Commentary: Pediatric infectious disease specialist on the reemergence of measles

In the winter of 1943 at 8 years of age, I developed measles. I recall very little of the episode other than that my bed was moved downstairs into the living room to facilitate my care. According to family lore, I developed pneumonia as a complication and was very sick at home. We lived in a rural area where the local hospital certainly had no pediatric facility, nor would they have wanted such a highly contagious patient in an inpatient ward. My report card shows that I missed 27 days (almost a month and a half) of school as the result of my illness. My mother says I lost a lot of weight and that, at one time, she despaired over my condition.

Measles is a highly contagious infection that used to infect virtually every child. Measles virus is transmitted via respiratory droplets. Once infected, the child is asymptomatic during an incubation period of roughly 6-14 days. Then the “three C’s” develop: cough, coryza (runny nose) and conjunctivitis. The cough worsens, the conjunctivitis becomes sufficiently severe that there is extreme light sensitivity, and fever develops. Doctors also may note an “enanthem” (interior rash) that appears on the inside of the cheek, opposite the molars in the form of bluish white dots and known as Koplik’s spots. They are fleeting, however, often missed and of no particular consequence other than confirming the diagnosis.

After 2-4 days of these so-called prodrome symptoms, the rash appears. First as bright red dots, it initially appears at the hairline and spreads down over the face and body, lingering and intensifying for a few days before ultimately clearing, beginning with the upper body and finally running out the toes. A child with measles is just plain miserable — fever, cough, runny nose, headache, red eyes, no appetite. Finally, once the rash has cleared, a “branny desquamation” in the form of sloughing of tiny flakes of dead skin signals the end of the infection. Immunity to reinfection is almost always lifelong.

As a pediatric infectious disease specialist during my career, I used to see many such children. Knowing that I was — and am — immune for life, I could confidently enter the patient’s room and often smell the classic odor of measles. I would see these children (and in later years, adults) for one of two reasons. First, to confirm the diagnosis, especially more recently when most physicians had never seen a case. Second, because they had developed a complication. Complications, to be sure, are not common, but they are severe and when every child in school used to get infected, they might take a significant toll.

Measles now is rare (infections in the U.S. were eradicated in 2000), but unfortunately, cases and outbreaks are becoming common again. Texas currently has more than 600 cases reported in the outbreak there. As with so many serious infections that no longer commonly afflict our children, it is well to remember why it was once so feared.

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Now retired, Lloyd C. Olson holds an MD degree from Harvard Medical School (1961) and was a board-certified pediatrician throughout his career, with sub-board certification in pediatric infectious diseases. His last position was at The Children’s Mercy Hospital in Kansas City, and chairman, Department of Pediatrics, University of Missouri-Kansas City School of Medicine. He lives in White Salmon.