Measles (Rubeola)

Topic Overview

What is measles?

Measles is a very contagious infection that causes a rash all over your body. It is also called rubeola or red measles. It is very rare in the United States because most children get the vaccine as part of their regular childhood shots.

What causes measles?

Measles is caused by a virus. It is spread when an infected person coughs, sneezes, or shares food or drinks. The measles virus can travel through the air. This means that you can get measles if you are near someone who has the virus even if that person doesn't cough or sneeze directly on you.

You can spread the virus to others from 4 days before the rash starts until 4 days after the rash appeared. The virus is most often spread when people first get sick, before they know they have it.

What are the symptoms?

The first symptoms of measles are like a bad cold—a high fever, a runny nose, sneezing, a sore throat, and a hacking cough. The lymph nodes in your neck may swell. You also may feel very tired and have diarrhea and red, sore eyes. As these symptoms start to go away, you will get red spots inside your mouth, followed by a rash all over your body.

When adults get measles, they usually feel worse than children who get it.

It usually takes 8 to 12 days to get symptoms after you have been around someone who has measles. This is called the incubation period.

How is measles diagnosed?

Your doctor will ask you about your symptoms and examine you. If your doctor suspects that you have measles, he or she will do a blood test that will tell if you have measles.

If you think you have measles, call your doctor so he or she can report the illness to the local health department.

How is it treated?

Measles usually gets better on its own. Most people can treat their symptoms at home. For home treatment, take medicines to lower your fever. Also, get plenty of rest and drink lots of fluids. Stay away from other people as much as you can so that you don't spread the disease.

Most people get better within 2 weeks.

Can measles be prevented?

The measles vaccine protects against the virus. The vaccine is usually given during childhood with the mumps and rubella (German measles) vaccines (MMR) or with the mumps, rubella, and chickenpox (varicella) vaccines (MMRV).

Some parents are afraid to give their child the MMR vaccine because they have heard that it can cause autism. But researchers have done many large studies and have found no connection between the MMR vaccine and autism.¹

Getting your child vaccinated is important, because measles can sometimes cause serious problems such as pneumonia. And in rare cases, it can even cause seizures or meningitis.

If you have been exposed to measles and you have not had the vaccine, you may be able to prevent the infection by getting a shot of immune globulin (IG) right away. Babies who are younger than 12 months, pregnant women, and people who have impaired immune systems that cannot fight infection may need to get immune globulin if they are exposed to measles.

If you have had measles, you can't get it again. Most people born before 1957 have had measles.

Frequently Asked Questions

Symptoms

Symptoms of measles usually develop 8 to 12 days after a person has been exposed to the virus. But the incubation period—the time between when you are first exposed to the measles virus and when you develop symptoms—can range from 7 to 18 days. Early symptoms of measles include fever [101°F (38°C) and higher], runny nose, sneezing, sore throat, hacking cough, swollen glands, fatigue, diarrhea, and loss of appetite. Many times, the eyes become red, irritated, swollen, and sensitive to light. There may be a discharge from the eyes.

These symptoms usually last 3 to 5 days. Toward the end of this phase, red spots with tiny grayish white heads, called Koplik spots, appear on the inside of the cheeks at the back of the mouth. These spots disappear within 18 hours, and a blotchy rash follows. It starts on the face and behind the ears and spreads downward over the entire body. A fever of 104°F (40°C) or higher often occurs with the rash but drops in about 2 days.

The rash lasts about 5 days and usually causes only slight itching, if any. The rash fades in the same order it appeared. After the rash disappears, the skin may have a brownish discoloration, which gradually fades away.

Some people develop dangerous problems from measles, such as lung infection (pneumonia) or brain swelling (encephalitis).

A person who has measles can spread the disease to others from 4 days before the rash breaks out to 4 days after the rash appeared.

Exams and Tests

Measles is most often diagnosed by a history of exposure to the disease, the presence of the characteristic rash, a fever of 101°F (38°C) or higher for 3 days or more, and other symptoms, including eye inflammation and chest congestion.

Blood tests (immunofluorescent antibody assay and ELISA-type assay) confirm the diagnosis and rule out other illnesses as causes of the symptoms. Swabs from the nose or throat (viral culture) also may be tested for the measles virus. Chest X-rays may be done if your doctor suspects pneumonia.

Treatment Overview

In cases without complications, measles is treated with bed rest and care at home. Home treatment includes drugs you can buy without a prescription that relieve pain and reduce fever, such as ibuprofen and similar drugs (for example, Advil, Motrin, Aleve) or acetaminophen (for example, Tylenol). Do not give aspirin to anyone younger than 20 because of its link to a rare but serious illness called Reye syndrome.

Antibiotics are not used to treat measles. But complications from the illness, such as pneumonia or an ear infection, may need antibiotic treatment.

Measles can cause a decrease in the level of vitamin A in the body, which can lead to dry eye syndrome (xerophthalmia) and blindness. Low levels of vitamin A in children raise the chance of death from measles complications.^{2, 3} Vitamin A supplements are recommended for:⁴

• Children ages 6 months to 2 years who are hospitalized because of measles or complications from measles.
• Children with measles who have impaired immune systems or vitamin A deficiency.
• All children who are diagnosed with measles in communities where vitamin A deficiency is a recognized problem, especially in developing countries or in remote regions.

