What Is Measles?

Measles (rubeola) is a highly contagious upper respiratory viral infection. Indeed, “it is the most contagious disease known to humankind,” says Amesh Adalja, MD, a senior scholar and an adjunct assistant professor who specializes in infectious diseases at the Johns Hopkins Center for Health Security in Baltimore.

After 25 years without outbreaks in the United States, measles is making a comeback as more people opt not to vaccinate.

You can stay safe and protect your family as measles gains steam by recognizing the symptoms and learning the basics of transmission, diagnosis, treatment, and prevention.

Symptoms of measles typically show up according to the following timeline.

About 7 to 14 Days After Infection

Initial symptoms include:

• High fever (may get higher than 104 degrees F)
• Cough
• Runny nose
• Red, watery eyes

About 2 to 3 Days After Symptoms Begin

White spots (called Koplik spots) may appear in the mouth.

About 3 to 5 Days After Symptoms Start

A measles rash appears, usually beginning as flat spots on the face before spreading down the neck, trunk, arms, legs, and feet.

Measles is caused by a virus in the paramyxovirus family (genus Morbillivirus) and is typically transmitted through direct contact and droplets emitted into the air when a person coughs, sneezes, talks, and breathes.

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. You can pass on the virus to someone else four days before and after a rash appears.

The virus can also be transmitted vertically, which means a pregnant woman can pass it to a fetus during pregnancy, delivery, or breastfeeding.

A healthcare practitioner who is familiar with measles may suspect it if a patient comes in with a fever, rash, runny nose, red eyes, and some history of not being vaccinated, says Amesh Adalja, MD, an assistant professor who specializes in infectious diseases at the Johns Hopkins Center for Health Security in Baltimore.

A laboratory test that uses a nasal or oral swab can confirm measles, he adds.

But diagnosis may not always be as straightforward as it sounds, says Dr. 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 very characteristic symptoms, according to Adalja, notably Koplik spots (little white spots inside the mouth).

Once a person recovers, they have immunity and won’t be able to get it again.

But there is mounting evidence that measles can devastate the immune system’s ability to fight other germs. Studies have shown 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 influenza and herpesviruses.

A person with immune amnesia is at risk for long-term health problems. An estimated 2 to 3 out of every 1,000 cases of measles will result in brain damage or death.

Medication Options

There is no specific antiviral treatment to cure the measles, and in many cases, symptoms don’t require treatment because they are mild.

At-Home Care

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

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

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Complementary and Integrative Approaches

Healthcare providers may decide to give high-dose vitamin A to infants and children as part of supportive care.

The evidence to support vitamin A as a treatment is mostly from other countries where children may not get all the vitamins and minerals they need, including vitamin A. It’s not clear if vitamin A will help people who aren’t deficient.

You shouldn’t take vitamin A unless your doctor tells you to. Excessive amounts can cause serious side effects, including liver damage.

Inhaled budesonide, a type of steroid, should not be used to cure the measles. Budesonide is an asthma medicine that can interfere with the body’s natural immune response to the virus.

The key to measles prevention is vaccination. Because measles is so contagious, a very high level of immunization in the population is critical, says Adalja.

The Measles Vaccine

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

“More than 95 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.

Can the MMR Vaccine Cause Autism?

Some people are hesitant to get their child vaccinated because of a fear that the vaccine may increase the risk of autism. A link was reported in a 1998 study that was later shown to use falsified data, and no other study since that time has ever shown a connection, including large studies that examined hundreds of thousands of children who received the MMR vaccine.

Measles Booster Shots

Because of the uptick in U.S. measles outbreaks, some adults may need a measles booster shot. People born before 1989 (which is when two doses of the vaccine began to be given, rather than one) or vaccinated between 1962 and 1967 (a period where people received a less effective vaccine) may not have full protection.

If you aren’t sure of your vaccine history, an extra dose of the MMR is a safe way to stay protected. Even if you’re unsure, it’s not harmful to get the booster.

Can Vitamin A Supplements or Cod Liver Oil Prevent Measles?

Vitamin A doesn’t prevent measles, and if a person doesn’t have measles, they should not take it as a preventive measure, according to the American Academy of Pediatrics. There is no evidence that any dose of vitamin A will protect a person from measles infection, and too much vitamin A can be toxic.

Measles can lead to serious complications in anyone, but certain groups are at a higher risk, including:

• Children younger than 5 years
• Adults older than 20
• Pregnant women
• People who have compromised immune systems, for example those with leukemia or HIV

Complications include:

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 of every 1,000 children who get 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.

Measles was declared “eliminated” from the United States in 2000, meaning that there was an absence of continuous disease transmission for a whole year. But falling vaccination rates have led to a surge in outbreaks and cases around the country.

German measles, also known as rubella or German measles rubella, is caused by a different virus from the one that causes measles. An infection usually causes a mild illness and includes symptoms such as a rash, low-grade fever, headache, and general discomfort. But German measles can be very dangerous for pregnant women and their developing babies, resulting in miscarriage or serious birth defects.

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

• Measles is an extremely contagious viral infection that can cause serious complications, including pneumonia, brain inflammation, and even death, especially in young children, pregnant women, and people with weakened immune systems.
• The best way to prevent measles is through the safe and effective MMR vaccine. Children, adults who may have received only one dose, and high-risk groups like healthcare workers should make sure their vaccinations are up-to-date.
• There’s no cure or specific treatment for measles. Supportive care, including rest, fluids, and fever management can help ease symptoms. In some severe cases, vitamin A supplements may be recommended under medical supervision.
• Although declared eliminated in the United States in 2000, measles has resurged because of declining vaccination rates. Staying informed and vaccinated is the best way to protect yourself and your community.