Measles

Measles is a highly infectious, viral illness. Children are most often affected, although it can occur at any age. Although the illness is unpleasant, most people make a full recovery. However, in certain cases, serious complications can develop.

Vaccination programs have had a huge impact on reducing the number of cases of measles. 1 However, measles is still a common disease in many other countries. 2

The measles virus is contained in water droplets and most often spread through the nose or mouth of an infected person. Physical contact, coughing and sneezing are the most common causes of infection spreading.

People with measles typically experience flu-like symptoms, such as a runny nose and coughing, fever, feeling generally unwell and a gradual rash. The symptoms of measles usually get better within seven to 10 days.

There are two types of measles. Although they share some of the same symptoms, they are caused by different viruses:

1. Standard measles, sometimes known as red measles, or hard measles, is caused by the rubeola virus.
2. German measles, also known as rubella, is an entirely separate illness caused by the rubella virus and is usually a milder infection than standard measles. 3 For more information, read this resource on rubella.

Once an affected person has caught measles, the virus multiplies in the back of the throat and begins to spread gradually throughout the body.

It can take up to 10 days for an infected person to show symptoms. The most common early symptoms of measles are: 4 5 6

• Cold-like symptoms, such as a runny nose, sneezing and coughing
• A high temperature or fever
• Sore, red eyes
• Sensitivity to light
• Grey-white spots inside the cheeks, mouth and throat
• Nausea
• Tiredness
• Lack of appetite
• Aches and pains

Around three to four days after the first symptoms, a skin rash will normally begin to appear. The rash is perhaps the most noticeable symptom of measles and is recognizable by: 6 7

• Red-brown spots, either flat or slightly raised, that may join together to form blotches
• Spots usually start on the head and neck and then gradually spread downwards through the rest of the body
• The rash may turn pale when pressed at first, but will gradually fade and become non-blanching (stays red when pressed)
• Slight itching

Generally, measles rash takes two to three days to cover the body and then another few days to fade, beginning on the head and disappearing in the same order in which it appeared. As other symptoms begin earlier, affected people usually feel most unwell on the first or second day that the rash is present.

Symptoms of measles usually begin to appear on average around seven to 14 days after becoming infected. However, affected people are usually infectious four days before to four days after the measles rash appears. 4

Overall, most people with measles feel better within seven to 10 days of first experiencing symptoms. On occasion, a dry cough may persist after all other symptoms have gone. 7

During the measles infection, the immune system builds up a resistance to the virus. It is therefore highly unlikely for anyone to have measles more than once in their lifetime. 7

Measles is caused by a viral infection, and is highly contagious. It is estimated that around 90 percent of unvaccinated people close to someone who is in the contagious phase of measles will also become infected. 8

Measles is transmitted in a similar way to colds and flu, i.e. breathing in the airborne water droplets coughed or sneezed out by an infected person. Although physical contact, coughing and sneezing are the most common causes of infection spreading, it is also possible to contract measles simply by breathing in contaminated air, or touching a contaminated surface and then breathing in the droplets.

The measles virus can live for up to two hours on surfaces and in airspace. 8

Measles is very rare in countries that have a vaccination program. In recent decades, the number of measles cases in the United States has significantly declined due to the introduction of the Measles, Mumps and Rubella (MMR) vaccine. However the disease has not been completely eradicated. In 2017 there were 120 reported cases of measles in the United States according to the Centers for Disease Control and Prevention (CDC). The majority of these cases were in people who were unvaccinated. 9

Unvaccinated people are at most risk of contracting measles, in particular people with a weakened immune system. Unvaccinated pregnant women should also be especially cautious. Pregnant women with measles may develop serious complications that can result in miscarriage or premature labor. 6 See more below.

A doctor will usually look for a combination of characteristic symptoms such as a skin rash, fever and cough to diagnose measles.

However, a blood or saliva test is the only way to definitively confirm the diagnosis. 10 These tests check for Immunoglobulin M and Immunoglobulin G antibody levels, both of which may indicate the current or past presence of measles. 11

If measles is suspected, it is important to call the surgeon and tell the staff when making a doctor’s appointment. Because measles is very contagious, it is common for medical professionals to ask initial questions over the phone to help them decide how likely the diagnosis of measles is, and whether a trip to the surgery can be avoided. If an appointment with a doctor is necessary, the doctor may make special arrangements, such as a home visit, in order to reduce the risk of infecting other patients. 12

If you are worried that you or someone you know may have measles, you can start a free symptom assessment with the Ada app at any time.

