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Measles Symptoms

Measles

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Updated August 06, 2014

Written or reviewed by a board-certified physician. See About.com's Medical Review Board.

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Learning about measles symptoms is important, both so you don't worry about measles every time your child has a fever and a rash, which happens commonly, and so that you can recognize a case of measles if it does happen.

Measles

Worldwide, measles is one of the leading causes of death in young children.

Since 1997, measles cases had ranged from a low of 37 in 2004 to a high of 222 in 2011. This year's measles outbreaks have already hit a new record.

Before the routine use of the measles vaccine (1963) and the MMR vaccine (1971), though, measles cases -- and complications from those cases -- were high. There used to be about 500,000 cases of measles and 500 measles deaths each year in the United States.

Measles Symptoms

About 10 to 12 days after exposure to someone with measles (this incubation period can range from 7 to 18 days), children without immunity to measles can develop measles symptoms and signs (prodromal symptoms), including:

  • high fever, which often starts at about 101 and peaks at 103 to 105 degrees F
  • cough
  • coryza (runny nose)
  • nonpurulent conjunctivitis (pink eye without discharge)
  • photophobia (sensitivity to light)
  • Koplik spots

Koplik spots are small, bright red spots with a bluish-white central dot and are often found inside the mouth, on the inside cheeks and soft palate.

Two to four days later, after the fever and other measles symptoms begin, a child with measles will develop the classic measles rash.

Measles Rash

Although many childhood viral infections are associated with a rash, the measles rash has some characteristics that makes it different from those viral rashes.

For one thing, unlike many other viral infections, such as roseola and chickenpox, which typically start on a child's trunk, the measles rash starts on a child's face and head.

Other things to notice about the red, blotchy measles rash include:

  • the rash will spread down your child's body over the next three days, eventually reaching his hands and feet, after starting around his hairline
  • it usually lasts about 5 to 6 days
  • after 3 to 4 days, the measles rash may no longer blanch under pressure
  • areas where the measles rash was most severe may undergo a fine desquamation (skin peeling)
  • once the rash begins to go away, it will fade in the same order that it started -- so it will begin to go away around the hairline and face first, trunk next, and extremities last

Also, unlike some other viral infections, when a child has measles, their fever usually continues when they develop the rash. In fact, the child may appear most ill during the first few days that the rash appears, and may not feel better until a few days later, when the fever breaks.

Other Measles Symptoms

In addition to the fever and other prodromal symptoms, as well as the characteristic measles rash, children with measles often have:

  • poor appetite
  • diarrhea
  • generalized lymphadenopathy (swollen glands)

Other measles symptoms are caused by complications from being sick with measles, and can include ear pain (ear infection), difficulty breathing (pneumonia), and seizures.

More severe symptoms, such as fever, headache, vomiting, stiff neck, meningeal irritation, drowsiness, convulsions, and coma, are usually caused by acute encephalitis. This complication of measles can occur in 0.1% of measles cases, usually begins about 6 days after the start of the measles rash, and can lead to death (15% of cases) or permanent brain damage (25% of cases).

Measles Symptoms -- What You Need To Know

Other things to know about measles and measles symptoms include:

  • About 2 to 5% of people do not respond to their first dose of measles vaccine, which is why a booster dose is recommended.

  • More than 99% of people develop immunity to measles after two doses of a measles vaccine, like MMR.

  • Measles is fatal in about 0.2% of cases.

  • The measles virus is spread by respiratory droplets and can stay in an area for up to two hours after a person with measles symptoms has left.

  • People with measles are contagious from four days before to four days after they develop the measles rash.

  • Measles is still endemic in many countries around the world, and measles cases and measles outbreaks are increasing in many developed countries recently because of vaccine refusal.

Sources:

CDC. Notifiable Diseases and Mortality Tables. MMWR. January 7, 2011 / 59(52);1704-1717.

Mandell: Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases, 7th ed.

The Pink Book: Epidemiology and Prevention of Vaccine Preventable Diseases. Updated 11th Edition, (May 2009)

World Health Organization. Measles Fact Sheet. December 2009. Accessed February 2011.

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