Measles
Visit the CDC’s website for the latest information on measles cases and outbreaks. Since 2025, after 2 decades of very few measles cases, the US has had a large increase because fewer people have gotten the Measles Mumps Rubella (MMR) vaccine. Before that, most measles cases were tied to international travel. Measles is still common in many countries and easily spreads through communities where groups of people are unvaccinated. Unvaccinated travelers to and from those areas of the US and other countries can spread it to others.
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 and stays in the air for up to 2 hours after an infected person leaves the room. 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. The best protection against measles is vaccination.
Who Is at Risk
Measles can be a serious illness in all age groups. Children younger than age 5, adults older than age 20, pregnant people, and immunocompromised people are more likely to suffer from measles complications. Measles complications such middle ear infection, diarrhea, and pneumonia can range from mild to life threatening and can lead to hospitalization or death.
Symptoms
Measles symptoms appear 7-21 days (average of 11-12 days) after exposure to a person infected with 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)
- Rash View images of measles symptoms, including rash
The first sign of measles is usually fever, along with one or all of the "3 Cs" (cough, coryza, or conjunctivitis) and sometimes Koplik spots.
Three to five days after symptoms start, a rash may appear. It usually starts as flat red spots that appear on the face or back of neck at the hairline and spread downward and outward toward the arms and legs. 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 breathing, 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 2 hours 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 measles 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. Most people in the US are protected by the measles, mumps, and rubella (MMR) vaccine. Rhode Island recommends continuing to follow the American Academy of Pediatrics' recommended vaccinations for children and adolescents to protect against measles.
Vaccination Recommendations and Requirements
Children should get a first dose of MMR at age 12-15 months and a second dose at age 4-6 years. Two doses of MMR are required for entry into kindergarten and all later grades. Two doses of MMR are also required for entry into Rhode Island colleges and universities. For any child who cannot be vaccinated for medical reasons, a healthcare professional can provide information on additional prevention measures. Learn more about immunization for schools and child care facilities and workers.
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. Contact your healthcare professionals to find out if you were vaccinated against the measles. If you were not vaccinated against or do not have evidence of immunity against measles, you should get at least 1 dose of MMR.
- If you were born after 1967 and know you were vaccinated against measles as a child, you do not need a booster shot.
- If you were born before 1957, you’re generally considered immune to measles.
- If you were born in 1958-1962 or vaccinated against measles from 1963-1967, you may need a new dose of the live MMR vaccine. This is because you may not have been vaccinated or you got an inactivated (killed) vaccine version that is not as effective as modern vaccines. If you got the inactivated vaccine or aren’t sure what type of vaccine you got, talk with your healthcare professional about the possibility of getting a titer to check for immunity. Insurance may not cover the cost of a titer.
- Pregnant women should not get any live virus vaccine during pregnancy, including MMR.
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 that travel. Learn more about preventing measles before and after travel.
Infants who get a dose of MMR from age 6-11 months still need the 2 recommended doses at age 12-15 months and 4-6 years.
Learn more about preventing measles before and after travel.
MMR is required for all healthcare workers in certain facilities. For 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.
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.