Measles (Rubeola)

Measles, historically also called "big red" measles or "10-day" measles, is a viral respiratory illness. It causes high fever, runny nose, cough, red eyes with severe sensitivity to light, and a red, blotchy rash or skin eruption.  There is a distinct rash that helps in making the diagnosis

Measles is spread from one person to another through direct contact with discharge from the nose and mouth because the virus lives in the mucus in the nose and throat. It is also spread through coughing and sneezing (airborne droplets) from an infected person.

Also, measles can live for up to 2 hours on a surface or in airspace where an infected person coughed or sneezed.  A person who touches a surface that has measles virus on it and then touches the eyes, nose or mouth, or a person who breathes the infected air can then get measles illness. 

Measles is a very contagious disease and 9 out of 10 people who are not protected by having had the measles vaccine or having had the measles illness will get measles after being exposed to a measles case.

Patients can be seen by Texas Children's experts in Infectious Disease.

Causes & Risk Factors

Measles virus, the cause of measles, is classified as a Morbillivirus. When measles was a common illness, it was mostly seen in the winter and spring. Measles is preventable by immunization with 2 doses of the measles vaccine.

Symptoms & Types

It generally takes from 7 to 14 days -- but sometimes as long as 21 days -- for a child to develop symptoms of measles after being exposed. It is important to know that a child is contagious about 4 days before the rash appears and can pass the infection to others before they even know she has measles.

During the early phase of the infection (which lasts between 1 and 4 days), symptoms usually resemble those of an upper respiratory infection with fever. The following are the common symptoms and signs of measles. However, each child may experience symptoms differently. Symptoms may include:

• Runny nose
• Hacking cough
• Conjunctivitis (pink eye) and complaints that light hurts the eyes
• Fever that may be higher than 103 to 104 degrees Fahrenheit
• Small spots with white centers (Koplik's spots) on the inside of the cheek (usually occur 2 or 3 days after symptoms begin)
• Rash. The rash normally appears about 4 days after symptoms begin.  The rash appears as red, flat spots that start on the face near the hairline and spread down to the trunk, arms, legs and feet. Small bumps may also appear on top of the flat, red spots.  When the rash appears, the fever typically becomes higher.  After 3 to 7 days, the rash will begin to clear, leaving a brownish discoloration and sometimes peeling skin.  However, the typical rash may not develop in children whose immune systems are compromised.
• Severe diarrhea 

Some people who get measles can suffer from serious complications and need to be admitted to a hospital. 

The most serious complications from measles include the following:

• Ear infections (1 out of 10 people infected) and may lead to permanent hearing loss
• Pneumonia
• Croup
• Encephalitis (inflammation of the brain) occurs in 1 out of 1,000 people infected.
• Blindness
• For every 1,000 children who get measles, 1 or 2 will die from the disease.
• A very rare but fatal complication is a serious disease of the nervous system called subacute sclerosing panecephalitis (SSPE). SSPE develops 7 to 10 years after a person has recovered from measles.

The symptoms of measles may resemble other skin conditions or medical problems. Always see your child's health care provider for a diagnosis.

Diagnosis & Tests

Measles is usually diagnosed based on a complete medical history and physical examination of your child. The characteristic measles rash is unique so many cases are diagnosed after a physical examination. In addition, your child's doctor may order a blood test or a throat or nose swab to confirm the diagnosis.

Treatment & Care

Specific treatment for measles will be determined by your child's health care provider based on:

• Your child's age, overall health, and medical history
• How sick she is
• Your child's tolerance for specific medications, procedures or therapies
• How long the condition is expected to last

The goal of treatment for measles is to help decrease the severity of the symptoms. Since it is a viral infection, antibiotics won't work. Treatment may include:

• Increased fluid intake
• Acetaminophen for fever (DO NOT GIVE A CHILD ASPIRIN)
• Vitamin A. 2 doses are recommended for all children in developing countries who get measles, to help prevent eye damage and blindness, and decrease the number of deaths from the disease. 2 doses of vitamin A also are recommended for children in the United States who have measles and are sick enough to be admitted to the hospital. Always see your child's health care provider for advice.

If your child was exposed to measles and has not been immunized against it, your child's doctor may give the measles vaccine (called the MMR vaccine) to the child within 72 hours or immune globin (IG) within 6 days of measles exposure to try to prevent the disease or make the illness less severe.

How is Measles prevented?

Since the use of the measles (or rubeola) vaccine, the incidence of measles has decreased substantially. The measles vaccine is usually given in combination with the mumps and rubella vaccine. It is called the MMR. It is usually given when the child is 12 months to 15 months old, and then again between the ages of 4 and 6 years.

MMR vaccine will prevent measles in 93% of people after getting the first dose of MMR and in 97% of people after getting 2 doses, so only a very small number of cases of measles are due to vaccine failure.   During a measles outbreak, another booster shot or getting the second dose of MMR before 4 years of age may be recommended by your child's health care provider.

Other ways to prevent the spread of measles include:

• Keeping children home from school or day care for 4 days after the rash appears. Always contact your child's health care provider for advice.
• Make sure all of your child's contacts have been properly immunized with 2 doses of MMR.