Signs and Symptoms

The symptoms of measles generally appear about seven to 14 days after a person is infected.

Measles typically begins with

  • high fever,
  • cough,
  • runny nose (coryza), and
  • red, watery eyes (conjunctivitis).
Koplik Spots

Mouth of a patient with Koplik spots, an early sign of measles infection.

Three to five days after symptoms begin, a rash breaks out. It usually begins as flat red spots that appear on the face at the hairline and spread downward to the neck, trunk, arms, legs, and feet. Small raised bumps may also appear on top of the flat red spots. The spots may become joined together as they spread from the head to the rest of the body. When the rash appears, a person’s fever may spike to more than 104° Fahrenheit.

Transmission

Measles is a highly contagious virus that lives in the nose and throat mucus of an infected person. It can spread to others through coughing and sneezing. Also, measles virus can live for up to two hours in an airspace where the infected person coughed or sneezed. If other people breathe the contaminated air or touch the infected surface, then touch their eyes, noses, or mouths, they can become infected. Measles is so contagious that if one person has it, up to 90% of the people close to that person who are not immune will also become infected.

Infected people can spread measles to others from four days before through four days after the rash appears.

Measles is a disease of humans; measles virus is not spread by any other animal species.

Complications

Measles can be a serious in all age groups. However, children younger than 5 years of age and adults older than 20 years of age are more likely to suffer from measles complications.

Common Complications

Common measles complications include ear infections and diarrhea.

  • Ear infections occur in about one out of every 10 children with measles and can result in permanent hearing loss.
  • Diarrhea is reported in less than one out of 10 people with measles.

Severe Complications

Some people may suffer from severe complications, such as pneumonia (infection of the lungs) and encephalitis (swelling of the brain). They may need to be hospitalized and could die.

  • As many as one out of every 20 children with measles gets pneumonia, the most common cause of death from measles in young children.
  • About one child out of every 1,000 who get measles will develop encephalitis (swelling of the brain) that can lead to convulsions and can leave the child deaf or with intellectual disability.
  • For every 1,000 children who get measles, one or two will die from it.

Measles may cause pregnant woman to give birth prematurely, or have a low-birth-weight baby.

Long-term Complications

Subacute sclerosing panencephalitis (SSPE) is a very rare, but fatal disease of the central nervous system that results from a measles virus infection acquired earlier in life. SSPE generally develops 7 to 10 years after a person has measles, even though the person seems to have fully recovered from the illness. Since measles was eliminated in 2000, SSPE is rarely reported in the United States.

Among people who contracted measles during the resurgence in the United States in 1989 to 1991, 4 to 11 out of every 100,000 were estimated to be at risk for developing SSPE. The risk of developing SSPE may be higher for a person who gets measles before they are two years of age.

Since measles is still common in many countries, unvaccinated travelers bring measles to the U.S. and it can spread. Protect yourself, you family, and your community with the measles-mumps-rubella (MMR) vaccine, especially before traveling internationally.

Frequently Asked Questions

Immediately call your doctor and let him or her know that you have been exposed to someone who has measles. Your doctor can

  • determine if you are immune to measles based on your vaccination record, age, or laboratory evidence, and
  • make special arrangements to evaluate you, if needed, without putting other patients and medical office staff at risk.

If you are not immune to measles, MMR vaccine or a medicine called immune globulin may help reduce your risk developing measles. Your doctor can help to advise you, and monitor you for signs and symptoms of measles.

If you do not get MMR or immune globulin, you should stay away from settings where there are susceptible people (such as school, hospital, or childcare) until your doctor says it’s okay to return. This will help ensure that you do not spread it to others.

CDC considers you protected from measles if you have written documentation (records) showing at least one of the following:

  • You received two doses of measles-containing vaccine, and you are a(n)—
    • school-aged child (grades K-12)
    • adult who will be in a setting that poses a high risk for measles transmission, including students at post-high school education institutions, healthcare personnel, and international travelers.
  • You received one dose of measles-containing vaccine, and you are a(n)—
    • preschool-aged child
    • adult who will not be in a high-risk setting for measles transmission.
  • A laboratory confirmed that you had measles at some point in your life.
  • A laboratory confirmed that you are immune to measles.
  • You were born before 1957.

A: If you’re unsure whether you’re immune to measles, you should first try to find your vaccination records or documentation of measles immunity. If you do not have written documentation of measles immunity, you should get vaccinated with measles-mumps-rubella (MMR) vaccine. Another option is to have a doctor test your blood to determine whether you’re immune. But this option is likely to cost more and will take two doctor’s visits. There is no harm in getting another dose of MMR vaccine if you may already be immune to measles (or mumps or rubella).

Immediately call your doctor and let him or her know about your symptoms you are having. Your doctor can

  • determine if you are immune to measles based on your vaccination record or if you had measles in the past, and
  • make special arrangements to evaluate you, if needed, without putting other patients and medical office staff at risk.

If you have measles, you should stay home for four days after you develop the rash. Staying home is an important way to not spread measles to other people. Talk to your doctor to discuss when it is safe to return.

