Measles

Signs and Symptoms

While measles is probably best known for its full-body rash, the first symptoms of the infection are usually a hacking cough, runny nose, high fever, and red eyes. A characteristic marker of measles are Koplik's spots, small red spots with blue-white centers that appear inside the mouth.

The measles rash typically has a red or reddish brown blotchy appearance, and first usually shows up on the forehead, then spreads downward over the face, neck, and body, then down to the arms and feet.

Measles is highly contagious — 90% of people who haven't been vaccinated for measles will get it if they live in the same household as an infected person. Measles is spread when someone comes in direct contact with infected droplets or when someone with measles sneezes or coughs and spreads virus droplets through the air.

A person with measles is contagious from 1 to 2 days before symptoms start until about 4 days after the rash appears.

Recent Outbreaks

Measles is very rare in the United States. Due to widespread immunizations, the number of U.S. measles cases has declined in the last 50 years. Before measles vaccination became available in the 1960s, more than 500,000 cases of measles were reported every year. From 2000 to 2007, just an average of 63 cases per year was reported.

However, in 2008 the United States saw an increase in measles cases and outbreaks (three or more linked cases), with 131 cases reported between January and July. More than 90% of those infected were not immunized or their immunization status was unknown.

The most important thing you can do to protect kids from measles is to have them vaccinated according to the schedule prescribed by your doctor.

Prevention

Infants are generally protected from measles for 6 months after birth due to immunity passed on from their mothers. Older kids are usually immunized against measles according to state and school health regulations.

For most kids, the measles vaccine is part of the measles-mumps-rubella immunization (MMR) or measles-mumps-rubella-varicella immunization (MMRV) given at 12 to 15 months of age and again at 4 to 6 years of age.

Measles vaccine is not usually given to infants younger than 12 months old. But if there's a measles outbreak, the vaccine may be given when a child is 6-11 months old, followed by the usual MMR immunization at 12-15 months and 4-6 years.

As with all immunization schedules, there are important exceptions and special circumstances. Your doctor will have the most current information regarding recommendations about the measles immunization.

The measles vaccine should not be given to these at-risk groups:

• pregnant women
• kids with untreated tuberculosis, leukemia, or other cancers
• people whose immune systems are suppressed for any reason
• kids who have a history of severe allergic reaction to gelatin or to the antibiotic neomycin, as they are at risk for serious reactions

During a measles outbreak, an injection of measles antibodies called immune globulin can help protect people who have not been immunized (especially those at risk of serious infection, such as pregnant women, infants, or kids with weakened immune systems) if it's given within 6 days of exposure. These antibodies can either prevent measles or make symptoms less severe.

For women who are not pregnant and people not in one of the other at-risk groups mentioned above, the measles vaccine may offer some protection if given within 72 hours of measles exposure.

Vaccine Side Effects

The measles vaccine occasionally causes side effects in kids who don't have underlying health problems. The most common reactions are fever 6-12 days after vaccination (in about 5%-15% of kids vaccinated) and a measles-like rash, which isn't contagious and fades on its own (in about about 5% of vaccinated kids).

Treatment

There is no specific medical treatment for measles. To help manage symptoms, which usually last for about 2 weeks, give your child plenty of fluids and encourage extra rest. If fever is making your child uncomfortable, you may want to give a non-aspirin fever medication such as acetaminophen or ibuprofen. Remember, you should never give aspirin to a child who has a viral illness since the use of aspirin in such cases has been associated with the development of Reye syndrome.

Kids with measles should be closely watched. In some cases, measles can lead to other complications, such as otitis media, croup, diarrhea, pneumonia, and encephalitis (a serious brain infection), which may require antibiotics or hospitalization.

In developing countries, vitamin A has been found to decrease complications and death associated with measles infections. In the U.S., vitamin A supplementation should be considered for children between 6 months and 2 years old who are hospitalized with measles and its complications.

Also, all kids over 6 months old with certain risk factors — such as vitamin A deficiency, a weakened immune system, or malnutrition — might benefit from vitamin A supplementation.

When to Call the Doctor

Call the doctor immediately if you suspect that your child has measles. Also, it's important to get medical care following measles exposure, especially if your child:

• is an infant
• is taking medicines that suppress the immune system
• has tuberculosis, cancer, or a disease that affects the immune system

Remember that measles, a once common childhood disease, is preventable through routine childhood immunization.

Reviewed by: Joel Klein, MD
Date reviewed: October 2011