Overview
Measles is a highly contagious viral illness that spreads through the air when an infected person coughs or sneezes. The virus can stay in the air or on surfaces for up to two hours.
It is most common in children and can be serious, especially in babies, young children and malnourished children. It also weakens the immune system for a time.
Symptoms
Symptoms usually begin 7 to 14 days after contact. The illness starts like a bad cold:
- High fever
- Runny nose and sneezing
- Cough
- Red, sore, watery eyes
- Tiny white spots inside the cheeks, before the rash
A few days later a rash appears, usually on the face and behind the ears first, then spreading down the body. It looks red or brown, is harder to see on brown or black skin, and is usually not itchy. It lasts about 4 to 8 days.
When to see a doctor
See a doctor soon if you think your child has measles, and phone the clinic first so that your child can be kept apart from other patients. Seek advice too if a high fever does not come down with paracetamol, if the child drinks or passes urine much less, or after close contact with measles in a baby under one year, a pregnant woman, an unvaccinated person or someone with weak immunity.
Causes
Measles is caused by the measles virus. It spreads through droplets from the nose and throat of an infected person, and by breathing in air that person has breathed out. A person can spread it from about 4 days before the rash appears until about 4 days after.
Risk factors
- Not being vaccinated, or having had only one dose
- Babies and children under 5, who are more likely to have complications
- Malnutrition, especially a lack of vitamin A
- A weak immune system, for example from HIV
- Pregnancy
- Crowded living conditions
Complications
Complications are more likely in young children and those with poor nutrition or weak immunity:
- Ear infection and severe diarrhoea
- Pneumonia, an infection of the lungs
- Brain swelling (encephalitis) or meningitis, which can cause fits and lasting brain damage
- Blindness, especially where vitamin A is lacking
- Miscarriage, stillbirth, early birth or a small baby, if it happens in pregnancy
- Death
Prevention
- Vaccination is the best protection. In India the measles-rubella (MR) is given in two doses, at 9 to 12 months and at 16 to 24 months
- Ask a doctor about catching up if a child missed a dose, or an older child or adult was never vaccinated
- Keep a child with measles at home until at least 4 days after the rash appears, and away from babies, pregnant women and people with weak immunity
- Wash hands often, bin tissues at once, and do not share cups, towels or bedding
Diagnosis
Doctors often recognise measles from the fever, cough, red eyes and rash, and from the white spots inside the cheeks. Because many illnesses cause a rash, the diagnosis is usually confirmed with a blood test for measles antibodies and a swab from the nose or throat to look for the virus (PCR).
Treatment
No medicine kills the measles virus. Treatment is supportive: rest, plenty of fluids and a healthy diet. Paracetamol can ease fever and discomfort. Sticky eyes can be wiped gently with cotton wool soaked in cooled boiled water. Most children begin to improve within about a week.
For children under 5 with suspected measles, the WHO recommends vitamin A on two days in a row, given as the doctor advises. It helps protect the eyes and may lower the risk of death.
are used only for complications caused by bacteria, such as pneumonia or ear and eye infections.
Myths and facts
Things people often say about this. Open each one to see what is true.
Myth“Measles is a mild childhood illness that every child should simply go through.”What is true?
Fact
Measles can cause pneumonia, brain swelling, severe diarrhoea, ear infections and blindness, and most deaths from measles come from these complications. Children under 5, children who are malnourished or lack vitamin A, and those with weak immunity are at higher risk. It also weakens the body's defences against other infections for a time.
Myth“Measles is a visit from the goddess, so the child should not be taken to a doctor.”What is true?
Fact
Families rightly keep a sick child comfortable at home, but measles is an infection caused by a virus that spreads through the air. A doctor can look for complications such as pneumonia and ear infection, which can be treated, and can advise vitamin A, which helps protect the eyes.
Myth“One dose of the vaccine is enough.”What is true?
Fact
Two doses are needed, because not every child develops immunity after the first. In India the first MR dose is given at 9 to 12 months and the second at 16 to 24 months.
Myth“A child is infectious only once the rash has come out.”What is true?
Fact
A person with measles can spread it from about 4 days before the rash appears until about 4 days after. So a child can pass on the virus before anyone knows it is measles. Keep the child away from others, especially babies, pregnant women and people with weak immunity.
Myth“Antibiotics will cure measles.”What is true?
Fact
Antibiotics do not work against the measles virus. Doctors use them only to treat complications caused by bacteria, such as pneumonia, or ear and eye infections.
Questions to ask your doctor
Tick the ones you want answered and take them with you.
Common questions
How long is a child with measles infectious?
A person can spread measles from about 4 days before the rash appears until about 4 days after. Keep the child at home and away from babies, pregnant women and people with weak immunity until at least 4 days after the rash first appears.
Can a vaccinated child still get measles?
It is uncommon, because two doses give strong protection. A small number of children do not develop immunity even after vaccination, which is one reason a second dose is given and why high vaccination rates in the community matter.
Can adults get measles?
Yes. Anyone who has not been vaccinated and has not had measles can catch it, and adults over 30 are at higher risk of complications. In pregnancy it can cause serious harm to the baby, so a pregnant woman who has been near measles should speak to a doctor.
My baby has been near someone with measles. What should I do?
Contact a doctor soon, even if the baby seems well, because babies are at higher risk of complications. Phone the clinic before you go, so that the baby can be kept away from other patients.