You should also

  • Cover your mouth and nose with a tissue when you cough or sneeze, and put your used tissue in the trash can. If you don’t have a tissue, cough or sneeze into your upper sleeve or elbow, not your hands.
  • Wash your hands often with soap and water.
  • Avoid sharing drinks or eating utensils.
  • Disinfect frequently touched surfaces, such as toys, doorknobs, tables, counters.

Call your doctor is you are concerned about your symptoms.

The measles vaccine is very effective. One dose of measles vaccine is about 93% effective at preventing measles if exposed to the virus. Two doses are about 97% effective.

Very few people—about three out of 100—who get two doses of measles vaccine will still get measles if exposed to the virus. Experts aren’t sure why. It could be that their immune systems didn’t respond as well as they should have to the vaccine. But the good news is, fully vaccinated people who get measles are much more likely to have a milder illness. And fully vaccinated people are also less likely to spread the disease to other people, including people who can’t get vaccinated because they are too young or have weakened immune systems.

No. CDC considers people who received two doses of measles vaccine as children according to the U.S. vaccination schedule protected for life, and they do not ever need a booster dose.

Adults need at least one dose of measles vaccine, unless they have evidence of immunity. Adults who are going to be in a setting that poses a high risk for measles transmission should make sure they have had two doses separated by at least 28 days. These adults include students at post-high school education institutions, healthcare personnel, and international travelers.

If you’re not sure whether you were vaccinated, talk with your doctor. More information about who needs measles vaccine.

Before the measles vaccination program started in 1963, about 3 to 4 million people got measles each year in the United States. Of those people, 400 to 500 died, 48,000 were hospitalized, and 4,000 developed encephalitis (brain swelling) from measles.

A: Nationally, the rates of people vaccinated against measles have been very stable since the Vaccines for Children (VFC) program began in 1994. In 2016, the overall national coverage for MMR vaccine among children aged 19—35 months was 91.1%. However, MMR vaccine coverage levels continue to vary by state, with MMR coverage levels of < 90% observed in 2016 in several states and local areas. At the county or lower levels, vaccine coverage rates may vary considerably. Pockets of unvaccinated people can exist in states with high vaccination coverage, underscoring considerable measles susceptibility at some local levels.

For more information about 2016 childhood vaccination coverage, see a CDC MMWR.

Travelers can bring measles into the United States from any country where the disease still occurs or where outbreaks are occurring including Europe, Africa, Asia, and the Pacific. Worldwide, the 19 cases of measles per 1 million persons are reported each year; about 89,780 die. In recent years, many measles cases came into the United States from common U.S. travel destinations, such as England, France, Germany, India. During 2014, many measles cases came from the Philippines and Vietnam.

In 2008, 2011, 2013, 2014, and 2015, states reported more measles cases compared with previous post-elimination years. CDC experts attribute this to:

  • more measles cases than usual in some countries to which Americans often travel (such as England, France, Germany, India, the Philippines and Vietnam), and therefore more measles cases coming into the US, and/or
  • more spreading of measles in U.S. communities with pockets of unvaccinated people.

For details about the increase in cases by year, see Measles Outbreaks.

State and local health departments have the lead in investigating measles cases and outbreaks when they occur. CDC helps and supports health departments in these investigations by—

  • communicating with public health officials from states with reported measles cases and providing technical assistance.
  • gathering data reported by states on confirmed measles cases and evaluating and monitoring these data from a national perspective.
  • testing specimens for difficult diagnostic cases of suspected measles infection when requested by states.
  • using Advanced Molecular Detection (AMD) methods to determine measles virus genotypes and strains.
  • providing rapid assistance on the ground during outbreak investigations, often through a formal request by the state health department.
  • investing in state and local health departments for public health infrastructure and laboratory capacity to support front-line response to suspected and confirmed measles cases.
  • alerting clinicians, healthcare facilities, and public health officials around the country about current outbreaks and providing vaccine policy and clinical guidance for healthcare providers.
  • providing information to public and healthcare providers through a variety of media including the CDC website.

Yes. In 2000, the United States declared that measles was eliminated from this country. The United States eliminated measles because it has a highly effective measles vaccine, a strong vaccination program that achieves high vaccine coverage in children, and a strong public health system for detecting and responding to measles cases and outbreaks.

CDC defines measles elimination as the absence of continuous disease transmission for 12 months or more in a specific geographic area. Measles is no longer endemic (constantly present) in the United States.

Every year, unvaccinated travelers (Americans or foreign visitors) get measles while they are in other countries and bring measles into the United States. They can spread measles to other people who are not protected against measles, which sometimes leads to outbreaks. This can occur in communities with unvaccinated people.

Most people in the United States are protected against measles through vaccination. So measles cases in the U.S. are uncommon compared to the number of cases before a vaccine was available. Since 2000, when public health officials declared measles eliminated from the U.S., the annual number of people reported to have measles ranged from a low of 37 people in 2004 to a high of 667 people in 2014.

Yes. Since measles is still common in many countries, travelers will continue to bring this disease into the United States. Measles is highly contagious, so anyone who is not protected against measles is at risk of getting the disease. People who are unvaccinated for any reason, including those who refuse vaccination, risk getting infected with measles and spreading it to others. And they may spread measles to people who cannot get vaccinated because they are too young or have specific health conditions.

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