There is no specific medicine used to treat measles. Because the disease is viral and not bacterial, antibiotics are not effective.

Treatment for measles instead aims to manage and ease the symptoms until the body’s natural immune system can clear the infection. Symptoms usually improve within seven to 10 days. Typical treatment recommendations include: 7 13 14

• Plenty of bed rest to help boost the immune system
• Drinking lots of fluids such as water, fruit juices and herbal teas, to prevent dehydration and help ease a sore throat; alcohol and caffeine should be avoided
• Closing curtains and dimming lights to control sensitivity to light
• A humidifier or sitting in a steamy bathroom to help ease a cough or sore throat
• Ibuprofen and paracetamol/acetaminophen may be recommended to relieve fever and aches
• Vitamin A supplements may be recommended to people suffering from measles, particularly children, in order to lessen the severity of the condition and the risk of complications 15

Please note that ingesting a high amount of vitamin A can result in a condition called hypervitaminosis A, or vitamin A toxicity. This is usually the result of a person taking high-dose dietary supplements, so always discuss vitamin A supplementation with a doctor before starting. 16

The best precaution against measles is to be vaccinated against it.

The most common vaccine is the MMR vaccine, which immunizes against measles, mumps and rubella. According to CDC, two doses of the MMR vaccine are about 97 percent effective at preventing measles, and a single dose is about 93 percent effective. 1

In countries with a vaccination program, the MMR vaccine is first administered to children around 12-15 months, with a second, booster dose when they are between four to six years old. 1 For babies travelling to countries with a high rate of measles infection, the first dose of the vaccine may be given as early as six months old. 17

Adults can request the measles vaccine from their doctors if they have never been immunized.

There is a further vaccine called MMRV, which protects against measles, mumps, rubella and varicella (chickenpox). Currently this vaccine is only licensed for use in children aged between 12 months and 12 years old. 1

The measles virus remains common in many countries in the world, particularly in parts of Africa and Asia. 2 Measles outbreaks in the United States most often occur when returning travellers spread the disease to other unvaccinated people, having contracted the illness in another country.

It is best to take precautions to reduce the risk of contracting and spreading the measles virus when travelling internationally. The most important of these is to receive the MMR vaccination prior to travelling. Children can receive their first dose at six months old when travelling internationally. Other ways to help prevent illness include: 18

• Wash hands frequently, ideally with soap and water, or alternatively hand sanitiser
• Cover the mouth and nose with a tissue, not the hands, when coughing and sneezing
• Avoid contact with people who are sick, especially close contact such as kissing, hugging and sharing cooking or eating utensils
• Do not touch the eyes, nose or mouth unless your hands are fully clean

The benefits of the MMR vaccine outweigh the risks, but side effects are possible. These commonly include: 19

• Aching, sore arm from the shot
• Short term, mild rash
• Temporary stiffness in the joints. Most commonly affects teenage and adult women
• Fever

Less common side effects include: 19

• Fits caused by fever, such as febrile seizures. These are rare and are not a sign of any long-term health problems
• A temporary low platelet count which affects the blood’s ability to clot. Again this is rare and usually goes away without treatment or any long-term issues
• Swelling of the glands in the cheeks, neck or jaw for a couple of days

In very rare cases, a person may have a serious allergic reaction after a dose of the MMR vaccine. For this reason, anyone who has had an allergic reaction to any component of the vaccine may be advised not be vaccinated. 20 If there are any concerns about the MMR vaccine and allergies, it is important to discuss these with a doctor.

Despite concerns that the MMR vaccine may cause autistic spectrum disorders, multiple studies have shown there is no link between being vaccinated and developing autism. 21

Due to how contagious the measles virus is, it is important to limit the risk of spreading the infection to others. Symptoms of measles usually begin to appear on average around seven to 14 days after first becoming infected. However, affected people are usually infectious four days before to four days after the measles rash appears. 4

For this reason, people with this condition should stay home from the moment symptoms begin to appear until four days after the rash disappears. 8

Friends, family, co-workers, classmates, carers and teachers should be notified if they may have come into contact with someone who has measles during the infectious period. This is particularly important if they are a vulnerable person.

