Linda Crampton is a writer and former teacher with a first-class honors degree in biology. She writes about the scientific basis of disease.
Measles and Rubella: Two Viral Infections
Measles and rubella are characterized by a rash containing small bumps that spreads over the body. Patients often develop additional symptoms. Both diseases are caused by a virus and both are more common in children than in adults. Measles is often the more serious of the two illnesses.
While many people recover from measles with no problems, some develop complications. Rubella (or German measles) is generally a milder disease that causes no complications. One exception occurs when a pregnant woman develops the illness. The rubella virus can cross the placenta and enter the baby's bloodstream, causing a serious condition known as congenital rubella syndrome.
Unfortunately, measles has been in the news for several years. Due to an inadequate number of vaccinated people in some areas, outbreaks of the disease have appeared. This is a serious concern because of the harmful effects that measles sometimes produces.
Identity and Structure of the Viruses
Measles is produced by a virus in the genus Morbillivirus, which is part of the family Paramyxoviridae. Rubella is produced by a virus in the genus Rubivirus, which is currently classified in the family Matonaviridae. Although they belong to different families, the viruses have some features in common.
Viruses exist as individual particles called virions. The virions of the measles and rubella viruses are roughly spherical in shape. Each virion consists of genetic material surrounded by a coat of protein. This coat is known as a capsid or a nucleocapsid. The genetic material is RNA (ribonucleic acid) instead of the DNA (deoxyribonucleic acid) that is present in many other viruses and in the nucleus of our cells. We do have some RNA in our cells, however. It helps DNA do its job.
In a virion, the RNA and its capsid are surrounded by a protective barrier of lipid and protein that separates the virion from the outer world. The lipid and protein covering is more than a barrier, however. It enables a virion to attach to a cell and then send its genetic material into the cell. In the measles virus shown at the start of this article, the hemagglutinin and the fusion protein help the virion to attach to a cell membrane.
Viruses can’t reproduce by themselves. They require the equipment and services of a cell to do these jobs. The RNA of a measles or rubella virion takes control of aspects of the cell’s biology and forces it to make new virions. These are then released from the cell, often killing it as they leave. They then infect other cells.
How the Viruses Are Spread
The viruses are spread in liquid droplets released from the nose or mouth during sneezing, coughing, talking, and exhaling. They are inhaled by other people and infect their bodies, usually settling in the respiratory system. A virus can also be passed from one person to another when someone touches a surface contaminated by the virus. Researchers have found that unvaccinated people living in close proximity to a person with measles have a 90% probability of developing the disease.
The alternate names of measles and rubella can be confusing. Measles is also known as rubeola, which some people confuse with the word rubella. In addition, rubella is sometimes called German measles or the three-day measles.
Common Symptoms of Measles
When a person is infected by the measles virus, they don't become sick immediately. There is an incubation period of one or two weeks before the first symptoms appear. While the disease symptoms described below are common, the list isn't exhaustive. In addition, not everyone has all of the symptoms in the list. Another point to note is that individual symptoms listed below may occur in other diseases besides measles.
- The first symptoms of measles generally resemble those of the flu. The infected person often coughs, sneezes, and has a runny nose.
- The person's eyes may become red and may be sensitive to light.
- The person usually develops a fever. They may also lose their appetite and feel very tired.
- Young children may experience diarrhea and vomiting.
- About two days after the first symptoms arise, patches called Koplik spots (or Koplik's spots) may appear on the inside of the cheeks. The red spots often have a blue-white center. They exist for only a short time and may be missed by an observer.
- Approximately two days after the Koplik spots appear, a red rash may develop on the skin. The rash usually starts on the forehead or beside the ears. It then spreads over the face, travels downwards over the trunk and arms, and finally spreads over the lower body.
- The rash may or may not be itchy.
- A measles rash lasts for about five or six days and then disappears.
Patients are generally infectious for about four days before the first appearance of the rash and for about four days after the rash appears. A doctor should be consulted about the required isolation period.
Possible Treatments for the Infection
Since measles and rubella are caused by a virus instead of a bacterium, they can't be cured by antibiotics. Although the body generally has to destroy the virus by itself, a doctor must be consulted so that they can monitor the disease and provide help. Supportive treatment is generally given to make the patient feel as well as possible. Any complications that develop are treated more aggressively. The doctor will provide a diagnosis and decide on the appropriate treatment for the person and their specific problems.
Possible Complications of the Disease
Many people recover from measles with no additional problems. Some people develop new health disorders as a result of the infection, however. One of the most common complications is pneumonia. Otitis media and croup are other complications. Otitis media is an infection and inflammation of the middle ear. A person with croup has a swollen throat and produces a barking cough.
