP; Fennelly, G; Burnett, M; Domachowske, J; Dyne, PL; Elston, DM; DeVore, HK; Krilov, LR; Krusinski, P; Patterson, JW; Sawtelle, S; Taylor, GA; Wells, MJ; Wilkes, G; Windle, ML; Young, GM (31 January 2014). "Measles". In Steele, RW. Medscape Reference. WebMD. Retrieved 23 March 2014.
- Caserta, MT, ed. (September 2013). "Measles". Merck Manual Professional. Merck Sharp & Dohme Corp. Retrieved 23 March 2014.
- Longo, D; Fauci, A; Kasper, D; Hauser, S; Jameson, J; Loscalzo, J (2011). Harrison's Principles of Internal Medicine (18 ed.). New York: McGraw-Hill Professional. ISBN 978-0-07174889-6.
- Risk of infection East and Southwest Asia (Report). Occucare International. May 16, 2012. p. 6. http://occucareinternational.com/blog/wp-content/uploads/2012/05/East-and-southeast-asia.pdf.
- Broy C, Williamson N, Morris J (2009). "A RE-emerging Infection?". Southern Medical Journal 102 (3): 299–300. doi:10.1097/SMJ.0b013e318188b2ca. PMID 19204645.
- Baxby D (1997). "Classic Paper: Henry Koplik. The diagnosis of the invasion of measles from a study of the exanthema as it appears on the buccal membrane". Reviews in Medical Virology 7 (2): 71–4. doi:10.1002/(SICI)1099-1654(199707)7:2<71::AID-RMV185>3.0.CO;2-S. PMID 10398471.
- NHS UK: Symptoms of measles. Last reviewed: 26/01/2010.
- Yasunaga H, Shi Y, Takeuchi M, Horiguchi H, Hashimoto H, Matsuda S, Ohe K (2010). "Measles-related hospitalizations and complications in Japan, 2007-2008". Internal Medicine (Tokyo, Japan) 49 (18): 1965–1970. doi:10.2169/internalmedicine.49.3843. PMID 20847499.
- Gardiner, W. T. (2007). "Otitis Media in Measles". The Journal of Laryngology & Otology 39 (11): 614. doi:10.1017/S0022215100026712.
- Anlar B (2013). "Subacute sclerosing panencephalitis and chronic viral encephalitis". Handbook of Clinical Neurology 112: 1183–1189. doi:10.1016/B978-0-444-52910-7.00039-8. PMID 23622327.
- Foster A, Sommer A (1987). "Corneal ulceration, measles, and childhood blindness in Tanzania". The British Journal of Ophthalmology 71 (5): 331–343. doi:10.1136/bjo.71.5.331. PMC 1041162. PMID 3580349.
- Sabella C (2010). "Measles: Not just a childhood rash". Cleveland Clinic Journal of Medicine 77 (3): 207–213. doi:10.3949/ccjm.77a.09123. PMID 20200172.
- Ellison, J.B (1931). "Pneumonia in Measles". 1931 Archives of Disease in Childhood 6 (31). pp. 37–52. PMC 1975146.
- Perry RT, Halsey NA (May 1, 2004). "The Clinical Significance of Measles: A Review". The Journal of Infectious Diseases 189 (S1): S4–16. doi:10.1086/377712. PMID 15106083.
- Sension MG, Quinn TC, Markowitz LE, Linnan MJ, Jones TS, Francis HL, Nzilambi N, Duma MN, Ryder RW (1988). "Measles in hospitalized African children with human immunodeficiency virus". American Journal of Diseases of Children (1960) 142 (12): 1271–2. doi:10.1001/archpedi.1988.02150120025021. PMID 3195521.
- Enders JF, Peebles TC (1954). "Propagation in tissue culture of cytopathogenic agents from patients with measles". Proceedings of the Society for Experimental Biology and Medicine. Society for Experimental Biology and Medicine (New York, N.Y.) 86 (2): 277–86. PMID 13177653.
