Overview
Measles, also known as rubeola, is a highly contagious viral disease that manifests with fever and a distinctive rash. The virus spreads through the air via respiratory droplets when an infected person talks, coughs, or sneezes. Currently, there is no specific medical treatment for measles; the virus must be allowed to run its course. Vaccination remains the most effective method of prevention.
Since the introduction of the measles vaccine, the incidence of the disease has significantly decreased. However, in recent years, declining vaccination rates in the United States and other parts of the world have led to outbreaks. Travelers from countries without comprehensive vaccination programs can also spread measles. Therefore, anyone not vaccinated against measles remains at risk.
Measles should not be confused with German measles (rubella). Other names for measles include 10-day measles or red measles.
Causes
What Causes Measles?
Measles is caused by the morbillivirus, an extremely contagious virus. It spreads through the air when an infected person breathes, coughs, or sneezes. The virus can remain airborne for up to two hours and can also spread by touching contaminated surfaces and then touching the mouth, nose, or eyes. The virus is contagious from about four days before to four days after the rash appears.
Symptoms
What Are the Symptoms of Measles?
Symptoms typically appear about 10 to 14 days after exposure to the virus and develop in stages over two to three weeks:
- Incubation Period (7–14 days): No symptoms are present.
Nonspecific Signs and Symptoms (2–3 days):
- Mild to moderate fever
- Persistent cough
- Runny nose
- Inflamed eyes (conjunctivitis)
- Sore throat
Acute Illness and Rash:
- High fever (104 to 105.8 F or 40 to 41 C)
- Flat red spots starting on the face and spreading downward
- Smaller raised white spots (Koplik’s spots) in the mouth
- Rash covering the entire body
Recovery:
- Rash fades, starting from the face
- Symptoms like cough and darkening or peeling of the skin may persist for about 10 days
Diagnosis
How Is Measles Diagnosed?
Diagnosis is usually based on the characteristic history and physical examination. Laboratory tests can confirm the diagnosis by detecting the virus in blood, throat, or urine samples. These tests are particularly useful for atypical cases or when measles is suspected but not confirmed by clinical symptoms alone.
Treatment
How Is Measles Treated?
There is no specific antiviral treatment for measles. Management focuses on relieving symptoms and preventing complications:
- Rest and adequate fluid intake
- Use of acetaminophen for fever and aches
- Vitamin A supplements, especially in malnourished children
- Hospitalization for severe cases to provide supportive care
Antibiotics may be used to treat secondary bacterial infections. In immunocompromised patients, antiviral treatment like ribavirin may be considered.
Complications
What Are the Complications of Measles?
Complications occur in about 30% of measles cases and can be severe, particularly in young children, pregnant individuals, and immunocompromised people:
Gastrointestinal:
- Diarrhea
- Hepatitis
Respiratory:
- Pneumonia (primary viral or secondary bacterial)
- Croup
Neurological:
- Encephalitis
- Subacute sclerosing panencephalitis (a fatal condition developing years after infection)
Others:
- Otitis media (ear infection)
- Myocarditis
- Thrombocytopenia (low platelet count)
- Blindness due to conjunctivitis or corneal ulceration
Prevention
Can You Prevent Measles?
Vaccination is the most effective way to prevent measles. The measles vaccine is often combined with mumps and rubella vaccines (MMR) or with varicella (chickenpox) vaccine (MMRV). The MMR vaccine is given in two doses: the first dose at 12-15 months of age and the second at 4-6 years of age.
Adults without proof of immunity and those at higher risk, such as healthcare workers and international travelers, should also get vaccinated.
Risk Factors
Who Is at Risk for Measles?
Those most at risk include:
- Unvaccinated individuals
- International travelers to areas where measles is common
- People with vitamin A deficiency
- Individuals with weakened immune systems
- Infants who have lost passive immunity before their first immunization
Prognosis
What Is the Outlook for Someone with Measles?
Most people recover from measles without serious long-term effects. However, complications can lead to severe outcomes or even death. The disease provides lifelong immunity once contracted.
Living With Measles
When to Contact a Healthcare Provider?
Contact your healthcare provider if you think you or your child have had contact with someone with measles. If you or your child has measles and seem to be getting worse instead of better, call your provider. Pregnant women and infants younger than 12 months are most susceptible to complications, so it’s important to contact a healthcare provider if either of these apply to you.
Common Questions
What Disease Mimics Measles?
Measles isn’t the only virus that causes symptoms like a skin rash and fever. There are several viruses that cause similar symptoms such as roseola and rubella. Contact your healthcare provider if you notice any skin rashes, fevers, and other symptoms that mimic measles.
What Rash Can Be Mistaken for Measles?
Other diseases that cause a rash that may be mistaken for measles include:
- Chickenpox
- Hand, foot, and mouth disease
- Roseola
- Rubella
- Scarlet fever
Preventing Measles
How to Prevent 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: Since 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: Ensure that anyone who is at risk of getting measles and hasn’t been fully vaccinated receives the measles vaccine as soon as possible. This includes infants older than six 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. However, herd immunity may now be weakening due to a drop in vaccination rates, and the incidence of measles in the U.S. has recently increased significantly.
Myths and Misconceptions
No Proven Link Between the MMR Vaccine and Autism
Following the publication of a now-discredited study in 1998, concerns were raised about a possible link between the MMR vaccine and autism. However, extensive reports from the American Academy of Pediatrics, the National Academy of Medicine, and the Centers for Disease Control and Prevention (CDC) have concluded that there is no scientifically proven link between the MMR vaccine and autism.
These organizations note that autism is often identified in toddlers between the ages of 18 and 30 months, which is about the time children receive their first MMR vaccine. However, this coincidence in timing should not be mistaken for a cause-and-effect relationship.
Prevention Measures
How to Avoid Spreading or Catching Measles?
Measles spreads when an infected person breathes, coughs, or sneezes. You are infectious from when you first have symptoms (around four days before the rash appears) until four days after the rash appears. There are things you can do to reduce the risk of spreading or catching measles:
Do:
- Wash your hands often with soap and warm water
- Use tissues when you cough or sneeze
- Throw used tissues in the bin
Don’t:
- Share cutlery, cups, towels, clothes, or bedding
Measles in Pregnancy
Measles and Pregnancy
If you contract measles while pregnant, it could harm your baby. It can cause:
- Miscarriage or stillbirth
- Premature birth (before the 37th week of pregnancy)
- Low birth weight
It is important to seek medical advice if you are pregnant and have been in close contact with someone who has measles.
References
Cleveland Clinic. (n.d.). Measles (Rubeola). Retrieved from https://my.clevelandclinic.org/health/diseases/11526-measles-rubeola
DermNet. (n.d.). Measles. Retrieved from https://dermnetnz.org/topics/measles
Harvard Health. (n.d.). Measles. Retrieved from https://www.health.harvard.edu/a_to_z/measles-a-to-z
Mayo Clinic. (n.d.). Measles. Retrieved from https://www.mayoclinic.org/diseases-conditions/measles/symptoms-causes/syc-20374857
National Health Service (NHS). (n.d.). Measles. Retrieved from https://www.nhs.uk/conditions/measles/
