Merck Manual

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(Rubeola; 9-Day Measles)


Brenda L. Tesini

, MD, University of Rochester School of Medicine and Dentistry

Reviewed/Revised Jun 2023
Topic Resources

Measles is a highly contagious viral infection that causes various cold-like symptoms and a characteristic rash.

  • Measles is caused by a virus.

  • Symptoms include fever, runny nose, hacking cough, red eyes, and a red itchy rash.

  • The diagnosis is based on typical symptoms and the characteristic rash.

  • Treatment is aimed at relieving symptoms.

  • Although the majority of children recover, measles can be fatal or lead to brain damage.

  • Routine vaccination can prevent the infection.

Before measles vaccination became widely available, measles epidemics occurred every 2 or 3 years, particularly in preschool-aged and school-aged children. Small, localized outbreaks occurred during the other years.

Measles is still common in some countries. Worldwide, each year, measles infects about 10 million people and causes about 134,000 deaths, primarily in children.

In the United States, measles is uncommon because of routine childhood vaccination. From 2000 to 2010, an average of only 63 cases per year were reported to the Centers for Disease Control and Prevention (CDC). However, in 2019, 1,274 cases of measles were reported to the CDC. That was the highest number reported since 1992. That increase was mostly caused by unvaccinated people who became infected in countries where measles is more common and then traveled to the United States.

Measles infection is more likely to spread in communities where many people live closely together, such as college campuses or other close-knit communities. Lack of routine childhood vaccination Childhood Vaccination Concerns Despite the strong vaccine safety systems in place in the United States, some parents remain concerned about the use and schedule of vaccines in children. These concerns can lead some parents... read more also contributes to the increase in diseases that could be prevented by vaccines.

A woman who has had measles or has been vaccinated passes immunity (in the form of antibodies) to her child. This immunity lasts for most of the first year of life. Thereafter, however, susceptibility to measles is high unless vaccination is given. A person who has had measles develops immunity and typically cannot contract it again.

People become infected with measles by breathing in small airborne droplets of moisture coughed out by an infected person. Most people who are not immune to measles develop the infection after they are exposed to a person with measles. Measles is contagious from 4 days before until 4 days after the rash appears.


Symptoms of Measles

Measles symptoms begin about 7 to 14 days after infection. The infected child first develops a fever, runny nose, hacking cough, and red eyes. Sometimes the eyes are sensitive to bright light. Before the rash begins, tiny, bright red spots with white or bluish white centers (Koplik spots) may appear inside the mouth. These white or bluish white centers may resemble grains of sand. Then the child develops a sore throat.

A mildly itchy rash appears 3 to 5 days after the start of symptoms. The rash begins on the face in front of and below the ears and on the side of the neck and looks like irregular, flat, red areas that soon become raised. The rash spreads within 1 to 2 days to the trunk, arms, palms, legs, and soles and then begins to fade on the face.

At the peak of the illness, the child feels very sick and develops eye inflammation (conjunctivitis), the rash is extensive, and the temperature may exceed 104° F (40° C). In 3 to 5 days, the temperature falls, the child begins to feel better, and any remaining rash quickly fades. The rash turns a brownish color, and then the skin peels.

Complications of measles

Brain infection (see encephalitis Encephalitis Encephalitis is inflammation of the brain that occurs when a virus directly infects the brain or when a virus, vaccine, or something else triggers inflammation. The spinal cord may also be involved... read more ) occurs in about 1 out of 1,000 children with measles. If encephalitis occurs, it often starts with a high fever, headache, seizures, and coma, usually 2 days to 2 weeks after the rash appears. The illness may be brief, with recovery in about 1 week, or it may be prolonged, resulting in brain damage or death.

Excessive bleeding may occur after the measles infection resolves because the person's blood platelet levels become low (thrombocytopenia Overview of Thrombocytopenia Thrombocytopenia is a low number of platelets (thrombocytes) in the blood, which increases the risk of bleeding. Thrombocytopenia occurs when the bone marrow makes too few platelets or when... read more Overview of Thrombocytopenia ). People usually have bruising of the skin and mild bleeding, but occasionally bleeding is severe.

Diagnosis of Measles

  • A doctor's evaluation

The diagnosis of measles is based on the typical cold-like symptoms, Koplik spots, and characteristic rash.