- Gowda VK, Sukanya V (2012). "Acquired Immunodeficiency Syndrome with Subacute Sclerosing Panencephalitis". Pediatric Neurology 47 (5): 379–381. doi:10.1016/j.pediatrneurol.2012.06.020. PMID 23044024.
- Breitfeld V, Hashida Y, Sherman FE, Odagiri K, Yunis EJ (1973). "Fatal measles infection in children with leukemia". Laboratory Investigation; A Journal of Technical Methods and Pathology 28 (3): 279–291. PMID 4348408.
- Chen S.S.P. (October 3, 2011). Measles (Report). Medscape. http://emedicine.medscape.com/article/966220-overview.
- Polonsky JA, Ronsse A, Ciglenecki I, Rull M, Porten K (2013). "High levels of mortality, malnutrition, and measles, among recently-displaced Somali refugees in Dagahaley camp, Dadaab refugee camp complex, Kenya, 2011". Conflict and Health 7 (1): 1. doi:10.1186/1752-1505-7-1. PMC 3607918. PMID 23339463.
- Kanda E, Yamaguchi K, Hanaoka M, Matsui H, Sago H, Kubo T (2013). "Low titers of measles antibodies in Japanese pregnant women: A single-center study". The Journal of Obstetrics and Gynaecology Research 39 (2): 500–503. doi:10.1111/j.1447-0756.2012.01997.x. PMID 22925573.
- "Vitamin A".
- Total Health (May 5, 2010). "Actual Confirmed Measles Cases in UK". totalhealth. Retrieved May 4, 2013.
- Helfand RF, Heath JL, Anderson LJ, Maes EF, Guris D, Bellini WJ (1997). "Diagnosis of measles with an IgM capture EIA: The optimal timing of specimen collection after rash onset". The Journal of Infectious Diseases 175 (1): 195–199. doi:10.1093/infdis/175.1.195. PMID 8985220.
- Njayou M, Balla A, Kapo E (1991). "Comparison of four techniques of measles diagnosis: Virus isolation, immunofluorescence, immunoperoxidase & ELISA". The Indian Journal of Medical Research 93: 340–344. PMID 1797639.
- Friedman M, Hadari I, Goldstein V, Sarov I (1983). "Virus-specific secretory IgA antibodies as a means of rapid diagnosis of measles and mumps infection". Israel Journal of Medical Sciences 19 (10): 881–884. PMID 6662670.
- Galindo BM, Concepción D, Galindo MA, Pérez A, Saiz J (2012). "Vaccine-related adverse events in Cuban children, 1999–2008". MEDICC Review 14 (1): 38–43. PMID 22334111.
- Helfand RF, Witte D, Fowlkes A, Garcia P, Yang C, Fudzulani R, Walls L, Bae S, Strebel P, Broadhead R, Bellini WJ, Cutts F (2008). "Evaluation of the immune response to a 2-dose measles vaccination schedule administered at 6 and 9 months of age to HIV-infected and HIV-uninfected children in Malawi". The Journal of Infectious Diseases 198 (10): 1457–65. doi:10.1086/592756. PMID 18828743.
- Ołdakowska A, Marczyńska M (2008). "Measles vaccination in HIV infected children". Medycyna Wieku Rozwojowego 12 (2 Pt 2): 675–680. PMID 19418943.
- UNICEF Joint Press Release
- "Measles kills more than 500 children so far in 2005". IRIN. 2005-03-21. Retrieved 2007-08-13.
- Wakefield AJ, Murch SH, Anthony A, Linnell J, Casson DM, Malik M, Berelowitz M, Dhillon AP, Thomson MA, Harvey P, Valentine A, Davies SE, Walker-Smith JA (1998). "Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children". Lancet 351 (9103): 637–41. doi:10.1016/S0140-6736(97)11096-0. PMID 9500320. (Retracted, see PMID 20137807)
- Deer B (2004-02-22). "Revealed: MMR research scandal". The Sunday Times (London).
