Measles is a virus infection that used to commonly affect children until the introduction of a the MMR vaccine in the UK. Unfortunately, it is on the rise particulalrly in parts of Europe and the United States. These outbreaks are occurring in unimmunised populations. It can present in a number of different ways depending on the immunsation status of the patient involved. In the unimmunised it can cause serious illness, some estimates suggest 1 in every 5000 people with measle will die because of complications.

The virus is spread by breathing in infected droplets or by touching contaminated surfaces.Symptoms usually appear 10-12 days after being infected. The child will have a fever lasting 2-4 days followed by a cough, runny nose, and red watery eyes. Spots can sometimes be seen on the inside of the cheeks near the back teeth. These are like grains of sand on a red background and are known as Koplik’s spots. They usually can be seen 48 hours before the start of the rash. The rash characteristically starts at the head and face and then moves down the body towards the feet. The spots are red and are slighlty raised but the redness disappears on pressing (for example using “the glass test”)

A patient will be infectious for 4 days prior to developing the rash to 4 days after the rash develops.

Other features include raised glands, a fever which peaks 2-3 days after the appearance of the rash, a sore throat and red eyes.

Symptoms usually begin to improve 48 hours after the appearance of the rash and the main focus of treatment is therefore to control the fever using paracetamol or ibuprofen and also to ensure adsequate fluid intake.

Over a period of about a week the rash will gradually fade, occasionally a cough will persist for upto 2 weeks after the measles infection.


Complications occur particularly in patients who have a defective immune system (immunocompromised), the pregnant, and those with vitamin A deficiency or those who have poor nutrition.

Complications include chest infections, inflammation of the brain (encephalitis), ADEM (acute disseminated encephalomyelitis), SSPE (subacute sclerosing panencephaitis, which may occur 7-10 years after measles infection), ulceration of the surface of the eye and suppression of the immune system.

Patients with defective immune systems (eg those with Aids, lymphoma or other malignancies) are at risk of severe infection with the measles virus.


Measles in pregnancy may harm both the fetus and also put the mother at risk of complications. This will require more detailed discussion with your doctor.


The question regarding immunisationhas been prominent since the publication of data by Andrew Wakefield who suggested a link between the measles vaccine and autism. Recent research completely refutes this association and demonstrates that the measles vaccination is a safe and effective vaccine that has no association with autism.

Authored by: Dr Tim Ubhi

Published: 8th March 2019

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