My Skin, My Health

Measles (also called rubeola) is a childhood infection caused by a virus. Once quite common, measles can now almost always be prevented with a vaccine, measles spreads easily and can be serious and even fatal for small children. While death rates have been falling worldwide as more children receive the measles vaccine, the disease still kills more than 200,000 people a year, mostly children.

Measles vs. rubella

You may have heard rubella referred to as “German measles.” But measles and rubella are actually caused by two different viruses.

Rubella isn’t as contagious as measles. However, it can cause serious complications if a woman develops the infection while pregnant.

Even though different viruses cause measles and rubella, they’re also similar in several ways. Both viruses:

can be spread through the air from coughing and sneezing
cause fever and a distinctive rash
occur only in humans

Both measles and rubella are included in the measles-mumps-rubella (MMR) and measles-mumps-rubella-varicella (MMRV) vaccines.

Symptoms

Measles signs and symptoms appear around 10 to 14 days after exposure to the virus. Signs and symptoms of measles typically include:

Fever
Dry cough
Runny nose
Sore throat
Inflamed eyes (conjunctivitis)
Tiny white spots with bluish-white centers on a red background found inside the mouth on the inner lining of the cheek — also called Koplik's spots
A skin rash made up of large, flat blotches that often flow into one another

The infection occurs in stages over 2 to 3 weeks.

Infection and incubation

For the first 10 to 14 days after infection, the measles virus spreads in the body. There are no signs or symptoms of measles during this time.

Nonspecific signs and symptoms

Measles typically begins with a mild to moderate fever, often with a persistent cough, a runny nose, inflamed eyes (conjunctivitis) and a sore throat. This relatively mild illness may last 2 to 3 days.

Acute illness and rash

The rash is made up of small red spots, some of which are slightly raised. Spots and bumps in tight clusters give the skin a splotchy red appearance. The face breaks out first.

Over the next few days, the rash spreads down the arms, chest and back, then over the thighs, lower legs and feet. At the same time, the fever rises sharply, often as high as 104 to 105.8 F (40 to 41 C).

Recovery

The measles rash may last about seven days. The rash gradually fades first from the face and last from the thighs and feet. As other symptoms of the illness go away, the cough and darkening or peeling of the skin where the rash was may stay for about 10 days.

When can a person spread the measles virus?

A person with measles can spread the virus to others for about eight days, starting four days before the rash appears and ending when the rash has been present for four days.

Causes

Measles isn’t just a little rash. Measles can be dangerous, especially for babies and young children. Measles typically begins with

high fever (may spike to more than 104°),
cough,
runny nose (coryza), and
red, watery eyes (conjunctivitis).

Measles is a highly contagious illness. This means it's very easily spread to others. Measles is caused by a virus found in the nose and throat of an infected child or adult. When someone with measles coughs, sneezes or talks, infectious droplets spray into the air, where other people can breathe them in. The infectious droplets can hang in the air for about an hour.

The infectious droplets may also land on a surface, where they can live and spread for several hours. You can get the measles virus by putting your fingers in your mouth or nose or rubbing your eyes after touching the infected surface. About 90% of people who haven't had measles or been vaccinated against measles will become infected when exposed to someone with the measles virus.

Risk factors

Risk factors for measles include:

Being unvaccinated

If you haven't had the measles vaccine, you're much more likely to get measles.

Traveling internationally

If you travel to countries where measles is more common, you're at higher risk of catching measles.

Having a vitamin A deficiency

If you don't have enough vitamin A in your diet, you're more likely to have more-severe symptoms and complications of measles.

People at high risk for complications

People at high risk for severe illness and complications from measles include:

Infants and children aged <5 years
Adults aged >20 years
Pregnant women
People with compromised immune systems, such as from leukemia and HIV infection

Complications

Complications of measles may include:

Diarrhea and vomiting

Diarrhea and vomiting can result in losing too much water from the body (dehydration).

Ear infection

One of the most common complications of measles is a bacterial ear infection.

Bronchitis, laryngitis or croup

Measles may lead to irritation and swelling (inflammation) of the airways (croup). It can also lead to inflammation of the inner walls that line the main air passageways of the lungs (bronchitis). Measles can also cause inflammation of the voice box (laryngitis).