Deer B (2007). "The Lancet scandal". BrianDeer.com.
Deer B (2007). "The Wakefield factor". BrianDeer.com.
Berger A (2004). "Dispatches. MMR: What They Didn't Tell You". BMJ 329 (7477): 1293. doi:10.1136/bmj.329.7477.1293.
Deer B (2009-02-08). "MMR doctor Andrew Wakefield fixed data on autism". Sunday Times (London).[dead link]
- Nick Triggle (24 May 2010). "MMR doctor struck off register". BBC Online. Retrieved 24 May 2010.
- "MMR row doctor Andrew Wakefield struck off register". The Guardian. 24 May 2010. Retrieved 2 May 2012.
- "MMR doctor wins High Court appeal". BBC Online. 7 March 2012. Retrieved 1 May 2012.
- Godlee F, Smith J, Marcovitch H (2011). "Wakefield's article linking MMR vaccine and autism was fraudulent". BMJ (Clinical Research Ed.) 342: c7452. doi:10.1136/bmj.c7452. PMID 21209060.
- Rutter M (2005). "Incidence of autism spectrum disorders: changes over time and their meaning". Acta Paediatrica (Oslo, Norway : 1992) 94 (1): 2–15. doi:10.1111/j.1651-2227.2005.tb01779.x. PMID 15858952.
- Torjesen I (2008-04-17). "Disease: a warning from history". The Health Service Journal: 22–4. PMID 18533314.
- Parker AA, Staggs W, Dayan GH, Ortega-Sánchez IR, Rota PA, Lowe L, Boardman P, Teclaw R, Graves C, LeBaron CW (2006). "Implications of a 2005 measles outbreak in Indiana for sustained elimination of measles in the United States". The New England Journal of Medicine 355 (5): 447–55. doi:10.1056/NEJMoa060775. PMID 16885548.
- Sugerman DE, Barskey AE, Delea MG, Ortega-Sanchez IR, Bi D, Ralston KJ, Rota PA, Waters-Montijo K, Lebaron CW (2010). "Measles outbreak in a highly vaccinated population, San Diego, 2008: role of the intentionally undervaccinated". Pediatrics 125 (4): 747–755. doi:10.1542/peds.2009-1653. PMID 20308208.
- Jaslow, Ryan (12 September 2013). "CDC: Vaccine "philosophical differences" driving up U.S. measles rates". CBS News. Retrieved 19 September 2013.
- "National, State, and Local Area Vaccination Coverage Among Children Aged 19–35 Months—United States, 2012". MMWR. Morbidity and Mortality Weekly Report (U.S. Department of Health and Human Services) 62 (36): 741–743. 13 September 2013. PMID 24025755.
- "Complications of Measles". Centers for Disease Control and Prevnetion (CDC).
- Starko KM, Ray CG, Dominguez LB, Stromberg WL, Woodall DF (6 Dec 1980). "Reye's Syndrome and Salicylate Use". Pediatrics 66 (6): 859–64. PMID 7454476. Retrieved 2011-03-17. "It is postulated that salicylate [taken by school-age children], operating in a dose-dependent manner, possibly potentiated by fever, represents a primary causative agent of Reye's syndrome."
- Casteels-Van Daele M, Van Geet C, Wouters C, Eggermont E (April 2000). "Reye syndrome revisited: a descriptive term covering a group of heterogeneous disorders". European Journal of Pediatrics 159 (9): 641–8. doi:10.1007/PL00008399. PMID 11014461. Retrieved 2011-03-17. "Reye syndrome is a non-specific descriptive term covering a group of heterogeneous disorders. Moreover, not only the use of acetylsalicylic acid but also of antiemetics is statistically significant in Reye syndrome cases. Both facts weaken the validity of the epidemiological surveys suggesting a link with acetylsalicylic acid."
