Measles

Measles, also known as rubeola, is a highly contagious respiratory disease caused by a virus. It spreads easily to others when an infected person breathes, coughs, or sneezes or through close personal contact. The best protection against measles is vaccination. Measles is so contagious that if one person has it, up to 9 out of 10 people around them will also become infected if they are not protected.

Visit the CDC’s website for the latest information on measles cases and outbreaks. More measles cases can occur with an increase in the number of travelers who get measles abroad and bring it into the US, and/or further spread of measles in US communities with pockets of unvaccinated people. Measles is still common in many countries throughout the world, and unvaccinated travelers can bring the disease with them when they travel to the US. Measles can spread easily throughout a community wherever groups of people are unvaccinated. With declining vaccination rates throughout the US, outbreaks in these communities are becoming more common. 

At-Risk Populations

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

Symptoms

Measles symptoms appear 7-21 days and an average of 11-12 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 one or all of the "3 C's" (cough, coryza, or conjunctivitis) and sometimes Koplik spots.

Three to five days after symptoms start, a rash may break out. It usually starts 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° F.

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: every person who has measles infects about 9 out of 10 people around them who have not been vaccinated and are not protected against measles.

The measles virus can live for up to 2hours 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 4 days before to 4 days after the rash appears.

RIDOH follows CDC guidance on isolation and exclusion requirements in educational, daycare, or healthcare settings to prevent the spread of disease in the event of a case of measles.

Prevention

Vaccination is the best prevention against measles. The vaccine that protects against measles is called MMR (measles, mumps, and rubella vaccine). About 1 in 5 people in the US who get measles without being vaccinated are hospitalized. 

Children should receive a first dose of MMR at age 12-15 months and a second dose at age 4-6 years. Adults who have not been vaccinated against measles, those who have only gotten 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 Rhode Island colleges and universities.

Healthcare workers: For new healthcare workers, 2 doses of MMR are required for pre-employment. For current healthcare workers born before 1957 who lack laboratory evidence of measles immunity or laboratory confirmation of disease, 2 doses of MMR are recommended. Those without 2 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 professionals 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 1 dose of MMR.

Travelers: People age 6 months and older who will be traveling internationally or to areas known to have measles cases should be protected against measles. Vaccinations should occur before any international travel.

Testing & Diagnosis

A healthcare professional 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.