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What Are the Signs and Symptoms of Measles?

The first measles vaccine was developed in 1963 and its use led to a quick drop in measles cases in the United States.

In fact, as most people know, the endemic spread of measles was declared eliminated in the United States in 2000.

What does that mean?

A typical case of measles, as described in 1920, doesn't sound very mild or marvelous as some folks claim it to be.
A typical case of measles, as described in 1920, doesn’t sound very mild or marvelous as some folks claim it to be.

For one thing, it means that many people in the United States have never actually seen anyone with measles.

What Are the Signs and Symptoms of Measles?

As we are seeing more and more measles cases each year, it makes it important for everyone to learn how to recognize what measles looks like. Measles is so contagious, that missing just one case can lead to a lot of other people getting exposed unnecessarily and can keep an outbreak going.

So what does measles look like?

Call before you go to the ER or to see your doctor if you think your child has measles so that you don't put others at risk.
Call before you go to the ER or to see your doctor if you think your child has measles so that you don’t put others at risk.

After being exposed, kids with measles will develop:

  • a high fever
  • cough and/or runny nose
  • red, watery eyes with photophobia (dislike of bright light)
  • sore throat
  • irritability
  • decreased appetite

That sounds like many other viral infections that kids get though, which is why measles is so hard to diagnose, at least at the beginning stages of the illness, when kids only have the first signs of measles – the fever, cough, runny nose, and conjunctivitis.

Koplik spots, small gray-white spots in your mouth, are another clue that a child might have measles. They can develop on the second or third day of fever.

Next, after having the high fever for 3 to 5 days, kids develop a worsening fever and the classic measles rash. It is important to note that you are contagious well before you get the rash though, up to about four days before the rash develops, providing plenty of chances to expose others before you ever know you have measles.

“It usually begins as flat red spots that appear on the face at the hairline and spread downward to the neck, trunk, arms, legs, and feet. Small raised bumps may also appear on top of the flat red spots. The spots may become joined together as they spread from the head to the rest of the body.”

Measles Signs and Symptoms

While many diseases have a fever with or followed by a rash, it is very characteristic of measles that the fever continues for a few more days as the child develops the rash.

“You’ll usually feel most ill on the first or second day after the rash develops.”

Measles Symptoms

This is when most kids get diagnosed, typically with laboratory confirmation.

Unfortunately, because of the high fever and irritability, they may have sought medical attention a few times and could have exposed a lot of people already, especially as you continue to be contagious until you have had the rash for at least four days.

“After a few days, the fever subsides and the rash fades.”

Measles Signs and Symptoms

All together, these classic measles symptoms typically last about a week. As the rash fades, parents might notice staining and then a fine desquamation (skin peeling).

Of course, if any complications develop, the symptoms can last much longer.

What complications? Remember, measles was once called a harmless killer

Complications of measles can include:

  • ear infections
  • diarrhea
  • croup
  • pneumonia
  • seizures
  • encephalitis
  • myocarditis

And tragically, some kids don’t survive having measles.

“Furthermore, the risk of contracting other infections or dying remains high for several months after recovery from acute measles infection.”

Treating Measles in Children

And although most do survive the acute infection, we know that these kids are still at risk for getting other infections in the next few months and are at a later risk for SSPE.

Get vaccinated. Stop the outbreaks. There is no good reason that our kids should have to get measles today.

More on the Signs and Symptoms of Measles

When You Ask for Vaccine Advice in an Anti-Vaccine Facebook Group…

Can you guess what happens when you ask for advice about vaccines in an anti-vaccine Facebook Group?

Meningitis is not a side effect of vaccines.

What could go wrong?

When You Ask for Vaccine Advice in an Anti-Vaccine Facebook Group…

While most of us are used to hearing about meningococcal meningitis being a big risk for teens and young adults, it is important to realize that rates of disease are also high for infants, with a second peak during adolescence.

The highest rates of meningococcal disease occurs during infancy and adolescence.

So why don’t we routinely vaccinate infants against meningococcal disease?

Many countries do, including Australia and the UK, and in the United States, high risk infants are vaccinated against meningococcal disease.

If you were on the fence but were advised by your paediatrician (Australian spelling) to get vaccinated and protected because a child in your town had just died, would you get vaccinated?

Or would you listen to folks in an anti-vaccine Facebook group who tried to convince you that meningitis was actually a side effect of getting vaccinated?

