{
  "abstract": "In 2019, there was a huge global increase in the incidence of measles driven by large epidemics in Madagascar, Ukraine, Brazil, Samoa and the Democratic Republic of the Congo. Vaccine hesitancy was a major factor in the reduced immunity in populations. The COVID-19 pandemic, of course, exacerbated the situation with a combination of the public’s suspicion of vaccines and the well-documented interruption of the routine immunisation schedules. Coverage of first measles vaccination reduced to 81%. Misinformation was a major culprit. Thus, reduced immunisation rates and increased measles cases are major challenges to public health, families, paediatric services and children. Can you recognise measles, a once common encounter? The Archivist has a distant memory of the angry, irritable child with maculopapular (morbilliform), sometimes petechial, rash; coughing with a runny nose and conjunctivitis; and a high fever that made the child miserable and the family worried, searching for those Koplik’s spots before the key features appeared to make an early diagnosis. It is not a simple viral infection and has some serious complications. Do LAH and Mulholland K (N Engl J Med 2025;393(24):2447–2458. DOI: 10.1056/NEJMra2504516) have published a really useful review of the infection and discussed this current epidemiological disaster. It is good revision. The first section is on clinical presentations and complications, reminding us of the classic measles syndrome, atypical measles syndrome (inactivated vaccine related) and modified measles syndrome. There is an interesting section on measles in special populations such as immunocompromised children. The next section is on current recommendations focusing on the global, paediatric measles vaccination policy, postexposure prophylaxis and, most importantly, the current management of measles. The final section summarises the current epidemiological background and examines immunity gaps in young infants and early measles vaccination as well as immunity gaps in adults and booster doses. The supplements are also worth reading, with more details on measles vaccine history, pathogenesis, diagnostic issues and genotype monitoring. The section on complications is informative and useful when discussing vaccination with families. It is helpful to remember that in resource-rich countries, the incidence of pneumonia is 1–6 per 100 cases; death occurs in 1–3 per 1000 cases; acute postinfectious encephalitis and measles inclusion-body encephalitis occur in 1 per 1000 cases; and, finally, subacute sclerosing panencephalitis occurs in 1–7 per 100 000 cases. The discussion about vitamin A deficiency and associated increased risk of infection, corneal ulceration and blindness is valuable. The post-measles pneumonia has been shown to be largely due to Streptococcus pneumoniae, and a booster dose of pneumococcal conjugate vaccine for patients recovering from measles may possibly prevent death. Of course, pneumonitis and giant-cell pneumonia are rare but severe and potentially fatal complications of measles. So, the challenge is there. Make sure you can recognise it and use this information when assessing miserable, feverish, virally infected, spotty, coughing children; discussing vaccination with families; and recognising and managing the complications of measles.",
  "authors": [
    {
      "affiliations": [],
      "name": "BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health"
    }
  ],
  "title": "Measles crisis, vaccination, recognition and management",
  "uid": "c10a32f3-9d09-5855-b75a-f6715e01e4cb"
}