Vaccines and Your Immune System

Measles

What Is Measles? Symptoms, Causes, Diagnosis, Treatment, and Prevention

Becky Upham
By Medically Reviewed by 
Reviewed:
Medically Reviewed

Measles is an upper respiratory viral infection that can be a relatively mild disease for many people, but about 20 percent of those infected with the virus can experience complications that require hospitalization, according to Amesh Adalja, MD, an assistant professor who specializes in infectious diseases at the Johns Hopkins Center for Health Security in Baltimore. “It was a very common disease in the United States until a highly effective vaccine was introduced in the early 1960s,” he says.

Signs and Symptoms of Measles

Symptoms of measles typically show about 7 to 14 days after infection. The virus causes a number of symptoms, most notably:

  • High fever (may get higher than 104 degrees F)
  • Cough
  • Runny nose
  • Red, watery eyes
  • White spots in the mouth
  • Rash
It can also lead to serious complications, including ear infections, pneumonia, diarrhea, and encephalitis (brain inflammation).

Measles is also known as rubeola, which is not the same thing as rubella (sometimes called German measles or three-day measles).

Rubella is a different virus-borne illness that causes similar symptoms, including a red rash and fever.

Learn More About Signs and Symptoms of Measles

Causes and Risk Factors of Measles

Measles is caused by a virus in the paramyxovirus family and is typically transmitted through direct contact and air.

When the measles virus enters the body, it initially infects immune cells known as macrophages and dendritic cells. The infected cells replicate and move to the lymph nodes, where they transfer the virus to lymphocytes (types of white blood cells) known as B and T cells.

Those infected cells move throughout the body and release virus particles into the blood. The spleen, lymph nodes, liver, thymus, skin, and lungs can all become infected with the virus.

The infection of the lungs causes the coughing and sneezing, which is the main way that measles is spread. The virus can survive on a surface or in an airspace where an infected person coughed or sneezed for up to two hours.

You can get measles if you breathe in contaminated air or touch your eyes, nose, or mouth after touching an infected surface. You can pass on the virus to someone else four days before and after a rash appears.

Measles is highly contagious — so much so that 90 percent of people who are close to an infected person and not immune to the virus will catch it.

Only humans (not animals) transmit the measles virus. You are at risk of getting measles if you are not vaccinated, were vaccinated but didn’t develop immunity to the virus, or travel in undeveloped countries with low rates of measles vaccinations.

How Is Measles Diagnosed?

“In general, if a doctor is examining a child with a fever, rash, runny nose and red eyes, and usually some history of not being vaccinated, they will suspect measles,” says Dr. Adalja. A laboratory test that uses a nasal or oral swab can confirm the diagnosis, he adds.

The diagnosis may not always be as straightforward as it sounds, says Adalja. “In the United States, many doctors have never seen a case of measles, and so sometimes they don’t even think to suspect it,” he says.

Many types of childhood viral diseases are accompanied by a rash, but measles does have some characteristic findings, according to Adalja. “If you look inside the mouth of someone with measles, they have something called Koplik spots, which are little white spots that are very characteristic of measles,” he says.

Prognosis of Measles

For most people, the prognosis of measles is excellent.

Once a person recovers from measles, they have immunity and won’t be able to get it again.
There is mounting evidence that the measles infection can impair the body’s immune memory. A study published in 2019 showed that the measles virus can wipe out 11 to 73 percent of the different antibodies that protect against viruses and bacteria to which a person previously had immunity, including pathogens like the flu and the herpes virus.

According to researchers, this immune suppression could last as long as two to three years.
There can be severe complications with measles that can cause long-term health problems.

This can vary from person to person.

Duration of Measles

The first indication of the disease is usually a high fever, which typically starts about 10 to 12 days after exposure to the virus.

The fever usually lasts four to seven days; other symptoms, such as a runny nose, cough, red and watery eyes, and small white spots inside the cheeks, can develop during this stage.

After this period, a rash (usually on the face and upper neck) appears. Over about a three-day period, it spreads all over the body, eventually reaching the hands and feet. The rash typically lasts five to six days until it fades.

Treatment and Medication Options for Measles

Medication Options

There is no specific antiviral treatment to cure the measles.

At-Home Care

Measles is mostly treated with supportive care, says Adalja. There are things you can do to help relieve symptoms, including:

  • Take over-the-counter pain relievers for pain and fever. Options include acetaminophen (Tylenol) or ibuprofen (Advil). Aspirin (Vazalore) should never be given to a child with a viral illness, as this has been linked to Reye’s syndrome, which can damage the brain and liver.
  • Drink lots of fluids.
  • Get as much rest as possible.

Complementary and Integrative Approaches

In parts of the developing world, some people with severe cases of the measles are given high doses of vitamin A, says Adalja. All children diagnosed with measles should get two doses of vitamin A supplements given 24 hours apart.

