Measles

Facts on Measles

Measles is best known for causing a fever and rash in childhood, but measles can affect other parts of the body and sometimes occurs in adults. Vaccination has significantly reduced the number of cases in the United States, although isolated outbreaks continue to occur, and measles has been occurring more frequently in recent years due to an increased number of vaccine refusals.

There are two types of measles, each caused by a different virus. Although both produce a rash and fever, they are really different diseases. When most people use the term measles, they are referring to the first condition below.

  • The rubeola virus causes "red measles," also known as "hard measles" or just "measles." Although most people recover without problems, rubeola can lead to pneumonia or inflammation of the brain (encephalitis).
  • The rubella virus causes "German measles," also known as "three-day measles." This is usually a milder disease than red measles. However, this virus can cause significant birth defects if an infected pregnant woman passes the virus to her unborn child.

What Causes Measles?

Both the rubeola and rubella viruses are spread through the respiratory route. This means they infect susceptible individuals exposed to an infected person who is coughing and sneezing. In fact, the rubeola virus is one of the most contagious viruses known to man. As a result, it can spread rapidly in a susceptible population. Infected people carry the virus in their respiratory tract before they get sick, so they can spread the disease without being aware of it.

If people are immune to the virus (either through vaccination or by having had measles in the past), they cannot get the disease caused by that virus. For example, someone who had rubeola as a child would not be able to get the disease again. Remember that rubella and rubeola are different viruses. An infection with or vaccination against one of these viruses does not protect against infection with the other.

What Are Symptoms and Signs of Measles?

Rubeola ("red measles" or "hard measles")

Symptoms appear about 10-14 days after a person is infected with the rubeola virus. This is called the incubation period. During this period, the virus is multiplying. Symptoms occur in two phases.

  • The early phase begins with these symptoms:
  • The red measles rash develops from two to four days later.
    • The rash usually starts on the face, spreading to the trunk and then to the arms and legs.
    • The rash is initially small red bumps that may blend into each other as more appear. From a distance, the rash often looks uniformly red.
    • People with measles may develop small grayish spots on the inside of the cheek, called "Koplik spots."
    • The rash is usually not itchy, but as it clears up, the skin may shed (this looks like skin that is peeling after sunburn).
    • Although red measles is often a mild disease, a few serious complications may occur. Red measles makes people more vulnerable to pneumonia and bacterial ear infections. Pneumonia as a complication of measles is especially serious in infants and is responsible for most deaths in this age group. Inflammation of the brain (encephalitis) occurs about once in every thousand cases of measles and is a serious complication that can be fatal.
    • Red measles is particularly severe in people with weakened immune systems, including people who are malnourished or have HIV.

Rubella ("German measles")

German measles causes milder symptoms than red measles. The incubation period between getting the virus and getting sick is 10 days to two weeks.

  • Initially, some people experience fatigue, low-grade fever, headache, or red eyes several days before the rash appears. These symptoms are more common in adults than in children.
  • Swollen, tender lymph nodes may occur in the back of the neck.
  • The rash is light red to pink. It starts as individual spots that may merge together over time. The rash usually starts on the face and moves down to the trunk.
  • The rash does not usually itch, but as it clears up, the skin may shed.
  • Adult women who get rubella may get painful joints for days to weeks after the infection. This typically affects the hands, wrists, and knees.
  • Symptoms may be so mild that they are not even noticed, especially in children. Most symptoms resolve in a few days, but swollen lymph nodes may persist for a few weeks.
  • The most feared complication of rubella is "congenital rubella," which occurs when an infected pregnant woman passes the virus to her unborn child. Among other problems and birth defects, affected infants may have cataracts, heart defects, hearing impairment, and learning disabilities. The risk of transmission is highest early in pregnancy. The virus may also cause miscarriage or stillbirth.

Measles (Rubeola)

What are Measles Treatment?

Measles is treated by providing supportive care to relieve symptoms and reduce the risk of secondary bacterial infections. High-dose vitamin A may be given to patients hospitalized with measles. Vaccination can prevent measles.

When to Seek Medical Care for Measles

Both rubella and rubeola have become so uncommon that patients normally present to their physician for a diagnosis of a rash and associated illness. In general, both children and adults who have a fever and a rash should contact their physician. People who have come in contact with an infected person should also be evaluated to see if they need special measures to keep them from getting sick. Normally, measles is not a disease that requires emergency care.