- Schrör K (2007). "Aspirin and Reye Syndrome: A Review of the Evidence". Paediatric Drugs 9 (3): 195–204. doi:10.2165/00148581-200709030-00008. PMID 17523700. Retrieved 2011-03-17. "The suggestion of a defined cause-effect relationship between aspirin intake and Reye syndrome in children is not supported by sufficient facts. Clearly, no drug treatment is without side effects. Thus, a balanced view of whether treatment with a certain drug is justified in terms of the benefit/risk ratio is always necessary. Aspirin is no exception."
- Macdonald S (2002). "Aspirin use to be banned in under 16 year olds". BMJ (Clinical Research Ed.) 325 (7371): 988. doi:10.1136/bmj.325.7371.988/c. PMC 1169585. PMID 12411346. "Professor Alasdair Breckenridge, said, "There are plenty of analgesic products containing paracetamol and ibuprofen for this age group not associated with Reye's syndrome. There is simply no need to expose those under 16 to the risk—however small.""
- "Aspirin and Reye's Syndrome". MHRA. October 2003. Retrieved 2011-03-17.
- "Surgeon General's advisory on the use of salicylates and Reye syndrome". MMWR. Morbidity and Mortality Weekly Report 31 (22): 289–90. June 1982. PMID 6810083.
- Reye's Syndrome at NINDS "Epidemiologic evidence indicates that aspirin (salicylate) is the major preventable risk factor for Reye's syndrome. The mechanism by which aspirin and other salicylates trigger Reye's syndrome is not completely understood."
- Huiming Y, Chaomin W, Meng M (2005). "Vitamin A for treating measles in children". In Yang, Huiming. The Cochrane Database of Systematic Reviews (4): CD001479. doi:10.1002/14651858.CD001479.pub3. PMID 16235283.
- D'Souza RM, D'Souza R (2002). "Vitamin A for treating measles in children". The Cochrane Database of Systematic Reviews (1): CD001479. doi:10.1002/14651858.CD001479. PMID 11869601.
- D'Souza RM, D'Souza R (April 2002). "Vitamin A for preventing secondary infections in children with measles—a systematic review". Journal of Tropical Pediatrics 48 (2): 72–7. doi:10.1093/tropej/48.2.72. PMID 12022432.
- White LK, Yoon JJ, Lee JK, Sun A, Du Y, Fu H, Snyder JP, Plemper RK (2007). "Nonnucleoside Inhibitor of Measles Virus RNA-Dependent RNA Polymerase Complex Activity". Antimicrobial Agents and Chemotherapy 51 (7): 2293–303. doi:10.1128/AAC.00289-07. PMC 1913224. PMID 17470652.
- Krumm SA, Yan D, Hovingh ES, Evers TJ, Enkirch T, Reddy GP, Sun A, Saindane MT, Arrendale RF, Painter G, Liotta DC, Natchus MG, von Messling V, Plemper RK (2014). "An Orally Available, Small-Molecule Polymerase Inhibitor Shows Efficacy Against a Lethal Morbillivirus Infection in a Large Animal Model". Science Translational Medicine 6 (232): 232ra52. doi:10.1126/scitranslmed.3008517. PMID 24739760.
- Will an anti-viral drug put paid to measles? New Scientist 16 April 2014
-  "Sub acute sclerosing panencephalitis"
-  "NINDS Subacute Sclerosing Panencephalitis Information Page"
-  at Merck Manual of Diagnosis and Therapy Professional Edition
- Bartlett, M.S. (1957). "Measles periodicity and community size". J. Roy. Stat. Soc. Ser. A (120): 48–70.
- Black FL (1966). "Measles endemicity in insular populations; critical community size and its evolutionary implications". Journal of Theoretical Biology 11 (2): 207–11. doi:10.1016/0022-5193(66)90161-5. PMID 5965486.
- Lozano R, Naghavi M, Foreman K, Lim S, Shibuya K, Aboyans V, Abraham J, Adair T, Aggarwal R, Ahn SY, et al. (Dec 15, 2012). "Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010". Lancet 380 (9859): 2095–128. doi:10.1016/S0140-6736(12)61728-0. PMID 23245604.