A very serious complication of measles is encephalitis, which is an inflammation of the brain. Luckily, it's a rare effect of the infection. Even rarer is a condition that may develop years after the initial infection by the measles virus. It arises due to the persistence of the virus in the body. The condition is known as SSPE (subacute sclerosing panencephalitis). In this disorder, brain and nerve tissue degenerate. Antiviral drugs can slow the progression of the disease. Unfortunately, the condition is often deadly.
Common Symptoms of Rubella
Rubella is generally a milder disease than measles and usually produces no complications. It may even be a subclinical infection (one that doesn't produce any symptoms). Rubella during pregnancy may be serious, however.
In children, the disease usually begins with a mild fever and swollen, painful lymph nodes behind the ears or in the back of the neck. These symptoms last for one or two days. They're followed by a rash that lasts for two to three days. A rubella rash is usually not as red as a measles one and often lacks the angry or fiery appearance. Like a measles rash, the redness begins on the face and spreads downwards. It generally starts to disappear on the face before it reaches the bottom of the body.
Rubella may cause other symptoms, which are most common in teenagers and adults. These symptoms include a runny or stuffy nose, red eyes, loss of appetite, and a headache. Lymph nodes may be swollen. Some people—especially women—may experience aching joints.
A person who has rubella is contagious for about ten days before the rash appears and for one to two weeks after the rash appears. Once again, a doctor's opinion should be sought with respect to the required isolation period.
Disease Complications During Pregnancy
If a woman develops rubella while she's pregnant, the baby may be born with congenital rubella syndrome. The risk is greatest in the first trimester of pregnancy, but problems can also develop in the later stages of the pregnancy.
Congenital rubella syndrome can be very severe and may cause the baby to have multiple disabilities. There may be heart, liver, bone marrow, or spleen defects. The baby may suffer from vision or hearing problems and may experience growth problems. He or she may also be mentally challenged.
MMR (Measles, Mumps, and Rubella) Vaccine
Measles and rubella can both be prevented by a vaccine. The two vaccines are often mixed with the vaccine for mumps, another disease that is common in childhood. The combined vaccine is called the MMR (measles, mumps, and rubella) vaccine. It's highly effective and has greatly reduced the incidence of measles and rubella. In developed countries these diseases are uncommon, although there have been some worrying outbreaks of measles recently which suggest that the disease may be making a comeback. Measles and rubella are common in many developing countries.
Andrew Wakefield and the MMR Vaccine
In 1998, a UK doctor named Andrew Wakefield published a report in which he linked the MMR vaccine with autism and bowel disease. This caused a dramatic drop in the number of parents getting their children vaccinated.
Investigators were unable to duplicate Wakefield's research results. His work was discredited, and he was accused of dishonesty. He was also accused of treating some children involved in his research with callousness. The Lancet, the respected medical journal that had published Wakefield's report, retracted the article. Wakefield's name was struck off the medical register and he was barred from practicing medicine in the UK. Andrew Wakefield maintains that he is innocent of any wrongdoing, however.
The video above mentions a measles outbreak that occurred in California and other states from December 2014 to February 2015. The outbreak is believed to have been started by an unvaccinated person who visited a Californian amusement park. The disease likely spread from this person to other unvaccinated people.
A Measles Outbreak in the United Kingdom
The fear of the MMR vaccine persisted in the UK for a long time after Wakefield's work was publicized. As a result, until recently a large number of children and teenagers were unvaccinated against measles, mumps, and rubella.
Health experts say that in order to prevent a measles outbreak, 90% to 95% of the population needs to be vaccinated. This produces what is known as "herd immunity". If fewer people are vaccinated, more people are likely to get sick. In some parts of the UK, the vaccination rate amongst older children and teenagers has been far below the required safety level until recently.
In 2012, a measles outbreak occurred amongst older children and teenagers in parts of the UK. It was blamed on the fact that children weren't vaccinated due to the Wakefield scare. In the past, there were only a few dozen to a few hundred cases of measles each year in England. In 2012, there were 2,030 cases. Fortunately, a catch-up vaccination program was successful and the number of measles cases gradually dropped.
Since the California and UK measles outbreaks mentioned above, more have occurred in various parts of the world. They are still appearing and are a public health concern. Prevention of measles is important due to the disease itself and to the complications that may develop.
