What is measles?

Measles is a highly contagious viral infection that typically causes a skin rash and fevers, mostly in young children. It has the potential to cause serious complications, including death. However, due to vaccination programs, the number of measles infections and deaths have dramatically reduced. Unfortunately, measles still kills over 100,000 people a year, mainly in developing countries where vaccination rates are below 85%. [1] [2]

Fevers

An increase in body temperature above the normal temperature range. Fever is often caused by the body's immune reaction to infection.

Vaccination

The practice of administering a vaccine, a solution containing a microorganism (that causes a specific disease) in a dead or weakened state, or parts of it, for the purpose of inducing immunity in a person to that microorganism.

1. Global health observatory data repository. World Health Organisation. Accessed 3 July 2014 from

External link

2. Moss W.J. and Griffin D.E. (2012) Measles. The Lancet 379:153–164.

Causes

Measles is caused by the measles virus, also known as the rubeola virus (not to be confused with rubella, a different disease altogether).

The virus is highly contagious, meaning that an unvaccinated person who has not been infected with the measles virus before has a high chance of being infected if they are in the presence of an infected person or share household or office items with an infected person. The virus can remain infectious outside of the body for two hours.

When an infected person sneezes or coughs, the virus spreads via millions of tiny droplets, each containing many viruses that are spread into the air. If a droplet enters your nose or mouth, you may then be infected. The droplets can also collect on surfaces and objects, so you can also catch the virus by touching an infected surface and then touching your nose or mouth area.

Sneezing.An infected person can spread the measles virus in the air via sneezes or coughs. 

Virus

A microscopic infectious agent that replicates itself only within cells of living hosts; a piece of nucleic acid (DNA or RNA) wrapped in a protein coat.

1. Global health observatory data repository. World Health Organisation. Accessed 3 July 2014 from

External link

2. Moss W.J. and Griffin D.E. (2012) Measles. The Lancet 379:153–164.

Risk factors

Anyone can catch measles if they have not been vaccinated or previously infected. Children between 1-4 years of age are most at risk of catching measles.

Breastfed newborn babies are often protected against infection by antibodies they receive from their mother during pregnancy and through breastmilk. However, this protection gradually decreases throughout the first year of life.

Antibodies

A protein molecule produced by the immune system. Antibodies bind specifically to foreign substances to neutralise them or target them for destruction.

Vaccinated

Having received a vaccine, which is a medication for the purpose of creating immunity to a specific infectious condition.

1. Global health observatory data repository. World Health Organisation. Accessed 3 July 2014 from

External link

2. Moss W.J. and Griffin D.E. (2012) Measles. The Lancet 379:153–164.

Signs and symptoms

The symptoms of measles usually appear about 7-12 days after the infection.

Early symptoms

Early symptoms of measles resemble cold symptoms. They can include:

  • Mild to moderate fever;
  • Dry, hacking cough;
  • Sore throat;
  • Sneezing;
  • Runny nose;
  • Reddish, watery eyes that are sensitive to light, and;
  • Malaise - a feeling of weakness and discomfort.

Later symptoms

  • Koplik's spots - small white spots inside the mouth appear about 2-3 days after the start of the early symptoms and normally disappear after a day or so;
  • A reddish, blotchy rash appears about 3-5 days after the start of the early symptoms. The rash usually starts on the face and behind the ears and gradually spreads downwards to the whole of the body, and;
  • Along with the rash, fever can increase in severity to above 40°C.

The symptoms of measles normally last about 7-10 days, then go away naturally unless there are complications. An infected person is contagious from around five days before the appearance of the rash.

The measles rash start at the face and spreads to the body.A reddish, blotchy rash is one of the later symptoms of measles. 

Fever

An increase in body temperature above the normal temperature range. Fever is often caused by the body's immune reaction to infection.

1. Global health observatory data repository. World Health Organisation. Accessed 3 July 2014 from

External link

2. Moss W.J. and Griffin D.E. (2012) Measles. The Lancet 379:153–164.

Methods for diagnosis

Measles can be diagnosed based upon the symptoms and signs, especially the distinctive rash. Blood tests (checking for the presence of the virus and for antibodies against it) can confirm the diagnosis. A viral culture can be done to find the specific type of virus, which is important for tracking outbreaks in the community.

Antibodies

A protein molecule produced by the immune system. Antibodies bind specifically to foreign substances to neutralise them or target them for destruction.

Blood tests

During a blood test, blood can be drawn using a needle or by a finger prick. Your blood can then be analysed to help diagnose and monitor a wide range of health conditions.

Virus

A microscopic infectious agent that replicates itself only within cells of living hosts; a piece of nucleic acid (DNA or RNA) wrapped in a protein coat.

1. Global health observatory data repository. World Health Organisation. Accessed 3 July 2014 from

External link

2. Moss W.J. and Griffin D.E. (2012) Measles. The Lancet 379:153–164.

Types of treatment

There is no specific treatment for measles. Treating a measles patient focuses on relieving some of the symptoms while the patient's immune system handles the disease. Some measures that can be taken to ease symptoms are:

  • Rest;
  • Medicines to reduce fever and coughing and ease throat soreness;
  • Drinking plenty of fluids to prevent dehydration, especially if diarrhoea occurs (see below);
  • Relieving eye dryness by dabbing them gently with moist cotton wool, and;
  • Reducing eye strain by minimising exposure to light.

There is extensive evidence to suggest that malnutrition in children, especially vitamin A deficiency, results in more severe disease and increased risk of death. [3] Treating an associated vitamin A deficiency with vitamin A supplements can result in better outcomes and reduced risk of death.

