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Measles

Last updated: May 16, 2021

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Measles (Rubeola) is a highly infectious disease that is caused by the measles virus. There are two phases of disease: a catarrhal (prodromal) stage and an exanthem stage. The catarrhal stage is characterized by a fever with conjunctivitis, coryza, cough, and pathognomonic Koplik spots on the buccal mucosa. The sudden development of a high fever, malaise, and exanthem represents the next phase. The exanthem stage is typically characterized by an erythematous maculopapular rash that originates behind the ears and spreads to the rest of the body towards the feet. Infection is usually self-limiting and followed by lifelong immunity. Disease management includes vitamin A supplementation, symptomatic treatment, and possible post-exposure prophylaxis (PEP). Measles causes transient immunosuppression and may lead to serious complications such as encephalitis, otitis, or pneumonia. A rare but lethal late complication of measles is subacute sclerosing panencephalitis (SSPE), which may also affect immunocompetent individuals. Active immunization against measles is available in form of a combination vaccine against mumps and rubella (MMR). The first dose is recommended between the ages of 12 and 15 months and the second dose between 4 and 6 years of age or at least 28 days after the first dose. The prognosis is good in uncomplicated cases. However, newborns and immunocompromised patients are more likely to suffer from severe complications.

  • Distribution: Measles typically occurs in regions with low vaccination rates and in resource-limited countries. [1]
  • Peak incidence: < 12 months of age [1]
  • Infectivity [1]
    • ∼ 90%
    • Highly contagious 4 days before and up to 4 days after the onset of exanthem.

Epidemiological data refers to the US, unless otherwise specified.

Incubation period

  • Duration: ∼ 2 weeks after infection

Prodromal stage (catarrhal stage) [2]

Exanthem stage [2]

  • Duration: ∼ 7 days (develops 1–2 days after enanthem)
  • Presentation

Recovery stage

The cough may persist for another week and may be the last remaining symptom.

The most important findings of measles are the 3 Cs and 1 K: Coryza, Cough, Conjunctivitis, and Koplik spots.

Measles should be suspected in a patient with typical clinical findings. Laboratory tests are always necessary to confirm the diagnosis. [3]

Subacute sclerosing panencephalitis (SSPE) [1][6][7]

Other complications [1][6]

Complications are likely to occur when the fever does not subside after a few days after onset of the exanthem.

We list the most important complications. The selection is not exhaustive.

  • The prognosis of measles infection is good in uncomplicated cases.
  • Fatal courses are more likely in newborns and immunocompromised patients.
  • High fatality rate in resource-limited countries due to secondary bacterial infections.

Immunization [1][3]

Primary immunization

Postexposure prophylaxis (PEP)

Reporting regulations [1][3]

  1. Measles (Rubeola) - For Healthcare Professionals. https://www.cdc.gov/measles/hcp/index.html. Updated: August 10, 2016. Accessed: March 18, 2017.
  2. Orenstein WA, Perry RT, Halsey NA. The clinical significance of Measles: a review. J Infect Dis. 2004; 189 : p.4-16. doi: 10.1086/377712 . | Open in Read by QxMD
  3. Manual for the Surveillance of Vaccine-Preventable Diseases - Chapter 7: Measles. https://www.cdc.gov/vaccines/pubs/surv-manual/chpt07-measles.html#reporting. Updated: April 1, 2014. Accessed: March 18, 2017.
  4. Measles. http://www.who.int/mediacentre/factsheets/fs286/en/. Updated: November 1, 2016. Accessed: March 18, 2017.
  5. Villamor E, Fawzi WW. Effects of vitamin A supplementation on immune responses and correlation with clinical outcomes. Clin Microbiol Rev. 2005; 18 (3): p.446-464. doi: 10.1128/CMR.18.3.446-464.2005 . | Open in Read by QxMD
  6. Complications of Measles. https://www.cdc.gov/measles/about/complications.html. Updated: February 17, 2015. Accessed: March 18, 2017.
  7. Jafri SK, Kumar R, Ibrahim S. Subacute sclerosing panencephalitis – current perspectives. Pediatric Health, Medicine and Therapeutics. 2018; Volume 9 : p.67-71. doi: 10.2147/phmt.s126293 . | Open in Read by QxMD
  8. Duyckaerts C, Litvan I. Dementias. Elsevier ; 2008
  9. Garg RK. Review Subacute sclerosing panencephalitis. Postgraduate Medical Journal. 2002; 78 : p.63-70. doi: 10.1136/pmj.78.916.63 . | Open in Read by QxMD
  10. R Garg. Subacute sclerosing panencephalitis. Postgraduate Medical Journal. 2002 .
  11. D.L. Fisher, S. Defres, T. Solomon. Measles-induced encephalitis. QJM: An International Journal of Medicine. 2014 .
  12. Measles Cases and Outbreaks. https://www.cdc.gov/measles/cases-outbreaks.html. Updated: March 6, 2017. Accessed: March 18, 2017.
  13. Scarlet Fever: A Group A Streptococcal Infection. https://www.cdc.gov/features/scarletfever/. Updated: January 17, 2017. Accessed: March 18, 2017.