Clinical Signs & Symptoms
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What Is Measles?
Measles, also called rubeola, is best known for its typical skin rash. It is, however, primarily a respiratory infection. The first symptoms are irritability, runny nose, eyes that are red and sensitive to light, hacking cough, and a fever as high as 105 degrees Fahrenheit (40.6 degrees Celsius).
Fever peaks with the appearance of the rash, which typically begins on the forehead, then spreads downward over the face, neck, and body. The child is particularly ill-looking during the first days of the rash. It usually takes about 3 days for the rash to make its way down to the feet. Once the rash appears on the legs and feet, symptoms usually subside within 2 days.
The rash itself looks like large flat red to brown blotches that often flow into one another to completely cover the skin, especially on the face and shoulders. The rash fades in the same order that it appeared, forehead first and feet last. The total time for the rash, from beginning to end, head to toe, is usually about 6 days. As the rash disappears, the healing skin may look brown temporarily, before it sheds in a finely textured peel.
One special identifying sign of measles is Koplik's spots. These are small, red, irregularly-shaped spots with blue-white centers found inside the mouth. Koplik's spots usually appear 1 to 2 days before the measles rash and may be noticed by a doctor looking for the cause of a child's fever and cough.
Measles can lead to many different complications: croup, bronchitis, bronchiolitis, pneumonia, conjunctivitis, myocarditis, hepatitis, and encephalitis. Measles can also make the body more susceptible to ear infections or pneumonias caused by bacteria. Symptoms and complications of measles are usually most severe in adults.
Measles is a respiratory infection caused by the measles virus. Before immunization was available, measles occurred in springtime epidemics, usually in cycles of 2 or 3 years.
Infants are generally protected from measles for 6 to 8 months after birth, due to immunity that was passed on from their mothers. Older children are usually immunized against measles according to state and school health regulations. Currently, outbreaks of measles are occurring most often on college campuses, among young persons who have either not been adequately immunized against measles, or whose immunity has decreased since childhood.
Measles is prevented by a vaccine that can be given before, or within 3 days after, exposure to the disease. In most children, measles vaccine is given as part of the mumps-measles-rubella immunizations (MMR) - one given at age 15 months, and the second at 11 to 12 years. Measles vaccine is not usually given to infants younger than 13 months old, except in times of measles outbreaks. In this case, a dose of measles vaccine alone may be given at 9 months, followed by the usual MMR immunization at 15 months.
Measles vaccine made before 1979 may not have been as effective as vaccine made today. Because of this, doctors often recommend that persons vaccinated before 1980 receive another measles vaccination if a measles outbreak occurs in their area, especially if they are in school. A blood test can be performed to determine a person's immunity and whether they need another immunization.
Measles vaccine should not be given to pregnant women, or to persons with active tuberculosis, leukemia, lymphoma, or depressed immune systems. Also, persons with severe allergies to eggs, or to the antibiotic neomycin, may risk life-threatening reactions to measles vaccine.
Measles vaccine occasionally causes side effects in persons with no underlying health problems. In about 10% of cases there is a fever between 5 and 12 days after vaccination, and in about 5% of cases there is a rash.
In special situations (pregnant women, infants, persons with cancer, tuberculosis, or depressed immune systems), persons exposed to measles can also be protected from infection by an injection of antibodies called gamma globulin. Gamma globulin is given within 6 days of exposure, and it either prevents measles or makes symptoms less severe.
As is the case with all immunization schedules, there are important exceptions and special circumstances. Your doctor should have the most current information regarding recommendations about the measles immunization.
The incubation period for measles is about 9 to 11 days between exposure and prodromal symptoms, or about 2 weeks between exposure and the appearance of a rash.
Measles usually lasts about 10 to 14 days, measured from the beginning of the prodromal symptoms to the fading of the rash. Most prodromal symptoms disappear 1 or 2 days after the rash begins, except for the cough, which may last as long as the rash.
Measles is a highly contagious disease, and about 90% of nonimmunized persons will develop measles if they live in the same house as someone who has the disease. The measles virus spreads in fluid from the nose or mouth, and in airborne droplets. Persons with measles are contagious from 5 days after exposure to 5 days after the rash appears.
If you think that your child may have measles, it's important to tell your doctor immediately. Your doctor can confirm that the illness is measles and can guide you in watching for complications. He or she can also notify those health authorities who keep track of childhood immunization programs and measles outbreaks.
After symptoms have begun, gamma globulin is not effective against measles, and antibiotics do not work against the measles virus.
Children who are weakened by measles are more susceptible to infections caused by bacteria, especially bacterial infections of the ear and lungs. When this happens, antibiotics are given to treat the bacterial infection.
When to Call Your Child's Doctor:
Call your child's doctor immediately if you suspect that your child has measles. Also, call your doctor if your child has been exposed to measles and your child is an infant; is taking medicines that depress the immune system; has tuberculosis, cancer, or a disease that affects the immune system.
If your child has measles, ask your doctor what to watch for. Keep track of your child's temperature and call your doctor if it goes above 103 degres Fahrenheit (39.4 degrees Celsius). Let your doctor know if your child has an earache, since this may be a sign of a bacterial infection.
Call your doctor if a child with measles has signs that a lung infection (pneumonia) may be starting. These signs may include: breathing that is difficult or very fast; a cough that lasts for more than four or five days or that brings up discolored mucus; lips or nails that are bluish or gray. Your doctor will give you more details.
Immediately call your doctor if your child has any of the following: severe headache; stiff neck; convulsion (seizure); severe drowsiness; difficulty waking up; or loss of consciousness.