DCH Question Bank

Measles presents with the classic triad of cough, coryza, and conjunctivitis followed by a maculopapular rash. The prodrome lasts 2-4 days before the rash appears, starting behind the ears and hairline before spreading cephalocaudally to the trunk and limbs. Koplik spots - small white lesions on erythematous buccal mucosa - are pathognomonic and appear 1-2 days before the rash. Fever is typically high (>39.5°C) and peaks as the rash emerges. Measles is a notifiable disease in the UK under PHE/UKHSA guidelines. The MMR vaccine provides 95-99% protection after two doses. Complications include otitis media, pneumonia (the most common cause of measles-related death), febrile convulsions, and rarely subacute sclerosing panencephalitis (SSPE) years later. Immunocompromised children may develop giant cell pneumonia. Post-exposure prophylaxis with MMR vaccine within 72 hours or human normal immunoglobulin within 6 days may be offered to susceptible contacts. Management is supportive with paracetamol and fluids. Remember: cough, coryza, conjunctivitis plus Koplik spots equals measles - notify public health and check vaccination status of contacts.

Acute otitis media is the most common complication of measles, occurring in approximately 7-9% of cases. Measles causes immunosuppression lasting several weeks, predisposing to secondary bacterial infections. The damaged respiratory epithelium and impaired mucociliary clearance facilitate bacterial invasion of the middle ear. Common causative organisms include Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis. Treatment follows standard NICE guidelines for acute otitis media - most cases resolve spontaneously, but antibiotics (amoxicillin first-line) are indicated if symptoms worsen after 48-72 hours of observation or if the child is systemically unwell. Pneumonia is the most common cause of measles-related death but otitis media is more frequent overall. Encephalitis occurs in approximately 1 in 1000 cases, presenting 1-2 weeks after the rash with seizures and reduced consciousness. SSPE is a rare late complication occurring years after infection. Immunisation with MMR remains the most effective prevention strategy. Remember: otitis media is the commonest measles complication - pneumonia is the commonest cause of measles death; both result from measles-induced immunosuppression.

Rubella (German measles) typically presents as a mild illness with low-grade fever, a pink maculopapular rash, and characteristic posterior auricular and suboccipital lymphadenopathy. The rash starts on the face and spreads to the trunk, lasting approximately 3 days. Unlike measles, rubella causes minimal systemic upset and lacks the prodromal cough, coryza, and conjunctivitis triad. Arthralgia may occur, particularly in adolescent girls and adults. Rubella is a notifiable disease in the UK. The major concern with rubella is congenital rubella syndrome when infection occurs in pregnancy, particularly during the first trimester - causing cataracts, congenital heart defects (PDA, pulmonary stenosis), sensorineural deafness, and microcephaly. Two doses of MMR vaccine provide over 99% protection. Post-exposure management includes serological confirmation and contact tracing, with particular attention to any pregnant contacts. PHE/UKHSA should be notified promptly. There is no specific antiviral treatment; management is supportive. Remember: rubella equals mild fever plus rash plus posterior auricular lymphadenopathy - always consider pregnant contacts and notify public health.