Measles is a highly contagious viral disease that occurs in children and adults. Symptoms include fever, rash, runny nose, and inflamed eyes, while further health complications are quite common.
Measles is easily preventable and no longer widespread in New Zealand thanks to a free and effective vaccination programme. Even so, it is estimated that up to 400,000 New Zealanders could be at risk of getting measles because they are not fully vaccinated and outbreaks do occur. 2019 saw one of the most significant outbreaks of recent years, with 2191 confirmed cases of measles across New Zealand, the majority of which (1734 cases) occurred in the Auckland region.
People who have already had measles develop immunity (meaning that their immune system is able to fight off subsequent exposure) and cannot get measles again.
Measles is a highly infectious disease that can spread rapidly. Nine out of 10 people around a person with measles will become infected if they are not immune. Outbreaks occur mainly in communities where the number of people vaccinated against measles is low.
Measles outbreaks usually involve unvaccinated older children, adolescents, and adults. Measles can be transmitted from an infected person to another person for a period of about eight days – from four days before until four days after the appearance of the rash.
For the five days before appearance of the rash, a person with measles will not know that they have the disease and that they are likely to be spreading it to other people. They continue to be contagious until five days after appearance of the rash. Measles is spread through the air by infectious droplets that are produced when someone with measles talks, coughs, or sneezes. Infected droplets may land on surfaces where they can remain contagious for several hours.
It takes an average of 7–14 days from exposure to the measles virus until the appearance of the first symptom.
The initial signs and symptoms of measles include:
- Mild to moderate fever
- Runny nose
- Dry cough
- Sore throat
- Red watery eyes or conjunctivitis ("pink eye")
- Skin rash, with a red motley appearance
- Small bluish-white spots (known as Koplik’s spots) inside the mouth.
- Sensitivity to light (photophobia).
- Loss of appetite
A doctor should be contacted if any of these symptoms is noticed.
The measles rash appears as small red spots, some of which may be raised. Clusters of spots give the skin a blotchy red appearance. The rash usually appears approximately 14 days after exposure and 3–5 days after the fever begins. It first appears along the hairline and behind the ears, spreads to the face and upper neck, and then proceeds down the body. The rash usually lasts 4–6 days.
Most people recover from measles but some people develop health complications that can be serious or even life threatening. Complications occur because the measles virus affects a person’s immune system, making them more vulnerable to other infections.
Up to one-third of people with measles experience one or more complications and one in ten people with measles will require hospital treatment. Children under five years old are more likely to develop complications than adults.
Complications of measles include:
- Ear infection
- Laryngitis (inflammation of the voice box)
- Encephalitis (swelling of the brain)
- Croup (inflammation of the airway)
- Pregnancy problems.
Bacterial ear infection, which can lead to hearing loss, is one of the most common complications of measles.
Pneumonia is also a common complication of measles. Left untreated, pneumonia can result in death. It accounts for almost two-thirds of deaths related to measles.
Encephalitis is a rare but serious complication of measles (approximately 1 in 1000 people with measles). It can lead to permanent brain damage.
Even with treatment, one or two out of 1000 people with measles will die.
Measles occurring during pregnancy increases the risk of premature labour, miscarriage, and low-birth-weight infants. Birth defects have not been linked to measles during pregnancy.
Measles can be especially severe in persons with weakened (compromised) immune systems, such as people with HIV/AIDS and those receiving cancer treatment.
In most cases, a doctor can diagnose measles based on its characteristic rash and the Koplik’s spots on the inside of the mouth.
If necessary, measles can be confirmed with a blood test and/or a throat or nasal swab.
No anti-viral drug has been approved for the treatment of measles. However, some treatments can be used to reduce the severity of the disease.
For pregnant women, infants, people with weakened immune systems, and unvaccinated individuals who have been exposed to measles, giving an injection of immune serum globulin (which is a solution of antibodies against the measles virus) within six days of exposure can reduce the severity of symptoms (and may prevent measles from developing).
Over-the-counter medications such as paracetamol or ibuprofen can relieve the fever that accompanies measles.
Antibiotics may be prescribed for people with measles who develop a bacterial infection (e.g. pneumonia or an ear infection).
Vitamin A deficiency is associated with severe measles so vitamin A supplements is recommended for children hospitalised with measles, to help reduce the disease's severity.
Prevention / vaccination
Staying home from day-care, school, or work is strongly advised for anyone with measles (from the time to feeling ill until 5 days after disappearance of the rash) as doing so will help to reduce transmission of the disease to others.
However, because measles is such a highly contagious disease, vaccination is the only effective means of prevention.
The combination MMR vaccine (M-M-R II) is used to protect children and adults against measles, mumps, and rubella. Completion of the two-dose course of the MMR vaccine is required to be fully protected. In New Zealand the MMR vaccine is available for free to people born in 1969 or later. People born before 1969 may not need to be vaccinated because they are likely to have had the disease as a child and hence be immune. Children will normally be given their two doses at 15 months and 4 years of age.
If an unvaccinated adult or child is exposed to the measles virus, giving the measles vaccine within 72 hours of exposure to the measles virus (post-exposure vaccination) can protect them against the disease. Even if measles develops, the severity and duration of symptoms will be less than if the person had not received the post-exposure vaccination.
Vaccination of family members or carers is important to protect people with weakened immune systems.
Measles remains common in many parts of the world. Therefore, it is important that all travellers to New Zealand be vaccinated to reduce the risk of causing an outbreak here.
Further information and support
People with symptoms of measles and parents of children with measles should watch for complications and seek medical advice from their doctor if necessary. Information and advice is also available from:
Free phone: 0800 611 116
Free phone: 0800 933 922
CDC (2019). Measles (rubeola) – Top 4 things parents need to know about measles (Web Page). Atalanta, GA: Centers for Disease Control and Prevention (CDC). https://www.cdc.gov/measles/about/parents-top4.html [Accessed: 20/01/20]
Chen, S.S.P (2019). Measles (Web page). Medscape Drugs and Diseases. New York, NY: WebMD LLC. http://emedicine.medscape.com/article/966220-overview [Accessed: 20/01/20].
Immunisation Advisory Centre (2019). Measles (Web Page). Auckland: University of Auckland. http://www.immune.org.nz/diseases/measles [Accessed: 20/01/20]
Mayo Clinic (2016). Measles (Web Page). Rochester, IL: Mayo Foundation for Medical Education and Research. http://www.mayoclinic.org/diseases-conditions/measles/basics/definition/con-20019675 [Accessed: 10/07/16]
Ministry of Health (2017). Measles (Web Page). Wellington: New Zealand Government Ministry of Health. https://www.health.govt.nz/your-health/conditions-and-treatments/diseases-and-illnesses/measles [Accessed: 20/01/20]
Ministry of Health (2020). 2019/20 measles outbreak information (Web Page). Wellington: New Zealand Government Ministry of Health. https://www.health.govt.nz/your-health/conditions-and-treatments/diseases-and-illnesses/measles/2019-20-measles-outbreak-information [Accessed: 20/01/20]
Updated: January 2020