Measles (Rubeola)

Measles, also called rubeola, is a viral illness that usually consists of a fever with cough, runny nose and pink eye (conjunctivitis), followed by a distinct rash.

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This distinct rash often helps aid in the diagnosis. However, immunocompromised people, young infants who still have maternal antibodies, and individuals who have received immunoglobulin may not have the classic rash.

Measles vaccination is highly effective in preventing infection.

Measles is one of the most contagious infectious diseases known. It is spread from one child to another through direct contact with discharge from the nose and throat. Sometimes, it is spread through airborne droplets from an infected child. 

Measles virus, the cause of measles, is classified as a Morbillivirus. It is mostly seen in the winter and spring. Rubeola is preventable by proper immunization with the measles vaccine.

It may take between seven to 14 days for a child to develop measles symptoms after being exposed to the disease. It is important to know that a child is contagious four days before the onset of signs and symptoms and four days after the rash develops. Therefore, children may be contagious before they even know they have the disease.

During the early phase of the disease (which lasts between one and four days), symptoms usually resemble those of an upper respiratory infection, often making it difficult to diagnose in the early stages. The following are the common symptoms of measles. However, each child may experience symptoms differently. Symptoms may include:

• Runny nose
• Hacking cough
• Conjunctivitis (pink eye) 
• Fever
• Small spots with white centers (Koplik's spots) appear on the inside of the cheek (usually occur two or three days after symptoms begin)
• Rash. Deep, red, blotchy, flat rash that starts on the face and spreads down to the trunk, arms, legs and feet. The rash starts as small distinct lesions, which then combines as one big rash. After three to seven days, the rash will begin to clear leaving a brownish discoloration and peeling skin.
• Severe diarrhea 

The most serious complications from measles include the following:

• Blindness
• Croup
• Ear infections
• Encephalitis (inflammation of the brain)
• Pneumonia

The symptoms of measles may resemble other skin conditions or medical problems. Always consult your child's doctor for a diagnosis.

Due to the highly contagious nature of measles, please contact your healthcare provider before you arrive at the doctor’s office or care center if you believe you have been exposed to or may be infected with measles. They will give advice on precautions to take to avoid potentially exposing others.

Measles is usually diagnosed based on a complete medical history and physical examination of your child. The lesions of rubeola are unique and usually allow for a diagnosis simply on physical examination. In addition, your child's doctor may order blood or urine tests to confirm the diagnosis.

Specific treatment for measles will be determined based on:

• Your child's age, overall health, and medical history
• Extent of the disease
• Your child's tolerance for specific medications, procedures or therapies
• Expectations for the course of the disease

The goal of treatment for measles is to help decrease the severity of the symptoms. Since it is a viral infection, antibiotics are ineffective. Treatment may include:

• Increased fluid intake
• Acetaminophen for fever (DO NOT GIVE ASPIRIN)
• Vitamin A to help prevent eye damage and blindness, and decrease the number of deaths from the disease. Always consult your child's doctor for advice.

If your child was exposed and has not been immunized, your child's doctor may give the MMR vaccine to the child within 72 hours or immune globin (IG) within six days of measles exposure to help prevent the disease.

Since the use of the measles (rubeola) vaccine, the incidence of measles has decreased substantially. A small percentage of measles are due to vaccine failure. The measles vaccine is usually given in combination with the mumps and rubella vaccine. It is called the MMR. It is usually given when the child is age 12 months to 15 months and then again between age 4 and 6. Other ways to prevent the spread of rubeola include:

• Children should not attend school or day care for four days after the rash appears. Always contact your child's doctor for advice.
• Assure all of your child's contacts have been properly immunized. 

Learn more about measles and the MMR vaccine at CHOP's Vaccine Education Center.