For a person who has measles or is at a high risk of infection, a doctor may recommend treatment with immunoglobulin G - antibodies against measles.

Antibodies

A protein molecule produced by the immune system. Antibodies bind specifically to foreign substances to neutralise them or target them for destruction.

Dehydration

The state of insufficient hydration; excessive loss of water; requiring more water in order to function normally.

Fever

An increase in body temperature above the normal temperature range. Fever is often caused by the body's immune reaction to infection.

Immune system

The organs and cells involved in protecting the body against infection.

Malnutrition

A condition in which a person does not receive the right amount of nutrients such as vitamins, minerals and proteins.

Immunoglobulin G

A type of antibody produced by the body in response to an infection by bacteria, viruses or fungi, to protect the body in the future from the same infection.

Vitamin A

A fat-soluble vitamin essential for skeletal growth, good vision and reproduction.

3. Hussey G.D. and Klein M. (1990) A randomized controlled trial of vitamin A in children with severe measles. New England Journal of Medicine 323:160–164.

Potential complications

Complications of measles appear in 30-40% of cases. [2] [ 4] Some of the complications of measles include:

Diarrhoea

Diarrhoea can appear in 8% of measles cases.

Pneumonia

A bacterial or viral infection of the lungs, pneumonia appears in about 6% of all measles cases and is responsible for most measles-related deaths, particularly among children.

Stomatitis

Stomatitis is the formation of mouth sores. These can make eating and drinking painful and uncomfortable.

Earache

Middle ear infection appears in 7% of all measles cases and can cause acute earache and discomfort.

Keratoconjunctivitis

This is an inflammation of the eyes (specifically the cornea and conjunctiva) that can lead to blindness.

Pregnancy complications

If a woman is infected with measles during pregnancy, serious complications can arise for both the mother and the baby. Increased fetal and maternal death, maternal pneumonia and encephalitis (see below), preterm birth, miscarriage and lower birth weight are among some of the many potential complications. 

Encephalitis

This is inflammation of the brain. A rare but serious complication of measles, it occurs in about one out of 1000 cases. [2] It is more common in adults and carries a high risk of death or significant brain damage.

Late-onset complications

In rare cases, some complications of measles can appear months or years after infection. Measles inclusion body encephalitis (MIBE) and subacute sclerosing panencephalitis (SSPE) are two serious late-onset complications. They affect the central nervous system and can be fatal. [2]

Central nervous system

The part of the body's nervous system that includes the brain and the spinal cord.

Conjunctiva

The mucous membrane that lines the inner surface of the eyelid and covers the front of the eye.

Cornea

The clear, dome-shaped structure at the front of the eye. It sits in front of the iris and pupil and helps to focus light onto the retina at the back of the eye.

2. Moss W.J. and Griffin D.E. (2012) Measles. The Lancet 379:153–164.

4. Measles cases and outbreaks. Centers for disease control and prevention. Accessed 3 July 2014 from

External link

2. Moss W.J. and Griffin D.E. (2012) Measles. The Lancet 379:153–164.

2. Moss W.J. and Griffin D.E. (2012) Measles. The Lancet 379:153–164.

Prognosis

If no complications ensue, measles clears up on its own after 7-10 days.

2. Moss W.J. and Griffin D.E. (2012) Measles. The Lancet 379:153–164.

4. Measles cases and outbreaks. Centers for disease control and prevention. Accessed 3 July 2014 from

External link

2. Moss W.J. and Griffin D.E. (2012) Measles. The Lancet 379:153–164.

2. Moss W.J. and Griffin D.E. (2012) Measles. The Lancet 379:153–164.

Prevention

Two doses of the measles vaccine are routinely recommended in children to reduce their risk of developing measles. The first dose is usually given at 12 months of age, as part of the measles, mumps, rubella (MMR) vaccine, and the second dose is given at 18 months as part of the measles, mumps, rubella, varicella (MMRV) combined vaccine. It can also be given to children over nine months old shortly after they have been exposed to the measles virus, but before symptoms of the disease begin to appear. Babies younger than nine months may be offered immunoglobulin G if exposed to the virus, depending on their individual situation.

In the case of an outbreak of measles in a community, infected and unvaccinated children may be asked to stay home and not come to day care or school until the situation improves.

Precaution

In recent years, some developed countries have seen a drop in vaccination rates. As a result, measles is making something of a comeback in the developed world, with tens of thousands of new cases reported annually in Europe and hundreds a year in the United States. [4] [5] Recent US cases are mostly due to unvaccinated people bringing measles with them from travel abroad.

Vaccination

The practice of administering a vaccine, a solution containing a microorganism (that causes a specific disease) in a dead or weakened state, or parts of it, for the purpose of inducing immunity in a person to that microorganism.

Vaccine

A preparation containing a microorganism (that causes a specific disease) in a dead or weakened state, or parts of it, for the purpose of inducing immunity in a person to that microorganism.

Virus

A microscopic infectious agent that replicates itself only within cells of living hosts; a piece of nucleic acid (DNA or RNA) wrapped in a protein coat.

Immunoglobulin G

A type of antibody produced by the body in response to an infection by bacteria, viruses or fungi, to protect the body in the future from the same infection.

4. Measles cases and outbreaks. Centers for disease control and prevention. Accessed 3 July 2014 from

External link

5. Muscat M. Bang H. Wohlfahrt J. et al. (2009) Measles in Europe: an epidemiological assessment. The Lancet 373:383–389.