Central nervous system syndromes associated with measles infection

Elena Grebenciucova MD (Dr. Grebenciucova of the University of Chicago has no relevant financial relationships to disclose.)
Karen L Roos MD FAAN (Dr. Roos of Indiana University School of Medicine has no relevant financial relationships to disclose.)
Originally released May 26, 2015; last updated June 27, 2017; expires June 27, 2020

This article includes discussion of central nervous system syndromes associated with measles infection, primary measles encephalitis, acute post-infectious measles encephalomyelitis, measles inclusion body encephalitis, subacute sclerosing panencephalitis, and SSPE. The foregoing terms may include synonyms, similar disorders, variations in usage, and abbreviations.

Overview

Measles is caused by a single stranded negative-sense RNA virus that belongs to the Morbillivirus genus of the Paramyxoviridae family (de Vries et al 2012) and is considered to be one of the most contagious infections known. Measles is typically spread via respiratory aerosol. Even in developed countries, mortality remains close to 3 in 1000 of those infected (Poland and Jacobson 2012). Despite worldwide efforts of measles eradication and the availability of a preventive vaccine since 1960s, outbreaks remain frequent. Reemergence of measles represents a major concern for public health. In 2017, between January and May 20th, 100 cases of measles from 11 states were confirmed in the United States. In 2015, that number was 188. In 2014, the Centers for Disease Control and Prevention reported a record number of 667 cases (Centers for Disease Control and Prevention 2017). Most of these cases occurred in those unvaccinated.

Failure to vaccinate due to the myth of MMR vaccine causing autism (Gerber and Offit 2009), travel to countries where vaccination programs are lacking, waning immunity, and the lack of antibody production in 2% to 10% of the patients vaccinated are thought to be responsible for the reemergence observed in the past decade.

Key points

 

• Neurologic syndromes associated with rubella include measles inclusion body encephalitis, acute post-infectious measles encephalomyelitis, primary measles encephalitis, and subacute sclerosing panencephalitis.

 

• Neurologic sequelae of measles are severe and, depending on the syndrome, may carry a substantial risk of disability and even death.

 

• Measles vaccination is highly effective in preventing primary infection. It does not cause autism.

Historical note and terminology

Some of the first descriptions of measles infection are believed to belong to Chinese alchemist and philosopher, Kong Hu, circa 300 C.E. Several centuries later, in 910, an Iranian physician, Abu Bakr Mohammad Ibn Zakariya al-Razi, known simply as Rhazes, published a treatise on the diagnostic differentiation of measles and chickenpox.

 

When, therefore, you see these symptoms, or some of the worst of them (such as pain of the back, and the terrors of sleep, with the continued fever) then you may be assured that the eruption of one or the other of these diseases in the patient is nigh at hand; except that there is not in the measles so much pain of the back as in smallpox; nor in the smallpox so much anxiety and nausea as in measles, unless the smallpox be of a bad sort; and this shows that the measles came from a very bilious blood (Hajar 2013).

The first measles inoculation attempts in the Western world are ascribed to Francis Home, a Scottish physician, who, in 1757, demonstrated that measles was caused by an infectious agent by inoculating several groups of children with blood and nasal discharge from patients with measles (Enders 1961).

The measles virus was first cultivated in kidney cell tissue by Thomas Peebles, a World War II bomber pilot turned pediatrician, who at that time was working with Enders, one of the most renowned virologists of the 20th century who invented the technique of viral tissue cultures, culminating in the creation of the polio vaccine and subsequently many others (Enders and Peebles 1954). Peebles isolated measles from an 11-year-old boy, Davis Edmonston, and used that strain to make the very first measles vaccine. The vaccine was approved in the United States in 1963 (Baker 2011).

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