- Measles, World Health Organization Fact sheet N°286. Retrieved June 28, 2012. Updated February 2014
- "Millennium Development Goals". United Nations. Retrieved 18 March 2013.
- WHO: Global summary on measles, 2006
- [http://www.who.int/immunization/monitoring_surveillance/burden/vpd/surveillance_type/active/measles_monthlydata/en/ Measles Surveillance Data after WHO, last updated 2014-3-6
- Measles reported cases by WHO in 2014
- Số người chết và mắc bệnh theo quốc gia, last update 2014-4-7 by WHO
- WHO Weekly Epidemiology Record, 4th December 2009 WHO.int
- McNeil, G.C. (January 12, 2009). "Eradication Goal for Measles Is Unlikely, Report Says". New York Times. Retrieved May 3, 2013.
- "Sixty-third World Health Assembly Agenda provisional agenda item 11.15 Global eradication of measles". Retrieved 2 June 2010.
- "Sixty-third World Health Assembly notes from day four". Retrieved 2 June 2010.
- Colombia, libre de sarampión y rubéola - Noticias de Salud, Educación, Turismo, Ciencia, Ecología y Vida de hoy - ELTIEMPO.COM
- Colombia fue declarada libre de sarampión y rubéol | ELESPECTADOR.COM
- "Vietnam minister calls for calm in face of 8,500 measles cases, 114 fatalities | Health | Thanh Nien Daily". Thanhniennews.com. Retrieved 2014-04-19.
- Plague in the Ancient World
- "Past pandemics that ravaged Europe", BBC News, November 7, 2005
- Harminder S. Dua, Ahmad Muneer Otri, Arun D. Singh (2008). "Abu Bakr Razi". British Journal of Ophthalmology (BMJ Group) 92: 1324.
- Byrne, Joseph Patrick (2008). Encyclopedia of Pestilence, Pandemics, and Plagues: A–M. ABC-CLIO. p. 413. ISBN 0-313-34102-8.
- Torrey EF and Yolken RH. 2005. Their bugs are worse than their bite. Washington Post, April 3, p. B01.
- Migration and Disease. Digital History.
- Fiji School of Medicine
- Measles hits rare Andaman tribe. BBC News. May 16, 2006.
- "Live attenuated measles vaccine". EPI Newsletter / C Expanded Program on Immunization in the Americas 2 (1): 6. 1980. PMID 12314356.
- Rima BK, Earle JA, Yeo RP, Herlihy L, Baczko K, ter Meulen V, Carabaña J, Caballero M, Celma ML, Fernandez-Muñoz R (1995). "Temporal and geographical distribution of measles virus genotypes". The Journal of General Virology 76 (5): 1173–80. doi:10.1099/0022-1317-76-5-1173. PMID 7730801.
- Offit PA (2007). Vaccinated: One Man's Quest to Defeat the World's Deadliest Diseases. Washington, DC: Smithsonian. ISBN 0-06-122796-X.
- "Measles Prevention: Recommendations of the Immunization Practices Advisory Committee (ACIP)". Centers for Disease Control and Prevention (CDC).
- Measles: Questions and Answers, Immunization Action Coalition.
- "Maurice R. Hilleman Dies; Created Vaccines". The Washington Post. April 13, 2005.
- "The Public Health Agency of Canada Travel Advisory". Retrieved 2008-05-02.
- Norrie, Justin (May 27, 2007). "Japanese measles epidemic brings campuses to standstill". The Sydney Morning Herald. Retrieved 2008-07-10.
- Stein-Zamir C, Zentner G, Abramson N, Shoob H, Aboudy Y, Shulman L, Mendelson E (February 2008). "Measles outbreaks affecting children in Jewish ultra-orthodox communities in Jerusalem". Epidemiology and Infection 136 (2): 207–14. doi:10.1017/S095026880700845X. PMC 2870804. PMID 17433131.