Folks who insist that deaths from vaccine-preventable disease aren’t real and that instead, they are actually vaccine-injuries?

We know what happens when you ask for vaccine advice in an anti-vaccine Facebook group. The members push their propaganda to scare you away from vaccinating and protecting your kids.

Don’t listen to them. Vaccines are safe and necessary.

More on When You Ask for Vaccine Advice in an Anti-Vaccine Facebook Group…

People with Cancer Are at Risk from Unvaccinated Kids

We know that kids with cancer aren’t at risk from shedding if someone has recently been vaccinated.

Johns Hopkins Medicine, which includes the Johns Hopkins University School of Medicine and The Johns Hopkins Hospital and Health System went out of their way to correct this anti-vaccine misinformation.
Johns Hopkins Medicine, which includes the Johns Hopkins University School of Medicine and The Johns Hopkins Hospital and Health System went out of their way to correct this anti-vaccine misinformation.

The real risk comes from those who are unvaccinated.

People with Cancer Are at Risk from Unvaccinated Kids

Confused on how that works?

Kids with cancer typically have a compromised immune system, so are at greater risk for getting sick and catching infectious diseases. This includes a risk from vaccine-preventable diseases because they often can’t be vaccinated and any vaccines they had in the past might no longer provide protection.

Don’t believe me?

Want some examples?

  • a 6-year-old girl who was in remission for ALL and had just received her final dose of chemotherapy was admitted with fever and neutropenia, found to have measles, and died after 28 days of intense therapy (1989)
  • an 8-year-old being treated for leukemia developed chicken pox and died two weeks later (1998)
  • a partially vaccinated 4-year-old girl who was being treated for acute lymphoblastic leukemia (ALL) was exposed to a cousin with chicken pox and later developed multi-organ failure and died (2012)
  • a 26-year-old man who was being treated for chronic lymphocytic leukemia died in Switzerland after he became infected with measles (2017)
  • a 6-year-old boy with leukemia died in Italy after catching measles from his intentionally unvaccinated sibling (2017)

Of course, there are many more, including many kids with cancer who get exposed to a vaccine-preventable disease and have to get treated with immunoglobulin and hope they don’t get sick. And many more who do get sick and are treated in the hospital for weeks and months and thankfully, get better.

And there are even more who get caught up in quarantines because they have true medical contraindications to getting vaccinated, and so have to stay home from school with the intentionally unvaccinated kids whenever there is an outbreak of measles or chicken pox, etc.

What can we do about this?

Vaccinate our kids! We have a choice. These kids with cancer don’t.

More on People with Cancer at Risk from Unvaccinated Kids

Who Dies with Measles?

Measles is another of those diseases that some claim used to be mild and a rite of passage for kids.

That’s why there was an episode of the Brady Bunch about it, right?

An episode in which all of the kids got sick and they had to call two pediatricians to do house calls…

Who Dies with Measles?

While measles was a rite of passage for kids, it wasn’t the kind you looked forward to, because measles is rarely mild.

“Before a vaccine became available in 1963, measles was a rite of passage among American children. A red rash would spread over their bodies. They would develop a high fever. Severe cases could cause blindness or brain damage, or even death.”

CDC says measles almost eliminated in U.S.

Instead, most people develop 10 days of measles symptoms, including a high fever, cough, runny nose, watery eyes, and a rash. Photophobia, irritability, sore throat, headache, and abdominal pain are other symptoms that children with measles might have.

Many require hospitalization and some die.

But isn’t it just older people or those with immune system problems that die with measles?

“From 1964 through 1971, 16.7% of the death certificates reviewed noted some underlying pathologic condition.”

Roger Barkin, MD on Measles mortality. Analysis of the primary cause of death.

Nope.

It is most often children, typically young children, without any medical problems who die.

Before the routine use of vaccines, most measles deaths were young children without any medical problems.
Before the routine use of measles vaccines, most measles deaths were young children without any previous medical problems.

In the post-vaccination era, no one would be expected to die with measles, but those with immune system problems sometimes do, as most others are vaccinated and protected. As vaccinated rates drop though, even otherwise healthy children and adults can once again die of measles.

Remember the measles outbreaks at the end of the 1980s?

