Typical measles rash. (Click to zoom.) Usually starts on the face three to five days after symptoms begin. Travels down the body.

Typical measles rash. (Click to zoom.) Usually starts on the face three to five days after symptoms begin. Travels down the body.

by James Hubbard, MD, MPH

One of the worst U.S. measles outbreaks in years is going on in Ohio. So far, around 70 people have been infected. Another outbreak, in California, has involved about 60 people.

Though the measles is considered essentially eradicated in the U.S., there are a few cases here every year. This is a big year for them though, with 187 cases nationwide as of May 9, according to the Centers for Disease Control and Prevention.

So this is a good time to bone up on your knowledge. Here are seven FAQs about this very contagious viral infection.

What’s That You Say? There’s a Big Outbreak in Ohio?

It seems that some unvaccinated Amish missionaries were working in the Philippines, which is having a large outbreak—over 26,000 suspected cases as of April 20, according to the CDC. When the missionaries went back home, four came down with measles. This has now spread to around 70 people.

Could I Get It?

If you’re around someone with the measles, here are some things to consider. But remember that you may not know when you’ve been exposed. The measles can be contagious before the carrier even knows they have it. (See the next section.) So be especially cautious if you’re in an area where an outbreak is happening.

  • Most people who get the measles haven’t been vaccinated. One shot is about 93 percent effective. A second one raises the effectiveness to 97 percent.
  • If you’ve already had the measles, you’re immune for life.

If you’re not immune and haven’t been vaccinated (or you’re caring for a young child who hasn’t been able to get vaccinated):

  • Isolation and respiratory precautions can help. The virus is spread by air droplets. It can also stay alive on surfaces for a couple of hours.
  • Getting the vaccine within three days of exposure can decrease your odds of getting the disease. (You won’t have symptoms at this point. They’d start seven to 21 days after exposure.)
How Contagious Is the Measles?

When I was a kid, before the vaccine was available, everyone got the measles. It was a passage of life.

Measles is one of the most contagious diseases known to man. If you’re around someone with the disease, your chance of getting it is 90 percent if you’re not vaccinated and have never had the measles.

The virus can start spreading about four days before the typical measles rash starts. The person stays contagious for another four days after the rash begins.

The Other Measles

There are two types of measles. These days, when people say “measles,” they normally mean the “red measles.” That’s the one I’m referring to in this article. The other kind, German measles, is now called “rubella” (after the virus that causes it). It’s usually not as bad but can cause severe problems in pregnancy.

Is the Measles Dangerous?

As with the other usual childhood viruses, most of us got over it just fine when I was a kid—but not everyone.

Measles can cause very serious complications, even death.

Chances of complications are higher in people who are poorly nourished or who have poor access to health care. (Think long-term disaster or undeveloped countries where the measles is still rampant.)

According to the CDC, in people who have measles:

  • 1 in 10 will get an ear infection.
  • Many will get diarrhea.
  • 1 in 20 will get pneumonia.
  • 1 in 1,000 will get encephalitis. Many have permanent brain damage.
  • 2 in 1,000 will die, usually of pneumonia, dehydration, or encephalitis.
  • In areas with poor nutrition and health care 10 percent can die.
  • Loss of pregnancy, preterm labor, or low birth weight can occur.

>> More long-term-disaster diseases.

Koplik spots, typical for the measles, though they occasionally show up with other viruses. (Click to zoom.)

Koplik spots. They’re the tiny white spots with the redder background close to the teeth. (Click to zoom.)

What Are the Signs and Symptoms of the Measles?

I’ve only seen a few cases, and I can tell you, it can be a tough diagnosis unless there’s already a local outbreak and your suspicion is high.

In the first few days, the symptoms are pretty general:

  • Fever up to 105 F
  • Cough
  • Sore throat
  • Runny nose
  • Watery, red eyes (basically a type of pinkeye)

About two to three days after the onset of symptoms, you’ll probably see Koplik spots: small, white spots on the inner cheeks (inside the mouth). Although these occasionally show up with other viruses, they’re considered pretty diagnostic for measles. Seventy percent—maybe more—of people with measles have these. But you have to look at the right time and know what you’re looking for (see photo at right). They usually last only a few days.

Three to five days after those initial symptoms start, a rash usually comes along (see photo at the top of this post). It normally consists of small, red, slightly raised spots which tend to come in bunches, making the rash sometimes look blotchy. It starts on the face and travels downward to all over the body.

>> Pictures of rashes from other diseases.

How Is Measles Diagnosed?

If it’s the first case or two in an area, measles may be confused for a nonspecific cold or flu. When the Amish missionaries from Ohio started getting symptoms of fever, muscle aches, and feeling bad, the most probable diagnosis was thought to be dengue fever. Then, I assume, they came down with a rash, and blood tests were done, and the real disease came to light.

It’s a much easier diagnosis to make if other people already have come down with full-blown measles.

In a survival situation you’d just have to do your best. A couple of other diseases come to mind that can cause the exact same symptoms, including the rash:

  • Scarlet fever. That’s essentially strep throat with a rash. It’s important to diagnose it since scarlet fever, like any strep, should be treated with antibiotics. In the absence of a quick-strep test I’d suspect strep if the throat were really, really sore or there were pus on swollen tonsils. Strep throat can occur without either one of these symptoms though.
  • Roseola. This disease is usually milder than the measles, and the child is getting better by the time the rash occurs.
What’s the Treatment for Measles?

It is a virus, so the treatment mostly consists of rest and time. Dehydration is a risk, especially with diarrhea, so make sure the sick person gets plenty of fluids. (Click here for info on preventing dehydration from diarrhea.)

There is some evidence that people who are vitamin A deficient may be prone to complications, so if you have it, a vitamin A supplement would be worth a try. (Read instructions, and know about any interactions, side effects, and precautions.)


Have you had experience with measles?


Rash photo: CDC/Heinz F. Eichenwald, MD. Koplik spots photo: CDC.

You May Also Like: