Measles

What is measles?

Measles is a highly communicable viral disease caused by the measles virus. The disease can lead to serious illness and occurs worldwide. In Singapore, while cases have decreased significantly since measles vaccination for children was mandated in 1985, it is not uncommon to experience sporadic cases and small clusters particularly when there is an increase in cases regionally or globally given Singapore’s position as a major travel hub and the high transmissibility of the disease among non-immune individuals.

How is measles transmitted?

Measles is primarily transmitted through inhalation of infectious respiratory particles when an infected person coughs or sneezes. It can also be transmitted via contact with contaminated surfaces such as when a person touches these contaminated surfaces and then touches their eyes, nose or mouth.

The incubation period is typically 8 to 14 days, ranging from 7 to 21 days.

What are the symptoms of measles?

Common symptoms include:

• Fever

• Rash, which typically start on the face before spreading to the rest of the body

• Cough

• Coryza (Runny nose)

• Conjunctivitis (Red and/or watery eyes)

Measles infection can lead to complications, including ear infections and severe diarrhoea.

More severe complications can include pneumonia (lung infection), encephalitis (inflammation of the brain) and death. In unvaccinated pregnant women, measles infection may cause premature birth or low birth weight in the infant.

What are the risk factors?

Risk factors include:

• Persons who are partially vaccinated or unvaccinated against measles

• Persons with weakened immune systems

• Persons travelling or living in areas with ongoing transmission or outbreaks

How is measles treated?

There is no specific antiviral therapy for measles. Treatment focuses on managing and relieving the symptoms of the disease. Antibiotics may be given to treat secondary bacterial infections as assessed by managing clinician. Vitamin A supplementation may be used to prevent eye damage and blindness in those with risk factors for Vitamin A deficiency, which would be rare in Singapore. Those with complications require hospitalisation and appropriate management of the complications.

How to prevent measles?

Vaccination is the most effective preventive measure for measles. The measles vaccination is compulsory for children in Singapore under the Infectious Diseases Act (IDA). Please refer to the National Childhood Immunisation Schedule (NCIS) and National Adult Immunisation Schedule (NAIS) for vaccine recommendation on measles.

Given the increase in measles cases globally, travellers are advised to be fully vaccinated against measles before travel. If uncertain about immunity status, seek medical assessment at least 4 to 6 weeks before travel to confirm measles immunity, or receive the measles, mumps and rubella (MMR) vaccine. For infants 6–11 months old who are travelling, they are advised to receive 1 dose of MMR vaccine at least 2 weeks before their travel to reduce the risk of infection during the trip.

Even if an infant has had 1 dose of MMR vaccine before 12 months, they should still follow the recommendations in NCIS and receive 2 additional doses at 12 months (first dose, at least 4 weeks from the additional dose received before 12 months) and 15 months (second dose) for long term protection.

Other preventive measures:

• Practise good personal hygiene at all times.

• Wash your hands regularly with soap, especially before handling food or eating, after going to the toilet, or when hands are dirty from coughing or sneezing.

• Avoid touching your face, including eyes, nose and mouth with unwashed hands.

• Avoid sharing of food/drinks or eating utensils.

• Avoid sharing personal items like pillows or towels.

• Wear a mask and seeking medical attention promptly when unwell, inform the doctor of any recent travel history.

Please refer to Health advice for travellers for additional precautions to take when travelling.