“Complications were reported in 672 (9.8%) cases, including otitis media in 318 (4.6%) cases, pneumonia in 178 (2.6%), diarrhea in 171 (2.5%), and encephalitis in five (0.1%). Nine hundred thirteen patients (13.3%) were hospitalized, and 10 measles-associated fatalities were reported (case-fatality rate: 1.5 deaths per 1000 reported cases). Eight of the deaths were reported in children less than 5 years of age, all of whom were unvaccinated. None had a reported underlying illness or immunodeficiency. Most deaths have been attributed to pneumonia.”

Measles — United States, First 26 Weeks, 1989

Probably not, but from 1989 to 1991 there were at least 123 measles deaths across the United States, even after measles had been declining for years with the introduction of the measles vaccine in the 1960s. Most of the deaths were otherwise healthy, without underlying medical problems.

They were unvaccinated and unprotected.

Because we don’t typically hear any details about measles deaths, including the almost 90,000 measles deaths that continue to occur around the world each year, most people likely assume that measles only kills in third world countries, where kids are already sick or malnourished. Of course, that wouldn’t explain how over one hundred people died with measles in Europe over the past few years…

Still think that measles isn’t deadly?

Tragically, there are plenty of stories (although most are never reported in the news and we don’t hear about them) and case reports that will prove you wrong:

  • Olivia Dahl died with measles when she was 7-years-old (1962)
  • an unvaccinated 3-year-old died in Maricopa County (1970)
  • a 13-year-old girl who had previously been vaccinated with one of the first inactivated measles vaccines which were found to be ineffective and were replaced with the newer live vaccines died in Michigan (1978)
  • a 9-month-old died in Chicago (1990)
  • an unvaccinated 13-year-old died in Kansas (1990)
  • Tammy Bowman, an 11-year-old unvaccinated girl died in Michigan (1990)
  • an unvaccinated 13-year-old became the first person in the UK to die with measles in 14 years (2006)
  • a 14-year-old died of Subacute Sclerosing Panencephalitis (SSPE), a late complication of a natural measles infection (2015)
  • an immunocompromised woman died after she was exposed in an outbreak in Clallam County, Washington (2015)
  • a 6-year-old boy with leukemia died in Italy caught measles from his intentionally unvaccinated sibling (2017)
  • an 11-month-old unvaccinated infant died in Greece (2017)
  • an intentionally unvaccinated 9-year-old girl with chromosomopathy, which is not a contraindication to getting vaccinated, died in Italy (2017)
  • a 10-month-old unvaccinated boy who likely caught measles when he had been hospitalized for an RSV infection, died in Italy (2018)
  • a 16-year-old who had received a heart transplant when she was 2-years-old died in France (2018)
  • an unvaccinated toddler in Jerusalem (2018)

Measles as a rite of passage?

“We baby boomers were apparently the last generation whose doctors, and therefore parents, accepted the measles as just one more annoying rite of passage of childhood that also happened to prime the immune system and provide lifelong immunity. Medical texts prior to the advent of the vaccine described measles as a benign, selflimiting (sic) childhood infectious disease that posed little risk to the average well-nourished child.”

Darrerl Crain, DC on The Great Measles Misunderstanding

While early pediatric textbooks did a great job describing the symptoms of measles, they also did a great job of documenting that measles was never a benign disease, something anti-vaccine folks still misunderstand because vaccines can do such a good job controlling the disease.

Even as overall mortality improved in the mid-20th Century, measles still wasn't a benign disease.
Even as overall mortality improved in the mid-20th Century, measles still wasn’t a benign disease.

Do benign, self-limiting childhood infections diseases kill hundreds of children every year?

This toddler died of measles in 1955.
This toddler died of measles in 1955.

Measles as a rite of passage is something we don’t want to have to go back to. It was a rite of passage that was endured because there was no other choice.

We have a choice now.

Don’t be misled into making the wrong one.

Don’t help anti-vaccine folks bring back measles and other vaccine-preventable diseases.

Vaccines are safe, effective and necessary.

“Today, vaccination is a cornerstone of pediatric preventive health care and a rite of passage for nearly all of the approximately 11,000 infants born daily in the United States.”

Cohn et al on Immunizations in the United States: A Rite of Passage

Getting vaccinated and protected is a rite of passage that you can look forward to, thanks to the many benefits of vaccines, not one that you should dread or avoid.

More on Measles Deaths