Pneumonia

Measles can commonly cause an infection in the lungs (pneumonia). People with weakened immune systems can develop an especially dangerous type of pneumonia that sometimes can lead to death.

Encephalitis

About 1 in 1,000 people with measles can develop a complication called encephalitis. Encephalitis is irritation and swelling (inflammation) of the brain. The condition can be especially dangerous for people with weakened immune systems. Encephalitis may occur right after measles, or it might not occur until months later. Encephalitis can cause permanent brain damage.

Pregnancy problems

If you're pregnant, you need to take special care to avoid measles because the disease can cause premature birth, low birth weight and fetal death.

Prevention

Measles vaccine in children

The measles vaccine is usually given as a combined measles-mumps-rubella (MMR) vaccine. This vaccine may also include the chickenpox (varicella) vaccine — MMRV vaccine. Health care providers recommend that children receive the MMR vaccine between 12 and 15 months of age, and again between 4 and 6 years of age — before entering school.

The MMR vaccine's two doses are 97% effective in preventing measles and protecting against it for life. In the small number of people who get measles after being vaccinated, the symptoms are generally mild.

Keep in mind:

If you'll be traveling internationally outside the U.S. when your child is 6 to 11 months old, talk with your child's health care provider about getting the measles vaccine earlier.
If your child or teenager didn't get the two doses of the vaccine at the recommended times, your child may need two doses of the vaccine four weeks apart.

Babies born to women who have received the vaccine or who are already immune because they had measles are usually protected from measles for about 6 months after birth. If a child requires protection from measles before 12 months of age — for example, for foreign travel — the vaccine can be given as early as 6 months of age. But children who are vaccinated early still need to be vaccinated at the recommended ages later.

Providing a child with the MMR vaccine as a combination of recommended vaccines can prevent a child's delay in protection against infection from measles, mumps and rubella — and with fewer shots. The combination vaccine is as safe and effective as the vaccines given separately. Side effects are generally mild and may include a sore arm where the shot was given and fever.

How is measles diagnosed?

Your healthcare provider will probably be able to diagnose measles by examining you. However, they may order laboratory tests to find the virus in samples of:

Blood.
Secretions from your nose and throat.
Urine (pee).

Preventing measles during an outbreak or known infection

If someone in your household has measles, take these precautions to protect family and friends without immunity:

Isolate
People who aren't vaccinated siblings, for example you should also stay away from the infected person.

Because measles is highly contagious from about four days before to four days after the rash appears, people with measles should stay home and not return to activities where they interact with other people during this period.

Vaccinate

Be sure that anyone who's at risk of getting measles who hasn't been fully vaccinated receives the measles vaccine as soon as possible. This includes infants older than 6 months and anyone born in 1957 or later who doesn't have proof of immunity.

Preventing new infections

Getting vaccinated with the measles vaccine is important for:

Promoting and preserving widespread immunity. Since the introduction of the measles vaccine, measles has virtually been eliminated in the U.S., even though not everyone has been vaccinated. This effect is called herd immunity.
But herd immunity may now be weakening a bit, likely due to a drop in vaccination rates. The incidence of measles in the U.S. recently increased significantly.
Preventing a resurgence of measles. Steady vaccination rates are important because soon after vaccination rates decline, measles begins to come back.
Here's one example. In 1998, a now-discredited study was published incorrectly linking autism to the measles-mumps-rubella (MMR) vaccine. In the United Kingdom, where the study originated, the rate of vaccination dropped to an all-time low of about 80% of all children in 2003 to 2004. In 2008, there were nearly 1,400 lab-confirmed cases of measles in England and Wales.

How to avoid spreading or catching measles

Measles is spread when an infected person coughs or sneezes. There are things you can do to reduce the risk of spreading or catching it.

wash your hands often with soap and warm water
use tissues when you cough or sneeze
throw used tissues in the bin

Don’t

do not share cutlery, cups, towels, clothes, or bedding

Treatment

There is no specific antiviral therapy for measles. Medical care is supportive and to help relieve symptoms and address complications such as bacterial infections.

Severe measles cases among children, such as those who are hospitalized, should be treated with vitamin A. Vitamin A should be administered immediately on diagnosis and repeated the next day. The recommended age-specific daily doses are