A New York State Outbreak
In 2018-2019, a major and long-lasting measles outbreak occurred in the state of New York. On March 26th, 2019, the Rockland County authorities issued a major edict. The outbreak in the area began in October, 2018. An emergency directive announced that unvaccinated people under the age of eighteen were prohibited from public places for thirty days. A "public place" was defined as one where more than ten people congregate in close proximity and included schools, shops, restaurants, and houses of worship.
The CDC (Centers for Disease Control and Prevention) website mentioned in the "References" section below has a Measles Cases and Outbreak page. This shows recent disease statistics and news from the United States.
From January 1 to December 31, 2019, 1,282 individual cases of measles were confirmed in 31 states. Of these cases, 128 were hospitalized and 61 reported having complications, including pneumonia and encephalitis.
— Centers for Disease Control and Prevention
In an ideal world, nobody would suffer from measles or rubella. Unfortunately, the viruses for both diseases still exist. Vaccination is sometimes a controversial topic, but observations show that when the MMR vaccine is widely used in an area, the incidence of measles, mumps, and rubella decreases dramatically. Anyone who has questions about the MMR vaccine or any other type of vaccine should visit a doctor to discuss the situation.
Protection from measles and rubella is important because of the potentially serious complications of the diseases. Even if a person doesn't experience a complication, they can pass the virus to an unvaccinated person. This person may experience not only the unpleasant effects of the disease itself but also experience an annoying or even dangerous complication This is an important consideration with respect to maintaining the health of individuals and the general public.
- Measles information from the CDC
- Rubella or German measles facts from the Mayo Clinic
- MMR Vaccine facts according to the National Health Service
- Information about measles outbreaks from Global News British Columbia
- New York state outbreak 2018-2019 from The Guardian
This content is accurate and true to the best of the author’s knowledge and does not substitute for diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed health professional. Drugs, supplements, and natural remedies may have dangerous side effects. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.
© 2013 Linda Crampton
Linda Crampton (author) from British Columbia, Canada on November 07, 2013:
These are very good points, Sarah. Thanks for sharing them.
Sarah Wingate from Tel Aviv, Israel on November 07, 2013:
My experience in the health system taught me that many parents object to vaccinating their children out of so many wrong myths and misconceptions. In addition, all this back to nature trend makes people give up vaccination as they see it as "artificial medical intervention". What they fail to understand is that prior to modern medicine (when there was no medical artificial intervention of any kind) so many kids died from diseases we can so easily prevent today
Linda Crampton (author) from British Columbia, Canada on November 04, 2013:
Hi, Sarah. Yes, public education about vaccinations is important. People need to know all the facts about vaccines and their effects. Thanks for the visit.
Sarah Wingate from Tel Aviv, Israel on November 04, 2013:
I agree with what is said in the hub regarding vaccination being controversial. I think that it is our duty to explain the public about the importance of vaccination in helping diseases disappear and thus reducing the probabilty for virus mutations and the creation of more violent strains.
Linda Crampton (author) from British Columbia, Canada on May 28, 2013:
Thanks, drbj. I appreciate all your visits to my hubs!
drbj and sherry from south Florida on May 28, 2013:
Whether it is measles or rubella, this disease can cause serious complications as you pointed out, Alicia. Thanks for this comprehensive dissertation on the subject.
Linda Crampton (author) from British Columbia, Canada on May 26, 2013:
Thank you for the visit and the comment, moonlake.
moonlake from America on May 26, 2013:
I had mumps, measles, chicken pox and whooping cough as a kid. Your hub was very interesting. Voted up.
Linda Crampton (author) from British Columbia, Canada on May 25, 2013:
Thanks for the visit and the comment, Deb. I had most of the common childhood diseases, but I never had mumps.
Deb Hirt from Stillwater, OK on May 25, 2013:
I had mumps and measles as a kid, most likely caught from schoolmates. I enjoyed reading the inside story and about today's vaccines.
Susan Bailey from South Yorkshire, UK on May 25, 2013:
Linda Crampton (author) from British Columbia, Canada on May 25, 2013:
Thanks for the interesting information, Sue. I appreciate the comment, the vote and the share!
Susan Bailey from South Yorkshire, UK on May 25, 2013:
Both my children had what is known as Roseola Infantum when they were babies. At first I thought it was German measles (Rubella) until the doctor identified it as a different virus. Great hub and very informative. Voted up & shared
Linda Crampton (author) from British Columbia, Canada on May 23, 2013:
Thank you, Bill. I always appreciate your comments, especially when they appear so soon after I publish a hub! I hope you have a great Memorial Day weekend.
Bill Holland from Olympia, WA on May 23, 2013:
Very interesting, Alicia. I actually knew nothing about rubella so thanks for the education.
Have a great weekend!