- Rotem, Tamar (August 11, 2007). "Current measles outbreak hit ultra-Orthodox the hardest". Haaretz. Retrieved 2008-07-10.
- Batty, David (9 January 2009). "Record number of measles cases sparks fear of epidemic". London: guardian.co.uk. Retrieved January 15, 2009.
- Eurosurveillance—View Article
- "Measles spreads to 12 provinces". Look At Vietnam. 20 February 2009.
- "Measles outbreak hits North Vietnam". Saigon Gia Phong. 4 February 2009.
- AmCham Vietnam | Public Notice: Measles immunization recommendation.
- Kupferschmidt K (27 April 2012). "Europe's Embarsssing Problem". Science 336 (6080): 406–7. doi:10.1126/science.336.6080.406. PMID 22539695.
- "Measles Outbreak In Joburg".
- "Childhood Vaccinations Peak In 2009, But Uneven Distribution Persists".
- "Measles Vaccination 'safe'".
- Chua, P.S. (March 29, 2010). "Measles can be serious". Inquirer Global Nation.
- Département des maladies infectieuses. "Epidémie de rougeole en France. Actualisation des données au 20 mai 2011". Institut de veille sanitaire.
- WHO Epidemiological Brief (Report). World Health Organization (WHO). May 2011. http://www.euro.who.int/__data/assets/pdf_file/0003/142176/WHO_EPI_Brief__May_2011e.pdf.
- Final report of the provincial outbreak of measles in 2011 (Report). Santé et Services sociaux Québec. March 21, 2012. http://www.msss.gouv.qc.ca/sujets/prob_sante/rougeole/portrait2011.php.
- "Measles: United States, January–May 20, 2011". MMWR. Morbidity and Mortality Weekly Report 60 (20): 666–8. May 2011. PMID 21617634.
- Press Association (April 30, 2013). "Measles outbreak: number of cases passes 1,000 in Swansea area". The Guardian. Retrieved May 1, 2013.
- BBC News (July 1, 2013). "Measles sufferer Gareth Colfer-Williams died from pneumonia". BBC News. Retrieved July 2, 2013.
- Legge, J. (April 28, 2013). "'Very large outbreak' of measles could hit London". The Independent. Retrieved April 28, 2013.
- Gallagher, J. (April 25, 2013). "Measles vaccination plan in England targets 1m children". BBC News. Retrieved April 28, 2013.
- Sheila Crisostomo (January 22, 2014). "DOH to vaccinate 2 M kids against measles". The Philippine Star. p. 17.
- "288 cases of measles reported in US in five months". Washington DC News.Net. Retrieved 29 May 2014.
- North York: Measles outbreak may bring new strategy, May 2008
- Smith, Stephen (2006-06-10). "Measles outbreak shows a global threat—The Boston Globe". Retrieved 2007-12-05.
- "Measles—United States, January 1 – April 25, 2008". MMWR. Morbidity and Mortality Weekly Report 57 (18): 494–8. May 2008. PMID 18463608.
- JS Online: Measles outbreak brewing, city health officials say
- "cdc.gov MeaslesUpdate". Retrieved 2008-05-02.
- Rotstein, Arthur (July 9, 2008). "Response curtailed measles outbreak". Associated Press. Retrieved 2008-07-10.
- Dunham, Will (July 9, 2008). Julie Steenhuysen and Peter Cooney, ed. "Measles outbreak hits 127 people in 15 states". Reuters. Retrieved 2008-07-10.
- "Measles outbreak mostly contained at 228 cases: Fraser Health". CBCNEWS. 24 March 2014. Retrieved 27 March 2014.
|Wikimedia Commons has media related to Measles.|
- WHO.int—'Initiative for Vaccine Research (IVR): Measles', World Health Organization (WHO)
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- Clinical pictures of measles
- Virus Pathogen Database and Analysis Resource (ViPR): Paramyxoviridae