Measles

Measles is a highly contagious viral illness that causes a skin rash and fever. It can lead to serious and potentially life-threatening complications.

Before measles vaccine came into widespread use, measles was a common childhood illness, and most people who grew up in that era caught it as children and are likely to be immune. Today, in places with high vaccination rates, measles is rare. However, it is still common in many parts of the world, and large outbreaks occur from time to time. Travelers can carry the virus across borders and spread it to people who are not immune. Worldwide, measles remains a leading cause of illness and death in children.

Symptoms#

The first symptoms of measles usually start about 10 days after exposure to the virus, but can appear anywhere from 7 to 18 days afterwards. They can include:

• Fever
• Feeling generally unwell (malaise) or tiredness
• Cough
• Runny nose
• Sore, red eyes (conjunctivitis)
• Koplik spots — tiny white, red or bluish spots inside the mouth

A few days later, a red, blotchy, non-itchy rash appears, usually around 14 days after exposure. The rash typically starts on the face and neck, spreads down the body, and lasts about 4 to 7 days. Diarrhea (especially in infants) and swollen lymph nodes can also occur.

Complications#

Up to a third of people with measles develop complications, and some need hospital care. Complications can include:

• Ear infections
• Diarrhea
• Pneumonia (infection of the lungs) and other respiratory infections
• Encephalitis (inflammation of the brain), which occurs in about 1 in every 1,000 people with measles

In pregnancy, measles raises the risk of complications such as miscarriage, premature labor and low-birth-weight infants.

Subacute sclerosing panencephalitis (SSPE) is an extremely rare complication, affecting roughly 1 in every 100,000 people who have had measles. SSPE is a progressive inflammation of the brain that causes brain degeneration, usually begins about 7 years after the infection, and is always fatal.

How measles spreads#

Measles is one of the most contagious infections known. It spreads mainly when a person breathes in virus that an infectious person has coughed or sneezed into the air. It can also spread through nose or throat secretions and by touching contaminated surfaces or objects.

The virus can survive up to 2 hours in the air or on surfaces, so simply being in the same room as an infectious person can lead to infection. People with measles are infectious from about 24 hours before symptoms appear until 4 days after the rash appears.

Who is at risk#

People who are not fully immunized and have never had measles are at increased risk. Anyone susceptible can become infected and develop severe illness, including adults. Some people are at higher risk of severe illness and complications, including:

• Pregnant women
• People with a weakened immune system
• Children younger than 5 years

People traveling to countries where measles cases or outbreaks are occurring are also at increased risk, and travel-related cases are a major source of new infections in places where measles is otherwise rare.

Prevention through vaccination#

The best protection is vaccination. Two doses of a measles-containing vaccine give long-term protection in about 99% of people. Measles vaccine is usually given in combination form, such as the measles, mumps and rubella (MMR) vaccine, or the measles, mumps, rubella and varicella/chickenpox (MMRV) vaccine. The MMRV vaccine is generally not recommended for people aged 14 years and over.

Two doses are recommended in childhood, with the first dose usually given around 12 months of age and a second dose in the following months or years. The exact ages and combinations depend on the immunization schedule where you live, so check your local schedule.

Anyone who has not received two doses of a measles-containing vaccine should consider a catch-up vaccination. This is especially important for people who work in healthcare, aged care or correctional facilities, and for those planning international travel. It is safe to receive a measles-containing vaccine more than twice, so people who are unsure of their history can be vaccinated.

To check whether you have been vaccinated, contact your doctor or immunization provider for your records, or check any immunization register that applies where you live.

Travel and infants#

Infants traveling to countries where measles occurs can sometimes be vaccinated from 6 months of age, based on a case-by-case assessment. However, a dose given before 12 months of age does not count toward the routine schedule, so the child still needs the two later doses after 12 months of age. Anyone planning international travel should speak to their doctor or immunization provider in good time to make sure they are fully protected before leaving.

Who should not be vaccinated#

Measles-containing vaccines are generally not recommended for:

• People with a weakened immune system (confirm with your doctor)
• Pregnant women

Women who are planning pregnancy and are not immune should be vaccinated before becoming pregnant, or wait until after the birth. Women should avoid pregnancy for 28 days after vaccination. If you are pregnant, planning a pregnancy, or have a weakened immune system, contact your doctor or immunization provider to discuss your options.

If you think you have measles#

People with symptoms of measles should seek urgent medical care. Call the doctor, emergency department or pathology provider before attending, so they can isolate you on arrival, and wear a mask to avoid spreading the virus to others. Let them know your symptoms and, where relevant, your travel history.

Measles is diagnosed from symptoms, physical examination and medical history (including immunization and travel history), and confirmed by tests such as a nose and throat swab, a urine sample or a blood test. Confirming the diagnosis is important because it lets public health staff follow up people who may have been exposed and are at risk.

Suspected cases should stay at home until they are told whether they are a confirmed case, and should not go to work, school or public places such as supermarkets in the meantime.

Treatment#

There is no specific treatment for measles, and antibiotics do not work because the illness is viral. An uncomplicated case usually lasts about 14 days, and most people make a full recovery. Care focuses on relieving symptoms:

• Rest and drink plenty of fluids
• Take paracetamol (acetaminophen) to treat fever
• Isolate at home

People with severe illness may need hospital care and treatment of complications.

People with measles should stay home until they are no longer infectious — usually 4 days after the rash appears — and until they feel well, to reduce the chance of spreading it. While infectious, avoid contact with anyone outside your home, particularly people at higher risk such as those with a weakened immune system, young children and pregnant women. Children with measles should not attend school or children’s services until at least 4 days after the rash appears.

If you have been exposed#

People who have had contact with an infectious person and are not fully immunized or have never had measles are at risk. It is important to watch for symptoms and seek urgent care if they develop, calling ahead and wearing a mask.

People who have been exposed may be offered preventive treatment to reduce the risk of infection. This can be either a dose of measles-containing vaccine or an injection of immunoglobulin, depending on how much time has passed since contact:

• A measles-containing vaccine may be given if it can be received soon after exposure (within about 3 days, or 72 hours).
• An injection of immunoglobulin may be given for specified groups within a slightly longer window (within about 6 days, or 144 hours).
• After this window, preventive treatment is no longer effective. Instead, for 18 days from last contact, avoid public places and contact with people at higher risk of serious illness.

In general, immunoglobulin is reserved for people who cannot have a measles-containing vaccine or who are at higher risk of serious illness, such as infants, pregnant women and people with a weakened immune system. People who receive immunoglobulin cannot have a measles-containing vaccine for at least 5 months, and children may need their vaccination timing adjusted. Discuss preventive treatment options with your doctor as soon as possible.

Children who have been exposed and are not fully immunized or have not had measles may need to stay away from school and children’s services for a period after the last case, unless they receive appropriate preventive treatment within the recommended window.

Key points#

• In the past, before vaccination was widespread, measles was a common childhood illness.
• However, measles is still common in many parts of the world and large outbreaks occur from time to time.
• Worldwide, measles is a leading cause of illness and death in children.
• Measles can cause serious illness and can be potentially life-threatening.
• Measles increases the risk of complications during pregnancy, such as low-birth-weight infants.

Where to get help#