Prevention

The measles vaccine is effective in preventing the disease. It is usually given in combination with the mumps and rubella (German measles) vaccines (MMR) or the mumps, rubella, and chickenpox (varicella) vaccines (MMRV). Because of widespread vaccination efforts, the disease is extremely rare in the United States, although it could quickly return if large numbers of people decide not to be vaccinated against it. Studies have found that the risk of a reaction to the vaccine for children who are allergic to eggs is extremely low. For more information, see the topic Immunizations. If you were born after 1956 or received an early version of the measles vaccine, check your immunization status before you travel to countries where measles is still common.

If the measles vaccine is given to people who are susceptible within 72 hours after they have been exposed to the measles virus, the vaccine will probably provide them with some protection against the disease.⁴

Another preventive option for a person who has been exposed to the measles virus is immune globulin (IG). An IG injection can prevent or shorten the measles illness. Babies younger than 1 year, pregnant women, and people who have impaired immune systems may need to get an IG injection if they are exposed to measles. Talk to your doctor if you or your child has been exposed to this illness.

Home Treatment

Plenty of rest at home is usually the best treatment for measles. Stay away from other people as much as you can so that you don't spread the disease.

If you have measles:

• Drink plenty of fluids. If you have a fever and are not drinking enough liquids, you can become dehydrated.
• Take medicines you can buy without a prescription that relieve pain and reduce fever, such as ibuprofen and similar drugs (for example, Advil, Motrin, Aleve) or acetaminophen (for example, Tylenol). Do not give aspirin to anyone younger than 20 because of its link to a rare but serious illness called Reye syndrome.
• Rest your eyes often. If your eyes are sensitive, close the window blinds in your room and limit the amount of time you watch television.
• Use a humidifier to add moisture to the air if you have a cough. Or go into the bathroom, shut the door, and turn on the shower to create steam. You could also try going outside in the cool night air. For more information, see the topics Coughs, Age 11 and Younger and Coughs, Age 12 and Older.
• Avoid contact with people who have never had measles and who have not been immunized. You can spread measles to others from 4 days before the rash breaks out to 4 days after the rash appeared.

If your child has measles, keep him or her out of school until at least 4 days after the rash appeared. Keep your child out longer if he or she is not feeling well.

Call your doctor if your child:

• Becomes confused or is difficult to wake up.
• Has a fever for more than 10 days. If your child still has a fever after the third or fourth day of the rash, he or she may need to be evaluated for signs of complications, such as ear infection, strep throat, or pneumonia.
• Has diarrhea that lasts longer than 2 weeks or has any signs of dehydration.
• Has severe headaches or a stiff and sore neck.
• Seems to feel better, but the symptoms return later.

If you or your child has measles and has not seen a doctor, call your local health department. The health department needs to record all cases of this illness.

Other Places To Get Help

Organizations

Related Information

• Immunizations
• Rash, Age 11 and Younger
• Rash, Age 12 and Older
• Travel Health
• Vaccine Information Statements

References

Citations

1. Centers for Disease Control and Prevention (2008). Mercury and Vaccines (Thimerosal). Available online: http://www.cdc.gov/vaccinesafety/concerns/thimerosal.htm.
2. Elliman D, et al. (2007). Measles, mumps, and rubella: Prevention, search date July 2006. Online version of BMJ Clinical Evidence: http://www.clinicalevidence.com.
3. Perry RT, Orenstein WA (2006). Measles. In FD Burg et al., eds., Current Pediatric Therapy, 18th ed., pp. 786–790. Philadelphia: Saunders Elsevier.
4. American Academy of Pediatrics (2006). Measles. In LK Pickering, ed., Red Book: 2006 Report of the Committee on Infectious Diseases, 27th ed., pp. 441–452. Elk Grove Village, IL: American Academy of Pediatrics.

Other Works Consulted

• Abramowicz M, ed. (2006). Advice for travelers. Treatment Guidelines From The Medical Letter, 4(45): 25–34.
• Cherry JD (2004). Measles virus. In RD Feigin et al., eds., Textbook of Pediatric Infectious Diseases, 5th ed., vol. 2, pp. 2283–2304. Philadelphia: Saunders.
• Gershon A (2008). Measles (rubeola). In AS Fauci et al., eds., Harrison's Principles of Internal Medicine, 17th ed., pp. 1214–1217. New York: McGraw-Hill.
• Gershon AA (2005). Measles virus (rubeola). In GL Mandell et al., eds., Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases, 6th ed., vol. 2, pp. 2031–2038. Philadelphia: Elsevier Churchill Livingstone.
• Kabra SK, et al. (2008). Antibiotics for preventing complications in children with measles. Cochrane Database of Systematic Reviews (3).
• Levin MJ, Weinberg A (2009). Measles (rubeola) section of Infections: Viral and rickettsial. In WW Hay et al., eds., Current Diagnosis and Treatment: Pediatrics, 19th ed., pp. 1101–1103. New York: McGraw-Hill.
• Mason WH (2007). Measles. In RM Kliegman et al., eds., Nelson Textbook of Pediatrics, 18th ed., pp. 1331–1337. Philadelphia: Saunders Elsevier.

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