Measles

Measles is also known as Rubeola and is a highly contagious respiratory disease caused by a virus. The measles spreads easily to others when an infected person coughs or sneezes or through close personal contact. The best protection against the measles is vaccination.

A record number of measles cases occurred in the United States in 2014, with 644 cases from 27 states. This is the highest number of cases since measles elimination was documented in the U.S. in 2000, according to the Centers for Disease Control and Prevention (CDC). The majority of people who were infected with the measles had not been vaccinated. Measles is still common in many countries throughout the world, and unvaccinated travelers can bring the disease with them when they travel to the U.S. Measles can spread easily throughout a community wherever groups of people are unvaccinated.

Guidance for Healthcare Providers

Public health officials closely monitor measles outbreaks and provide updated guidance as needed. (Rhode Island | U.S.)

At-Risk Populations

Measles can be a serious illness in all age groups. However, children younger than 5 years of age and adults older than 20 years of age are more likely to suffer from measles complications.

Symptoms

Measles symptoms appear 7 to 14 days after exposure to the virus. Symptoms typically include:

  • High fever
  • Cough
  • Runny nose (coryza)
  • Red, watery eyes (conjunctivitis)
  • Tiny white spots inside the mouth on the inner lining of the cheek (Koplik spots)
  • A rash made up of large, flat blotches. View images of measles symptoms, including rash.

The first sign of measles is usually fever, along with the "Three C's" (cough, coryza, or conjunctivitis) and sometimes Koplik spots.

Three to five days after symptoms begin, a rash may break out. It usually begins as flat red spots that appear on the face at the hairline and spread downward and outward. Small raised bumps may also appear on top of the flat red spots. The spots may become joined together as they spread from the head to the rest of the body. When the rash appears, a person’s fever may spike to more than 104° Fahrenheit.

After a few days, the fever subsides and the rash fades.

How It Spreads

The measles virus lives in the nose and throat mucus of an infected person. It can spread to others through coughing and sneezing. Measles is one of the most contagious diseases: for every one person who has measles, he or she infects about 9 out of 10 people around him or her who have not been vaccinated and are not protected against measles.

The measles virus can live for up to two hours on a surface or in a room where an infected person coughed or sneezed. For this reason, if other people enter the same space and breathe in the contaminated air or touch infected surfaces, they can also get infected with measles.

Infected people can spread measles to others from four days before to four days after the rash appears.

Prevention

Vaccination is the best prevention against the measles. The vaccine that protects against the measles is called MMR (measles, mumps, and rubella vaccine).

Children should receive a first dose of MMR between 12 and 15 months of age, and a second dose between 4 and 6 years of age. However, adults who have not been vaccinated against the measles, those who have only received one dose of MMR, or those who are not sure of their immune status can still be vaccinated.

Vaccination Recommendations and Requirements

Children & Students: Two doses of MMR are required for entry into kindergarten and all subsequent grades. Two doses of MMR are also required for entry into colleges and universities in Rhode Island.

Healthcare workers: For new healthcare workers, two doses of MMR are required for pre-employment. For current healthcare workers, two doses of MMR are recommended. (Those without two doses of MMR or who were born before 1957 will also be required to be fully vaccinated during outbreaks.)

Adults: Adults should contact their healthcare providers to find out whether they were vaccinated against the measles. Adults who were not vaccinated against the measles and who do not have evidence of immunity against the disease should get at least one dose of MMR.

Travelers: People 6 months of age and older who will be traveling internationally should be protected against measles. Vaccinations should occur prior to any international travel.

Testing & Diagnosis

A healthcare provider may offer a preliminary diagnosis of measles for patients with fever, rash, and other measles symptoms. A laboratory will confirm if the rash is caused by measles by testing nose or throat swabs, blood, and/or urine samples.

Treatment

There is no specific antiviral therapy for measles. Medical care is supportive and to help relieve symptoms and address complications such as bacterial infections.