Measles in Child
Alerts and Notices
SynopsisMeasles (rubeola) is a highly contagious, infectious disease caused by a single-stranded RNA virus within the Paramyxoviridae family. The disease is worldwide in distribution. The infection primarily occurs in late winter and spring when individuals are in close contact. Cases are more common in developing countries, as the majority of individuals in industrialized nations have been vaccinated. Classically, the disease is more often seen in children. In an unvaccinated population, children younger than 5 years are at highest risk of infection and death. The disease runs a more severe course in malnourished children.
Measles is transmitted via respiratory droplets and can remain viable and transmissible for up to 2 hours in an airspace after an infected person leaves an area. The incubation period after the measles virus enters the upper respiratory mucosa is about 10 days (range 7-21 days), with the rash typically appearing about 14 days after an exposure. Infected individuals are considered contagious from about 4 days prior to the appearance of the rash through about 4 days after its appearance.
A prodrome characterized by fever (up to 40.5°C [105°F]), coryza (nasal congestion), cough, and conjunctivitis occurs for about 3-4 days followed by the onset of the rash (sometimes immunocompromised individuals do not develop the rash). The coryza, a "barking" cough, and conjunctivitis will increase in severity until the rash reaches its peak. The US Centers for Disease Control and Prevention (CDC) reports that approximately 1 in 10 children with measles will develop otitis media, and up to 1 in 20 will develop pneumonia. Encephalitis is a complication in about 1 in 1000 cases.
Subacute sclerosing panencephalitis (SSPE) is a delayed neurodegenerative disorder occurring approximately 10-11 years after acute infection. This complication is characterized by changes in personality, seizures, and coma and eventuates in death.
Although measles was declared eliminated in the United States in 2000, outbreaks continue to occur. Most cases are associated with importation of measles by unvaccinated international travelers resulting in local outbreaks in communities with clusters of unvaccinated individuals. There was a high number of reported measles cases in the United States in 2014, with 667 cases reported to the CDC, largely from underimmunized communities in Ohio. In 2019, however, an even higher number of confirmed cases was documented: over 1250 cases from 31 states. Since then, the following numbers of cases have been reported annually in the United States: 13 cases in 2020 (8 jurisdictions [jurisdictions include any of the 50 states, New York City, and the District of Columbia]), 49 cases in 2021 (5 jurisdictions), and 121 cases in 2022 (6 jurisdictions). As of February 28, 2023, 3 measles cases have been reported in 2 jurisdictions, including a confirmed case of measles in an individual who attended a large spiritual revival gathering in Kentucky while contagious in mid-February. Refer to the CDC for the latest information on measles cases and outbreaks in the United States.
Related topic: atypical measles
B05.9 – Measles without complication
14189004 – Measles
Differential Diagnosis & Pitfalls
- Before the eruption, the differential diagnosis includes any cause of an upper respiratory infection.
- Morbilliform or exanthematous drug eruption
- Other viral exanthems – rubella, roseola, enterovirus, Epstein-Barr virus, parvovirus B19, human herpesvirus 6 (HHV-6), and dengue fever
- Rocky Mountain spotted fever
- Kawasaki disease
- Leukocytoclastic vasculitis
- Graft-versus-host disease
- Meningococcemia, especially with atypical measles
- Gianotti-Crosti syndrome
Patient Information for Measles in Child
OverviewMeasles (also known as rubeola) is an infection of the respiratory system that is caused by the measles virus. Measles is highly contagious and is spread when an infected person coughs or sneezes. It is best prevented by vaccination.
Measles is more common in developing countries, since most people in industrialized nations are vaccinated. However, "cluster outbreaks" (local outbreaks in communities with clusters of unvaccinated individuals) still occur in the United States.
The symptoms of measles generally begin between 7 and 14 days after the person was infected and start with 3-5 days of high fevers, cough, runny nose, and red, watery eyes followed by a rash. The rash consists of small red bumps on top of flat red spots that begin on the head and face near the hairline and move downward toward the feet to cover the body.
The patient is usually well after 2 weeks of illness and then has life-long resistance (immunity) to becoming infected again. Complications from measles more commonly occur in children aged younger than 5 and adults older than 20 and include ear infections and diarrhea. Serious complications of measles include blindness, inflammation of the brain caused by infection (encephalitis), and pneumonia. About one in every 1000 children will die from complications of a measles infection.
Who’s At RiskMeasles occurs all over the world, primarily in late winter and spring. Most children in the United States have been immunized against measles. Measles is often brought into the United States by unvaccinated travelers who spread it to susceptible individuals with whom they have contact.
Signs & Symptoms
- The first signs of infection are a bad cough, runny nose, fever, and red, watery eyes.
- Sometimes, at this stage, small red spots with blue-white centers appear inside the mouth ("Koplik spots").
- After 3-4 days, a rash begins with red spots, first appearing behind the ears and at the forehead, spreading down the neck, arms, trunk, and finally the legs. The red spots can merge together on the face.
- Measles does not usually itch.
- Make sure everyone in contact with the ill child has been vaccinated against measles or had measles in the past.
- Treat fever with acetaminophen (Tylenol) or ibuprofen.
- Encourage the child to drink fluid and to rest.
- Use a cool-mist vaporizer to reduce coughing.
When to Seek Medical Care
- Call your child's doctor if you think he or she has measles. Measles is especially dangerous for infants and children with weakened immune systems due to illness or certain medications.
- Call the doctor immediately if the child has problems breathing, confusion, vision problems, or pain in the chest or belly.
TreatmentsThere are no medications to cure measles, but the doctor can recommend ways to reduce symptoms such as fever or cough. Your doctor may prescribe a dose of vitamin A once a day for 2 days.
Bolognia, Jean L., ed. Dermatology, pp.1258-1259. New York: Mosby, 2003.
Freedberg, Irwin M., ed. Fitzpatrick's Dermatology in General Medicine. 6th ed. pp.2044, 2047-2048. New York: McGraw-Hill, 2003.
World Health Organization. Measles. http://www.who.int/mediacentre/factsheets/fs286/en/. Revised November 2007. Accessed October 30, 2008.
Measles in Child