Rubella and Rubeola are two distinctly different infections. Rubeola is referred to as measles.

Measles is a highly contagious disease caused by the rubeola virus.

Epidemiology

Endemic or sustained measles transmission has not occurred in the United States since the late 1990s. The minimal number of cases yearly in the United States is due to the high rate of vaccination. Occasional small outbreaks from imported cases of measles primarily infects unvaccinated individuals.

Even though the ongoing transmission of endemic (native) measles was declared to be eliminated in the United States in 2000, the disease is still common in many other countries and can be imported into the United States by foreign visitors or returning travelers who are not fully protected against the dis ease. During 2001 to 2008, a median of 56 cases of measles were reported to the Centers for Disease Control and Prevention (CDC) annually. However, during the first 19 weeks of 2011, 118 cases of measles were reported, the highest number reported for this period since 1996. Of these cases, 87% were imported from the World Health Organization (WHO) European and Southeast Asia regions; 89% of these patients were unvaccinated.

Measles are caused by a single-stranded RNA virus, the only member of the genus Morbillivirus (Paramyxoviridae family). Human beings are the only natural reservoirs of this virus, which is spread by respiratory droplets. It is highly contagious, with more than a 90% transmission rate among non-immunized individuals.

Prevention

Prevention includes measles, mumps, and rubella (MMR) vaccine administered to 12- to 15-month-old children, with revaccination between 4 and 12 years of age. A high fever and pulmonary infiltrates can occur in patients exposed to measles that were vaccinated with MMR from 1964 to 1967. Because the vaccine is a live attenuated virus, it should not be used in pregnant women or those with significant immunosuppression.

Laboratory Testing

 Laboratory confirmation of measles is made by the detection measles-specific immunoglobulin M antibodies in serum of, isolation of measles virus, or detection of measles virus RNA by nucleic acid amplification in an appropriate clinical specimen (e.g., nasopharyngeal or oropharyngeal swabs, nasal aspirates, throat washes, or urine; Table 1).

Table1. Measles (Rubeola) Antibody Testing

Serum testing for antibodies is done for the following reasons:

• Can confirm acute infection with measles using IgM and IgG serial testing

 • Can confirm seroconversion after vaccination using IgG testing

• IgM and IgG cerebrospinal fluid (CSF) testing to identify subacute sclerosing panencephalitis, which may occur years after the original infection using IgG testing

• Viral culture

• Nasopharyngeal and blood cultures—most sensitive if collected during prodrome up to 1 to 2 days after onset of rash

• Virus can be isolated from urine culture up to 1 week or more after onset of rash

• Difficult to isolate from CSF and brain tissue

The reverse transcription polymerase chain reaction (RT PCR) assay is not widely available, but is useful for testing CSF.

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