How to Test for Measles

  • Depending on the symptoms, the doctor may diagnose measles based on the patient's history and physical exam alone.
  • In questionable cases, the doctor can perform specialized blood tests to help with the diagnosis, but these tests usually are not needed.
  • Blood tests can also be used to see if a person is immune to measles.

Self-Care at Home for Measles

Although there is no cure for measles, there are steps that can make the disease more tolerable. These include the following:

  • Get plenty of rest.
  • Sponge baths with lukewarm water may reduce discomfort due to fever.
  • Drink plenty of fluids to help avoid dehydration.
  • A humidifier or vaporizer may ease the cough.
  • Pain relievers and fever reducers such as acetaminophen (Tylenol, Liquiprin Drops, and other brands) and ibuprofen (Advil, Motrin, and other brands) can help with symptoms when used according to directions. Remember never to give aspirin to children or teenagers because it may cause a disease known as Reye's syndrome.

What Is Measles Treatment?

There is no specific treatment or cure for measles. Children should stay at home and out of school until they are cleared to return by their health care professional.

Follow-up for Measles

Although complications are rare, a physician should be contacted if symptoms worsen or do not resolve, or if there is confusion or change in the level of consciousness. Shortness of breath, a cough that produces sputum, and/or chest pain may be symptoms of pneumonia.

What Are Measles Prevention and Vaccination?

Because of widespread vaccination of children, both kinds of measles occur much less often than in the past. However, recently there have been a number of well-publicized outbreaks in communities around the United States. In the United States in 2011, there were 222 rubeola measles cases in the United States, and 89% of those affected were unimmunized. Of the 222 infected, 70 were admitted to hospitals, but luckily there were no deaths. Outbreaks in the US continue, with up to 90% due to importation of measles from another country, including many European countries. For example, a major outbreak in France in 2011 involved more than 15,000 patients. In 2013, there were 11 U.S. outbreaks, and in 2014, there were 23 measles outbreaks in this country. In 2015, a multi-state outbreak originated in a California amusement park, likely due to an international traveler.

  • The most effective way to prevent measles is through immunization.
    • Children in the United States routinely receive the measles-mumps-rubella (MMR) vaccine according to a published immunization schedule. This vaccine protects against both red measles and German measles. Vaccination is required for entry into school.
    • Doctors usually give the first dose of the measles immunization at 12-15 months of age.
    • Doctors give a second dose of the immunization when the child is 4 to 6 years old.
    • Although most children tolerate the vaccine well, a few may develop fever and even a rash from five to 12 days after the immunization. Adult women who get the vaccine may notice short-term aching in their joints.
    • The vaccine is about 95% effective in preventing measles of either type. That means that a small number of people who get the vaccine may still be able to get measles.
    • The vaccine should not be used in people with egg allergies.
    • Rarely, the measles vaccine can cause a measles-like illness. This is most common in people with weak immune systems, such as those with advanced HIV or those on chemotherapy. In such patients, the risk of vaccination should be balanced carefully against the risk of getting measles.
    • Women who may become pregnant should have a blood test to be sure they are immune to rubella ("German measles").
  • Both types of measles are still common in areas that do not offer immunization and in people who have not been immunized.
  • As with all other contagious illnesses, covering the mouth when coughing or sneezing and good hand-washing practices will help prevent the spread of the diseases.
  • A special immunization -- immune globulin -- may be necessary for certain high-risk people after they are exposed to measles. These include children younger than 1 year, children with weakened immune systems, and pregnant women. If you have been exposed to measles, contact your physician to determine if you need immune globulin.

Measles Prognosis

  • Measles of either type usually clears up on its own in seven to 10 days. Once a person has had a case of the measles, they are almost always immune for life.
  • As discussed above, complications are rare but may be serious. This is the reason why vaccination is so universally recommended.
Reviewed on 11/20/2017

Medically reviewed by Robert Cox, MD; American Board of Internal Medicine with subspecialty in Infectious Disease

REFERENCE:

United States. Centers for Disease Control and Prevention. "Measles -- United States, 2011." MMWR 61.15 Apr. 20, 2012: 253-257.

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