Blood tests to identify the virus are done mainly to document cases for public health purposes so that health officials can try to contain outbreaks and limit further spread.

Treatment of Measles

  • Vitamin A

  • Drugs to reduce fever

Infected people who are hospitalized should be placed in special hospital rooms and isolated from others during their illness. Infected people who are not hospitalized should severely limit contact with others during their illness.

Doctors give vitamin A to children with measles, because vitamin A has been shown to reduce the number of deaths and serious disease resulting from measles in countries where vitamin A deficiency Vitamin A Deficiency Vitamin A deficiency can result from a diet low in vitamin A or an absorption or liver disorder. Night blindness is an early symptom. Blindness can eventually develop. The eyes, skin, and other... read more is common.

Children with measles are kept warm and comfortable.

Acetaminophen or ibuprofen may be given to reduce fever.

Prognosis for Measles

Worldwide, approximately 134,000 people die each year of measles, typically from complications of pneumonia or encephalitis.

Prevention of Measles

  • MMR vaccine

Prevention before exposure

The MMR vaccine generally provides lasting immunity and has decreased cases of measles in the United States by 99%.

Two doses of MMR vaccine are routinely recommended. The first dose is given between 12 and 15 months of age but can be given to children as young as 6 months during a measles outbreak or before international travel. The second dose is given between 4 years and 6 years of age.

Children who were less than 1 year of age when immunized still need 2 more doses after their first birthday.

MMR is a live vaccine and is not given during pregnancy.

Preventive treatment after exposure

Children (and adults) who are exposed to measles and who do not have immunity may be given the vaccine within 3 days of exposure and may then be protected.

People who should not receive the MMR vaccine, such as pregnant women and people with a severely weakened immune system, may be protected if they receive an injection of immune globulin within 6 days of exposure. People who receive immune globulin can be given the MMR vaccine 5 to 6 months later if possible.

Drugs Mentioned In This Article

Generic Name Select Brand Names
A Mulsin, Aquasol A, Dofsol-A
7T Gummy ES, Acephen, Aceta, Actamin, Adult Pain Relief, Anacin Aspirin Free, Apra, Children's Acetaminophen, Children's Pain & Fever , Comtrex Sore Throat Relief, ED-APAP, ElixSure Fever/Pain, Feverall, Genapap, Genebs, Goody's Back & Body Pain, Infantaire, Infants' Acetaminophen, LIQUID PAIN RELIEF, Little Fevers, Little Remedies Infant Fever + Pain Reliever, Mapap, Mapap Arthritis Pain, Mapap Infants, Mapap Junior, M-PAP, Nortemp, Ofirmev, Pain & Fever , Pain and Fever , PAIN RELIEF , PAIN RELIEF Extra Strength, Panadol, PediaCare Children's Fever Reducer/Pain Reliever, PediaCare Children's Smooth Metls Fever Reducer/Pain Reliever, PediaCare Infant's Fever Reducer/Pain Reliever, Pediaphen, PHARBETOL, Plus PHARMA, Q-Pap, Q-Pap Extra Strength, Silapap, Triaminic Fever Reducer and Pain Reliever, Triaminic Infant Fever Reducer and Pain Reliever, Tylenol, Tylenol 8 Hour, Tylenol 8 Hour Arthritis Pain, Tylenol 8 Hour Muscle Aches & Pain, Tylenol Arthritis Pain, Tylenol Children's, Tylenol Children's Pain+Fever, Tylenol CrushableTablet, Tylenol Extra Strength, Tylenol Infants', Tylenol Infants Pain + Fever, Tylenol Junior Strength, Tylenol Pain + Fever, Tylenol Regular Strength, Tylenol Sore Throat, XS No Aspirin, XS Pain Reliever
Advil, Advil Children's, Advil Children's Fever, Advil Infants', Advil Junior Strength, Advil Migraine, Caldolor, Children's Ibuprofen, ElixSure IB, Genpril , Ibren , IBU, Midol, Midol Cramps and Body Aches, Motrin, Motrin Children's, Motrin IB, Motrin Infants', Motrin Junior Strength, Motrin Migraine Pain, PediaCare Children's Pain Reliever/Fever Reducer IB, PediaCare Infants' Pain Reliever/Fever Reducer IB, Samson-8
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