Measles Symptoms: Signs, Complications, and Prevention

Measles is a highly contagious viral infection that primarily affects children but can occur at any age in unvaccinated individuals. The disease is caused by the measles virus (a paramyxovirus) and spreads through respiratory droplets when an infected person coughs or sneezes. Measles is so contagious that 90% of unvaccinated people exposed to the virus will become infected. The virus can remain active in the air or on surfaces for up to two hours after an infected person leaves the area.

Before the measles vaccine became available in 1963, measles infected nearly all children by age 15 and caused approximately 2.6 million deaths worldwide annually. Thanks to widespread vaccination, measles was declared eliminated from the United States in 2000. However, outbreaks still occur, primarily among unvaccinated individuals or in communities with low vaccination rates. In recent years, measles cases have increased globally due to declining vaccination rates in some areas.

Measles typically begins with fever, cough, runny nose, and red, watery eyes, followed 3-5 days later by a distinctive red, blotchy rash that starts on the face and spreads downward to cover the body. While many people recover without complications, measles can cause serious and sometimes fatal complications, including pneumonia, encephalitis (brain inflammation), and death, particularly in young children, pregnant women, and people with weakened immune systems. The MMR (measles, mumps, rubella) vaccine is safe, highly effective, and the best protection against measles.

Common Causes

Exposure to Infected Individuals

Measles spreads when you breathe in respiratory droplets from an infected person's coughs or sneezes, or when you touch a contaminated surface and then touch your mouth, nose, or eyes. The virus is extremely contagious—you can catch measles simply by being in a room where an infected person was up to two hours earlier.

Signs of exposure:

• You were in close contact with someone diagnosed with measles
• You were in a public place during a known measles outbreak
• You traveled to areas with active measles transmission
• You're unvaccinated or incompletely vaccinated
• Symptoms appear 7-21 days after exposure (average 10-14 days)

Lack of Vaccination

The primary risk factor for measles is not being vaccinated with the MMR vaccine. Two doses of MMR vaccine are about 97% effective at preventing measles. People who have never been vaccinated or received only one dose are at significantly higher risk of infection when exposed to the virus.

Signs vaccination status increases risk:

• You've never received the MMR vaccine
• You received only one dose instead of the recommended two
• You were born after 1957 and don't have documentation of vaccination or immunity
• You're unsure of your vaccination history
• You have religious or philosophical objections to vaccination

International Travel

Measles remains common in many parts of the world, including Europe, Asia, Africa, and the Pacific. Traveling to countries with ongoing measles transmission increases your exposure risk, especially if you're unvaccinated. Travelers can bring measles back to the US, triggering outbreaks in unvaccinated communities.

Signs travel increases risk:

• You recently traveled internationally, especially to areas with measles outbreaks
• You're planning international travel and are unvaccinated
• You had contact with international travelers
• You work in settings with international visitors (airports, hotels, tourist areas)

Weakened Immune System

People with compromised immune systems from HIV/AIDS, cancer treatment, immunosuppressive medications, or severe malnutrition are at higher risk of severe measles and complications. Some immunocompromised individuals cannot receive the live MMR vaccine, making them dependent on community immunity (herd immunity).

Signs immune status increases risk:

• You have HIV/AIDS or other immune system disorders
• You're undergoing cancer treatment or taking immunosuppressive drugs
• You have severe vitamin A deficiency or malnutrition
• You're taking medications that suppress immune function
• You cannot receive live vaccines due to medical contraindications

Age Factors

Infants under 12 months (too young for routine MMR vaccination), children who haven't received both vaccine doses, and adults born after 1957 who lack evidence of immunity are at higher risk. Infants under 6 months may have some protection from maternal antibodies if the mother is immune, but this protection wanes.

Signs age increases risk:

• You're an infant under 12 months old
• You're a child who hasn't completed the two-dose MMR series
• You're an adult born after 1957 without proof of immunity
• You're planning pregnancy and lack immunity

Community Outbreaks

Living in or visiting communities with low vaccination rates increases measles risk. Outbreaks often occur in close-knit communities where vaccination rates have declined due to vaccine hesitancy, religious beliefs, or other factors. Schools, daycare centers, and healthcare facilities can be outbreak sites.

Signs community factors increase risk:

• You live in an area with a known measles outbreak
• Your community has low vaccination rates
• You attend schools or daycares with vaccine exemptions
• You're part of a community with vaccine hesitancy
• Local health authorities have issued measles warnings

When to See a Doctor

Contact a healthcare provider immediately if:

• You suspect measles exposure and are unvaccinated, especially if you're pregnant, immunocompromised, or have an infant under 12 months
• You develop measles symptoms (fever, cough, runny nose, red eyes, followed by rash)
• You're unsure of your vaccination status and may have been exposed
• You're planning international travel and need vaccination guidance
• Your child develops measles symptoms

Call ahead before visiting a doctor's office or emergency room to prevent spreading measles to others. The facility can arrange to isolate you from other patients.

