Measles is a viral childhood infection. It is vaccine preventable. The incubation period for the fever is 7 days to 2 weeks. Koplic's spots appear 2-4 days after fever onset. The rash appears 3-5 days after the fever onset.

350 (US); 114,000 (Global)
Fever: 7 days to 2 weeks; Koplic's spots: 2-4 days after fever onset; Rash: 3-5 days after fever onset; [Merck Manual, p. 2760]
Prodrome of fever, cough, coryza (runny nose), conjunctivitis, and Koplik spots; then on day 3-7: rash on head and neck, spreading peripherally and lasting 4-7 days; Leukopenia is common. [CCDM]
Airborne until 4 days after onset of rash; [CDC 2007 Guideline for Isolation Precautions] Immunocompromised patients may present with pneumonia without rash. They shed virus for a prolonged period and are contagious "as long as they have catarrhal symptoms." [Cecil, 24th Ed, p. 2105]
Koplik spots (stomatitis) are white, raised, and 1-2 mm in diameter. They are located on the buccal mucosa near the lower molars, starting 2 days before the onset of the rash and fading after about 4 days. Lymphadenopathy (cervical, postauricular, and/or occipital) is common. Vomiting, diarrhea, and abdominal pain occur occasionally in younger children. [ID, p. 1181-2] Measles can cause severe pharyngitis. [Cohen, p. 234] Desquamation follows the disappearance of the rash. [Merck Manual, p. 2760] Atypical measles has been described in patients who received inactivated measles vaccine and then were exposed to measles virus 2-4 years later. The rash was maculopapular, urticarial, or petechial; it was sometimes on the palms and soles and sometimes vesicular. Respiratory distress was common. Atypical measles has also been reported in patients who had received live measles vaccine. [ID, p. 1182]

Giant-cell pneumonitis occurs in AIDS patients. Most complications are due to secondary bacterial infections, e.g., otitis media and pneumonia. [Harrison ID, p. 932] Complications of measles caused by either the virus or bacterial superinfection include pneumonia, otitis media, diarrhea, and encephalitis. In malnourished children, measles may precipitate a hemorrhagic rash, acute kwashiorkor, and blindness. Subacute sclerosing panencephalitis occurs several years after the infection in about 4-11 per 100,000 cases. Adults may have hepatitis, hypocalcemia, and elevated creatinine phosphokinase levels. [CCDM, p. 389-90] The incidence of acute encephalitis is 1 in 1000-2000 cases of measles. "Radiological evidence of pneumonia is common even during apparently uncomplicated measles." [PPID, p. 2113] Subacute sclerosing panencephalitis is a complication months to years after the initial infection. Risk factors are not known. Symptoms include progressive mental impairment, seizures, coma, and death. [Cohen, p. 1400] Transient hepatitis may occur during the acute phase. Encephalitis may present with seizures. Features of atypical measles may include abdominal pain, pneumonia, hilar adenopathy, and a rash that is vesicular, urticarial or purpuric. Severe bleeding may accompany acute thrombocytopenic purpura. [Merck Manual, p. 2760] At risk for severe measles: patients with AIDS, immune suppression, pregnancy, cancer, or vitamin A deficiency; [ABX Guide] Case mortality rates range from <1% (developed countries), to 5-10% (sub-Saharan Africa), to 20-30% (refugee camps). [Harrison ID, p. 932]

Health care personnel (HCP) are immune if they have received 2 doses of measles vaccine or have antibodies to measles virus. [Harrison ID, p. 930] "Persons infected with measles are infectious 4 days before rash onset through 4 days after rash onset. . . . When a person who is suspected of having measles visits a health-care facility, airborne infection-control precautions should be followed stringently. . . . If possible, only staff with presumptive evidence of immunity should enter the room of a person with suspect or confirmed measles. . . . Because of the possibility, albeit low (~1%), of measles vaccine failure in HCP exposed to infected patients, all HCP should observe airborne precautions in caring for patients with measles. . . . Case-patient contacts who do not have presumptive evidence of measles immunity should be vaccinated, offered intramuscular immune globulin of 0.25 mL/kg (40 mg IgG/kg), which is the standard dosage for nonimmunocompromised persons, or quarantined until 21 days after their exposure to the case-patient. . . . Available data suggest that live virus measles vaccine, if administered within 72 hours of measles exposure, will prevent, or modify disease. [ACIP, 2011] Immune globulin can be effective if given to household contacts within 6 days of exposure. [Cecil, p. 2169]
Clinical; IgM antibodies (Confirm with culture or RT-PCR in low incidence area.); Paired sera; Detection of antigen in nasal wash by FA; Culture; RT-PCR to detect in urine, blood, or nasal mucous; [CCDM]
Global: Measles still occurs in large outbreaks outside of the Western Hemisphere. [CDC Travel, p. 288]
  • >arthralgia
  • >fatigue, weakness
  • >fever
  • >myalgia
  • E pharyngitis
  • E rhinitis
  • E stomatitis
  • G abdominal pain
  • G diarrhea
  • G liver function test, abnormal
  • G nausea, vomiting
  • H leukopenia
  • H lymphadenopathy
  • H splenomegaly
  • H thrombocytopenia
  • N headache
  • N seizure
  • O conjunctivitis, acute
  • R cough
  • R dyspnea
  • S papules or plaques
  • S petechiae and ecchymoses
  • S rash (exanthem)
  • S rash on palms
  • S skin blister or vesicles
  • S urticaria
  • *bleeding tendency
  • *blindness
  • *encephalitis
  • *erythema nodosum
  • *glomerulonephritis
  • *hepatitis
  • *myelitis
  • *myocarditis
  • *paralysis
  • *pneumonia
  • *pneumonitis
  • *rhabdomyolysis
  • *stupor, coma
  • *uveitis




  • Care for patients (droplet/airborne)
  • Fail to complete immunizations
  • Live together in close quarters
  • Travel to endemic area
1. (US) Published in MMWR 2011: 220 cases; 37-667 cases per year from 2001 through 2017; [CDC Travel] 602 cases in 2014 as of October 31; [CDC website]
2. (Global) Estimated 5 to 8 million deaths per year before measles vaccine; [Harrison ID, p. 929] 158,000 deaths in 2011 down from 548,000 with increasing vaccination since 2000; [Fact sheets from WHO 2013] WHO estimates 17 million cases and 242,000 deaths in 2006; About 19 cases per million globally in 2016; [CDC Travel] 19 X 6000 = 114,000;