Measles: symptoms, diagnosis, complications and treatment (factsheet)
Published 17 August 2014
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1. Measles: type of organism
Measles is a morbillivirus of the paramyxovirus family.
2. How measles is spread
Measles is spread through coughing and sneezing, close personal contact or direct contact with infected nasal or throat secretions.
Measles is one of the most highly communicable infectious diseases. Spending more than 15 minutes in direct contact with someone infected with measles is sufficient to transmit virus.
3. Incubation period
It takes from 7 to 18 days (average 10 to 12 days) after exposure for a patient to develop measles infection.
Period of infectivity: a patient is infectious from 4 days before the onset of rash to 4 days afterwards.
4. Symptoms and signs
The earliest signs of measles infection include:
- high fever
- runny nose
- cough
- red and watery eyes
- koplik spots (small red spots with bluish-white centres) inside the mouth
After several days, a rash appears, usually on the face and upper neck. The rash spreads, eventually reaching the hands and feet and lasts 5 to 6 days before fading. Measles is commonly confused with other infections that can lead to a rash.
5. Diagnosis
Confirmation of the diagnosis of measles is performed on oral fluid or serum samples at the reference laboratory (IDU). In acute cases measles RNA can also be detected in clinical specimens.
6. Complications
The most common complications of measles infection are ear infections (otitis media), pneumonia, severe diarrhoea and related dehydration. Other, less common complications include convulsions and encephalitis (an infection that causes the brain to swell). Serious consequences are more common in individuals with poor immune systems (such as children being treated for leukaemia or on certain drugs).
A patient with measles should avoid contact with unvaccinated young children, susceptible pregnant women and immunocompromised persons during the contagious period (specifically until 4 days after onset of rash).
7. Typical treatment
There’s no specific treatment or antiviral therapy for uncomplicated measles. Most patients with uncomplicated measles will recover with rest and supportive treatment (such as hydration and antipyretics).
Secondary bacterial infections should be treated with antibiotics. All suspected cases should be confirmed, ideally by testing of oral fluid (saliva), but management will often have to be based on a clinical and epidemiological risk assessment of the likelihood of the case being true measles.
8. Immunosuppressed and vulnerable individuals
Immunosuppressed individuals should be urgently assessed and may require admission to hospital for intravenous immunoglobulin. Active measures may also be required to protect other vulnerable contacts, such as infants and pregnant women.
9. Clinical management
Further information on clinical management is available from the National Institute for Health and Care Excellence (NICE) Clinical Knowledge Summaries
10. Serum and saliva testing to determine immunity to measles, mumps and rubella
Commercial assays that measure IgG to measles and mumps were designed for the diagnosis of acute infection and haven’t been validated for the determination of protection against these diseases. They’re not therefore recommended for testing before vaccination.
Saliva (oral fluid) testing for IgG to measles and rubella is also only used, in combination with IgM testing, for the diagnosis of acute infection and is not suitable for the determination of immunity to these diseases.
Combined measles-mumps-rubella (MMR) vaccine is not contra-indicated in children who may be immune to one or more components of the vaccine. MMR vaccine contains 3 live attenuated viruses. Each vaccine virus will not replicate to a significant level in a host who has pre-existing immunity to that infection as a result of either vaccination or natural disease. MMR may therefore be safely given to people without other contra-indications regardless of prior vaccination status or a history of natural infection.