|SSM Cardinal Glennon Children's Medical Center|
Measles, also called rubeola, is a highly contagious respiratory infection that's caused by a virus. It causes a total-body skin rash and flu-like symptoms, including a fever, cough, and runny nose. Though rare in the United States, 20 million cases happen worldwide every year.
Since measles is caused by a virus, there is no specific medical treatment for it and the virus has to run its course. But a child who is sick should drink plenty of fluids, get lots of rest, and be kept from spreading the infection to others.
Signs and Symptoms
While measles is probably best known for its full-body rash, the first symptoms of the infection are usually a hacking cough, runny nose, high fever, and red eyes. Children who get the disease also may have Koplik's spots, small red spots with blue-white centers that appear inside the mouth.
The measles rash breaks out 3-5 days after symptoms start, and can coincide with high fevers up to 104°F (40°C). The red or reddish-brown rash usually first shows up as flat red spots on the forehead. It spreads to the rest of the face, then down the neck and torso to the arms, legs, and feet. The fever and rash gradually go away after a few days.
Measles is highly contagious — 90% of people who haven't been vaccinated for measles will get it if they are near an infected person. Measles spreads when people breathe in or have direct contact with virus-infected fluid, such as the droplets sprayed into the air when someone with measles sneezes or coughs. A person who is exposed to the virus might not show symptoms until 8-10 days later.
People with measles are contagious (can spread the disease) from 4 days before the rash appears until about 4 days after it does, and are most contagious while they have a fever, runny nose, and cough. Those with weakened immune systems due to other conditions (like HIV and AIDS) may be contagious until they recover from measles.
Measles is very rare in the United States. Before measles vaccination became available in the 1960s, more than 500,000 cases were reported every year. Back then, about 500 people died of the disease each year, and around 4,000 people a year had encephalitis (swelling of the brain) from the disease.
Due to widespread immunizations, the number of U.S. measles cases declined steadily to a low of 37 people in 2004. From 2000 to 2007, only about 63 cases per year were reported.
But recent years have seen spikes in measles outbreaks, including 131 cases in the first half of 2008 and 644 cases in 2014. Most U.S. outbreaks begin with people who were infected outside of the country, with the disease spreading quickly in areas where too few people have received the vaccine. About 85% of people infected with measles were not immunized or their immunization status was unknown, although they were eligible to receive the vaccine.
The people at highest risk of getting measles during these outbreaks are infants (who aren't old enough to get the vaccine), pregnant women, and people with poor nutrition or weakened immune systems.
During a measles outbreak, an injection of measles antibodies (called immune globulin) can help protect people who haven't been vaccinated if they come into contact with an infected person (called "exposure"). The injection is most effective if it's given within 6 days of exposure. These antibodies can either prevent measles or make symptoms less severe.
For women who are not pregnant and people not in one of the other at-risk groups, the measles vaccine may offer some protection if given within 72 hours of measles exposure.
Unvaccinated people who are exposed to measles and show symptoms of the virus should seek medical care. Otherwise, they should stay home and not return to childcare, school, or work until 21 days after they were exposed.
The most important thing you can do to protect your kids from measles is to have them vaccinated according to the immunization schedule prescribed by your doctor.
Older kids are usually immunized against measles according to state and school health regulations. For most, measles protection is part of the measles-mumps-rubella vaccine (MMR) or measles-mumps-rubella-varicella vaccine (MMRV) given when they're 12 to 15 months old and again when they're 4 to 6 years old.
Infants are generally protected from measles for 6 months after birth due to immunity passed on by their mothers. Measles vaccine usually is not given to infants younger than 12 months old. But if there's a measles outbreak, or a child will be traveling outside the United States, the vaccine may be given when a child is 6-11 months old, followed by the usual MMR immunization at 12-15 months and 4-6 years of age.
The measles vaccine sometimes causes side effects in kids who don't have underlying health problems. The most common reactions are fever 6-12 days after vaccination (in about 15% of kids vaccinated) and a measles-like rash, which isn't contagious and fades on its own (in about 5% of vaccinated kids).
As with all immunization schedules, there are important exceptions and special circumstances. Your doctor will have the most current information about vaccine recommendations.
The measles vaccine should not be given to these at-risk groups:
Because certain people cannot receive the measles vaccine for health reasons, it's all the more important to make sure that children who can get the vaccine get it on schedule. At-risk children depend on "herd immunity." This means a high percentage of people have been immunized against a disease, which prevents the disease from spreading in a population and helps prevent outbreaks.
There is no specific medical treatment for measles. To help manage symptoms, which usually last for about 2 weeks, give your child plenty of fluids and encourage extra rest. If a fever is making your child uncomfortable, you can give a non-aspirin fever medicine, such as acetaminophen or ibuprofen.
Remember, you should never give aspirin to a child who has a viral illness, as its use in such cases has been associated with the development of Reye syndrome.
Kids with measles should have their condition closely monitored by a doctor. In some cases, measles can lead to other complications, such as otitis media, croup, diarrhea, pneumonia, and encephalitis, which may require antibiotics or hospitalization.
In developing countries, vitamin A has been found to decrease complications and death associated with measles infections. In the U.S., vitamin A supplementation should be considered for children between 6 months and 2 years old who are hospitalized with measles and its complications.
Also, all kids over 6 months old with certain risk factors — such as vitamin A deficiency, a weakened immune system, or malnutrition — might benefit from vitamin A supplementation.
Children with measles should be quarantined for 4 days after their rash appears. If they have a weakened immune system, they should stay in isolation until they make a full recovery and all symptoms are gone.
When to Call the Doctor
Call the doctor immediately if you suspect that your child has measles. Also, it's important to get medical care after measles exposure, especially if your child:
Most important: remember that measles, a once common disease, is preventable through routine childhood immunization.
Reviewed by: Scott A. Barron, MD, and Rupal Christine Gupta, MD