Seek emergency care if you or your child with measles develops:

• difficulty breathing or shortness of breath
• Severe headache, stiff neck, or confusion (possible encephalitis)
• Seizures or loss of consciousness
• Severe dehydration (no urination for 8+ hours, extreme lethargy)
• Chest pain or persistent high fever (possible pneumonia)
• Altered mental status or extreme drowsiness

Measles complications can be life-threatening and require immediate medical attention.

Self-Care and Treatment

Isolation to Prevent Spread

If you have measles, stay home and avoid contact with others from 4 days before the rash appears until 4 days after. This is when you're most contagious. Keep infected children out of school and daycare. Notify people you had contact with so they can take precautions.

Rest and hydration

Get plenty of rest to help your body fight the infection. Drink lots of fluids (water, broth, electrolyte solutions) to prevent dehydration, especially if you have fever. Dehydration is a common complication, particularly in children.

Fever Management

Use acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) to reduce fever and discomfort. Follow dosing instructions carefully. Never give aspirin to children or teenagers with viral infections due to the risk of Reye's syndrome, a rare but serious condition.

Symptom Relief

Use a humidifier or breathe steam from a hot shower to ease cough and congestion. Rest your eyes in a dimly lit room if light sensitivity is bothersome. Use artificial tears for eye discomfort. Gargle with salt water for sore throat.

Vitamin A Supplementation

The World Health Organization recommends vitamin A supplementation for children with measles, as it can reduce severity and complications. Consult your healthcare provider about appropriate dosing, especially for children under 2 years, those with vitamin A deficiency, or those with severe measles.

Monitor for Complications

Watch for signs of complications like difficulty breathing, severe headache, confusion, seizures, or worsening symptoms after initial improvement. Seek medical care immediately if complications develop. Children under 5, adults over 20, pregnant women, and immunocompromised individuals are at highest risk.

No Specific Antiviral Treatment

There's no specific antiviral medication for measles. Treatment focuses on supportive care, managing symptoms, and preventing complications. Antibiotics may be prescribed if bacterial complications like pneumonia or ear infections develop, but they don't treat the measles virus itself.

Frequently Asked Questions

Prevention Tips

The best prevention for measles is vaccination with the MMR (measles, mumps, rubella) vaccine. Children should receive two doses: the first at 12-15 months and the second at 4-6 years. Adults born after 1957 without evidence of immunity should receive at least one dose, with two doses recommended for healthcare workers, international travelers, and students. If you're unsure of your vaccination status, getting vaccinated is safe even if you were previously vaccinated. Infants 6-11 months old traveling internationally should receive one dose of MMR before travel, then follow the routine schedule. Pregnant women cannot receive the MMR vaccine (it's a live vaccine), so ensure immunity before pregnancy. If you're exposed to measles and are unvaccinated, post-exposure prophylaxis with MMR vaccine (within 72 hours of exposure) or immune globulin (within 6 days of exposure) may prevent or reduce disease severity. Practice good hygiene by washing hands frequently, covering coughs and sneezes, and avoiding touching your face. If measles is circulating in your community, avoid public places if you're unvaccinated or immunocompromised. Ensure your children's vaccinations are up to date before school entry and international travel. Support community immunity by maintaining high vaccination rates (95%+ needed to prevent outbreaks). If you're planning international travel, check vaccination requirements and measles activity at your destination. Healthcare workers should ensure they're immune through vaccination or documented disease. Isolate infected individuals to prevent spread. By maintaining high vaccination coverage and taking appropriate precautions, measles can be prevented and eliminated.

The Bottom Line

Measles is a highly contagious viral infection that causes fever, cough, runny nose, red eyes, and a characteristic red rash spreading from face to body. The disease spreads through respiratory droplets and is so contagious that 90% of unvaccinated exposed individuals will become infected. While many people recover without issues, measles can cause serious complications including pneumonia, encephalitis, and death, particularly in young children, pregnant women, and immunocompromised individuals. There's no specific treatment for measles—care focuses on symptom management, rest, hydration, and monitoring for complications. The MMR vaccine is safe, highly effective (97% after two doses), and the best protection against measles. Vaccination has dramatically reduced measles cases and deaths worldwide, and the disease was eliminated from the US in 2000. However, outbreaks still occur in unvaccinated populations. If you suspect measles exposure or develop symptoms, contact a healthcare provider immediately and call ahead before visiting to prevent spreading the virus. Ensure you and your children are up to date on MMR vaccination—it's the most effective way to prevent this potentially serious disease. With high vaccination rates, measles can be eliminated, protecting both vaccinated individuals and those who cannot be vaccinated due to medical reasons.