Contact with vulnerable people such as young children, pregnant women and those with weakened immune systems should be especially limited.

In the majority of cases, people with the measles virus make a full recovery after around seven to 10 days and will experience no further complications. However serious complications which can be life-threatening do occur.

Measles complications can happen at any age, but are more likely to occur in certain groups of people, such as: 7 10

• Children younger than five years old
• Children who have a poor diet or are malnourished
• Children with a weakened immune system, such as those with leukaemia or HIV
• Adults older than 20 years of age
• Pregnant women

There are a number of common complications that may arise from measles, such as: 22 23 24

• Vomiting and diarrhoea, which can lead to dehydration
• Eye infection, conjunctivitis
• Ear infection, otitis media, which can lead to earache
• Inflammation of the voice box, laryngitis

While these symptoms can be distressing, they are not usually serious. However, affected people should see a doctor if they are concerned.

More uncommon complications from measles may include: 22 23 24

• A squint, if the measles virus affects the nerves or muscles of the eye
• Fits caused by fever, such as febrile seizures
• Inflammation of the liver, known as hepatitis
• Infection of the airways and lungs, such as pneumonia, bronchitis or croup, which can be very serious

In rare cases, measles can lead to: 25 26 27 28

• Serious eye disorders such as infection of the optic nerve, which can lead to blindness
• Infection of the membranes around the brain and spinal cord, such as viral meningitis
• Inflammation of the brain, or encephalitis, affects roughly 1-3 out of every 1,000 cases
• Central nervous system disease known as subacute sclerosing panencephalitis (SSPE) which can develop several years after contracting measles. This disease can be fatal but is extremely rare, occurring in roughly two per 100,000 cases

If any concerning symptoms develop, always contact a doctor.

Pregnant women who contract measles have an increased risk of developing serious complications which can lead to miscarriage, stillbirth or premature labor. 29

The CDC guidelines recommend that the MMR vaccine be administered to unvaccinated women no less than a month before becoming pregnant. The MMR vaccine not only protects against measles, but also against mumps and rubella. Rubella can also cause severe problems during pregnancy, including birth defects, miscarriage and stillbirth. 19

Q: Are measles and German measles the same?
A: No. Measles, also known as rubeola, and German measles, also known as rubella, are two completely separate illnesses. They do have certain symptoms in common, including:

• Cold-like symptoms such as a runny nose, sneezing and coughing
• A high temperature or fever
• Sore, red eyes
• A skin rash

They are also both spread in the airborne water droplets coughed or sneezed out by an infected person, as well as prevented by the MMR vaccine. However, they are caused by different viruses and have different specific symptoms, complications and treatments.

Q: What does the measles rash look like?
A: The measles rash is characterized by red-brown spots that may join together to form blotches. It is usual for spots to first appear on the head and then gradually spread down throughout the body. For some people the rash will be slightly itchy, but this is not always the case. Generally the rash takes around two to three days to cover the body and then another few days to fade in order of appearance.

Q: Is there a vaccine against measles?
A: Yes. The MMR vaccine protects against measles, mumps and vaccine protects against measles, mumps and rubella, and two doses of the vaccine have been shown to be around 97 percent effective at preventing measles. Children aged between 12 months and 12 years old may also get the MMRV vaccine, which immunizes against measles, mumps, rubella and varicella (chickenpox).

Q: What is the treatment for measles?
A: Because there is no medication that targets the measles virus, most treatment focuses on managing and easing the symptoms of measles.

Q: What precautions can be taken against measles?
A: The only way to prevent measles is by having a vaccination. Measles is very contagious, so it is important for people with this condition to stay home from the moment symptoms begin to appear to four days after the rash disappears.

Other useful preventative methods include:

• Washing hands frequently, ideally with soap and water or hand sanitizer
• Covering the mouth and nose with a tissue when coughing and sneezing
• Avoiding close contact with people who are sick
• Avoid touching the eyes, nose or mouth unless hands are fully clean