Healthcare professionals are advised to follow the same guidance.

Treating with vitamin A can help prevent eye damage and blindness and reduce the number of measles deaths.


Learn More About Treatment for Measles: Medication, Alternative and Complementary Therapies, and More

Prevention of Measles

The key to preventing measles is vaccination, says Adalja. “Because measles is the most contagious disease known to humankind, you need to have a very high level of immunity in the population,” he says.

Measles can be prevented with the measles, mumps, and rubella (MMR) vaccine. In the United States, routine immunization with the measles, mumps, and rubella (MMR) vaccine is recommended for children at 12 to 15 months and 4 through 6 years old.

“More than 90 percent of a population needs to be protected, or this virus will find a way to spread. That’s why the herd immunity threshold for measles is very high, much higher than for any other infectious disease,” says Adalja.

According to a 2020 article, herd immunity “works to control the spread of disease within a population when a specific amount of that population (threshold) becomes immune to the disease through vaccination or infection and recovery.”

“Measles is a great example of the fact that vaccines work — before the vaccine, this disease left a mark on almost every American child,” says Adalja. In the decade before 1963 when the vaccine became available, almost every child in the United States got measles before they turned 15 years old. It’s estimated that three to four million people in the United States were infected with measles each year, and an estimated 400 to 500 people died of complications.

Complications of Measles

About 1 out of 5 unvaccinated people in the United States who gets measles is hospitalized.

Complications can happen to anyone, but certain groups are at a higher risk including:
  • Children younger than age 5
  • Adults older than age 20
  • Pregnant women
  • People who have compromised immune systems, for example those with leukemia or HIV infection
Pneumonia About 1 out of every 20 children with measles gets pneumonia, which is infection of the lungs. It’s the most common cause of death from measles in children.


Brain Infection Also called encephalitis, this infection results in swelling of the brain. This happens in about 1 out every 1,000 children who gets measles, and it can lead to hearing loss or permanent intellectual disability.

Ear Infection Approximately 10 percent of children who get measles also get an ear infection, which can result in permanent hearing loss.

Subacute Sclerosing Panencephalitis (SSPE) This fatal disease of the central nervous system is a very rare complication that results from a measles infection. It generally happens 7 to 10 years after a person has the measles infection. This disease is rarely reported in the United States.

Research and Statistics: How Many People Have Measles?

In 2019 there were an estimated 207,500 deaths due to measles around the world, the highest number in 23 years and 50 percent higher than the number of deaths in 2016, according to a 2020 report.

Authors of the report blame years of insufficient vaccination coverage around the globe. There are also concerns that the COVID-19 pandemic made things worse, as vaccination rates have gone down.

Measles was declared “eliminated” from the United States in 2000, meaning that there was an absence of continuous disease transmission for a whole year, and the disease is no longer native to the country.

However, that’s not to say people don’t ever get measles: Outbreaks of measles can still happen.

From 2000 to 2013, between 37 and 220 cases of measles were reported in the United States. Most of those cases originated outside the country.

In 2015, more than 150 people in the United States reportedly got the disease, mostly from a measles outbreak at the Disneyland amusement park in Anaheim, California.

During the period of January through December 2019, there were 1,274 cases of measles reported in the United States, the highest annual number since 1992. It’s estimated that 89 percent of those infected were unvaccinated or had an unknown vaccination status, and 10 percent were hospitalized. However, no measles deaths were reported in the United States in 2019.

Approximately 86 percent of those cases were associated with underimmunized, close-knit communities, including two outbreaks in New York Orthodox Jewish communities.

COVID-19 and Measles

One of the tragedies of the COVID-19 pandemic, says Adalja, is that measles vaccination efforts around the world faltered. “Even in the United States, we saw measles vaccination rates go down during the height of the pandemic, in the spring when there were stay-at-home orders, and nonemergency care was suspended,” he says. Measles remains a threat, and the more people that get the measles vaccine, the quicker we can eradicate this virus from the planet, he adds.

Related Conditions of Measles

Rubella, or German Measles Rubella, also known as German measles, is an infection that usually causes a mild illness and includes symptoms such as a rash, low-grade fever, headache, and general discomfort.

About 25 to 50 percent of people infected with rubella won’t have any symptoms.

The infection can be prevented with the MMR vaccine, the same vaccine used for measles prevention.

Resources We Love

Centers for Disease Control and Prevention (CDC)

The CDC website provides comprehensive, up-to-date information about infectious diseases, such as measles, found in the United States and around the world.

FamilyDoctor.org

This website, from the American Academy of Family Physicians, offers education and medical advice on a variety of conditions, including measles.

MedlinePlus

MedlinePlus is a service of the National Library of Medicine, the world’s largest medical library, which is part of the National Institute of Health (NIH). The agency provides health and wellness information in both English and Spanish.

Additional reporting by Joseph Bennington-Castro.

Editorial Sources and Fact-Checking

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