Measles: What Parents Need To Know

Measles is a highly contagious viral illness that can lead to serious complications and even death. Recent outbreaks have occurred within the US and worldwide, making it important for parents to understand measles symptoms, transmission, risks, and prevention strategies.

How Contagious Is Measles?

Pictograph demonstrating that measles has a 90% attack rate

The measles virus is considered to be one of the most contagious. 90% of susceptible individuals (typically those that are unvaccinated or immunocompromised) who come in close contact with the measles will become infected themselves. This means that if a single infected person is in a room with 10 other susceptible people, 9 of them will become sick with the measles.

The virus is spread mainly through respiratory droplets (coughing and sneezing). The viral particles can stay in the air for up to 2 hours after the sick person leaves the area, and the particles can live on surfaces for up to 2 hours as well. This means that you do not have to be standing directly next to the infected person to potentially become exposed.

People become contagious 4-5 days before the appearance of the classic rash and remain contagious until about 4 days afterwards. Individuals typically start showing symptoms of the measles around 10-12 days after exposure, though this can range anywhere from 6 to 21 days.

What Are The Symptoms Of Measles?

Picture of the inner cheek of child's mouth with Koplik spots

Measles typically begins with a fever, cough, runny nose, and red, watery eyes, fatigue, and poor appetite.

Within 1-2 days white spots called Koplik spots may be seen inside the cheeks. This occurs before the onset of the classic skin rash and is sometimes missed. The spots typically fade as the skin rash develops.

The rash develops around 2-4 days after the fever starts and appears as red spots on the skin starting on the face and spreading downward involving the back, chest, arms and legs. Fever often worsens as the rash begins. The rash fades over about 1 week.

Ill child on a table with the classic measles rash on his face, arms and torso

What Are The Complications?

Approximately 30% of individuals with the measles will develop a complication. It is estimated that 1 in 5 infected people will be hospitalized. The most common complications in children include diarrhea, ear infections, respiratory infections (pneumonia, croup, bronchiolitis), neurological problems such as encephalitis (swelling of the brain) and seizures. The most common causes of death in children with the measles are secondary to pneumonia or other respiratory complications or encephalitis. Younger children/infants, pregnant persons, and immunocompromised individuals are at increased risk for complications or a more severe course of illness.

There is a rare but fatal delayed neurological complication that can occur called subacute sclerosing panencephalitis (SSPE). This is a progressive degenerative neurological disease that can develop 7-10 years after the natural infection. Children infected at younger ages (under age 2) are at higher risk overall, though this can affect any age group.

Measles is also a virus that can cause immune amnesia. Basically, it can affect your body's ability to mount an immune response to other illnesses, making you more susceptible to other bacterial or viral illnesses for as long as 2-3 years after the acute infection.

What Is The Treatment For Measles?

Unfortunately, there is no definitive cure for the measles. Treatment once sick involves supportive care to best manage the symptoms. This may include medications such as tylenol or ibuprofen to alleviate fever or pain. Encouraging fluids and rest. Nasal saline sprays for congestion and possibly breathing treatments. More severe cases may require hospital and even ICU admission and support.

Picture of an ill female toddler showing the classic red watery eyes and rash seen with measles infection

There has been a lot of recent conversations about the role of Vitamin A in treatment of the measles. This is still a supportive care measure and not a cure. It does not prevent infection. Vitamin A can be used to help reduce severity of disease, but is most effective in areas where vitamin deficiency is more common which is not typical for most children in the United States. It is also important to note that higher than recommended doses of Vitamin A can be toxic, so please do not give your child supplemental vitamin A without advice from their regular doctor.

What Is The Role Of The MMR Vaccine?

The best treatment of the measles is honestly through prevention. The MMR (measles, mumps, rubella) vaccine is highly effective at preventing disease. In recent history, >90% active cases of measles occur in unvaccinated people. It is estimated that 93% of people will be immune to the measles after a single dose and 97% of people will be immune after 2 doses. This protection is thought to be life long. Side effects of the vaccine may include fever, mild rash and soreness at the injection site. Rarely it can cause a febrile seizure which is non lethal and does not result in long term complications.

Picture of a child sitting on a parent's lap after receiving an injection. He is looking at his arm as the gloved healthcare person applies a bandaid

The standard recommendations are to administer the MMR vaccine at age 12-15 months and again at age 4-6 years.

In cases of outbreaks or if traveling internationally or traveling to areas with high measles activity, the first dose can be given as early as 6 months and the second dose can be given as early as 30 days after the first dose. Note, if the first dose is given before age 1, then 2 subsequent doses would still be recommended after age 1.

Infants under 6 months of age and people with certain medical conditions are not able to receive the vaccine. Infants under 6 months old may have some passive immunity from the birthing parent if that person either already had the disease or is vaccinated. This protection wanes over time.

Please talk to your pediatrician if you are concerned that your child may need an early dose of the vaccine or have questions about the vaccine in general.

What Should I Do If My Child is Exposed?

Picture of. a father and daughter sitting at a desk with a laptop open for a virtual doctors appointment. the father has his hand on the daughter's forehead as if checking for fever.

If unvaccinated and older than 6 months old, it is recommended to receive the MMR vaccine within 72 hours. This may help prevent or decrease severity of illness.
Measles immune globulin (IG) may be offered within 6 days of exposure as a post-exposure prophylaxis to infants under 6 months old, pregnant women and immunocompromised individuals in effort to prevent or reduce severity of illness.
If you are fully vaccinated, you will likely be fine, but you should monitor for symptoms. If you do get sick it is likely to be a more mild course and you are not likely to become as contagious as those who are not vaccinated.
Let your doctor know so they can give any additional advice based on your situation and also help guide appropriate testing and management should you develop any concerning symptoms.

Conclusion

The information I am sharing is not meant to cause panic. My goal is for parents to feel informed so that they can make the best decision for their family. Staying informed and proactive is key to keeping our children and our communities safe.

-Dr. Christina Piron

Board Certified Pediatrician

MamaDoc NJ