Measles

Measles is a highly contagious viral disease that occurs in children and adults. Symptoms include fever, cough, rash, runny nose, and inflamed eyes, while further health complications are quite common.

2019 had seen one of the largest recent outbreaks, with 2,191 confirmed cases of measles across New Zealand, the majority of which (1,734 cases) occurred in the Auckland region.

Measles is easily preventable. There is a free and effective vaccination programme in New Zealand. Even so, it is estimated that up to 400,000 New Zealanders are not fully vaccinated and are at risk. Anyone who has not been vaccinated, should see their doctor regarding a free vaccine.

Causes

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 can easily be spread to other people before a person knows that they are infected. 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.

Symptoms

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
• Earache
• Red watery eyes or conjunctivitis ("pink eye")
• Skin rash, with a red blotchy appearance
• Small bluish-white spots (known as Koplik’s spots) inside the mouth
• Sensitivity to light (photophobia)
• Loss of appetite
• Tiredness.

A doctor should be contacted if any of these symptoms are 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.

Complications

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. Even with treatment, one or two out of 1,000 people with measles will die.

Complications of measles include:

• Diarrhoea
• Ear infection
• Bronchitis
• Laryngitis (inflammation of the voice box)
• Pneumonia
• 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 1,000 people with measles). It can lead to permanent brain damage.

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.

Diagnosis

In most cases, a doctor can diagnose measles based on a physical exam. If necessary, measles can be confirmed with a blood test and/or a throat or nasal swab.

Treatment

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. Maintaining adequate fluid intake is also important.

Antibiotics may be prescribed for people with measles who develop a bacterial infection (e.g. pneumonia or an ear infection). Vitamin A supplements may help to reduce disease severity.

Prevention / vaccination

Staying home from day-care, school, or work, and avoiding other activities such as grocery shopping or social engagements, is strongly advised for anyone with measles (from the time of 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.

Measles remains common in many parts of the world; therefore, it is important for all travellers to be vaccinated to reduce the risk of causing an outbreak in New Zealand after returning or arriving from overseas.

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:

Healthline

Free phone: 0800 611 116
Website: www.healthline.govt.nz

PlunketLine

Free phone: 0800 933 922
Website: www.plunket.org.nz

References

CDC (2020). Measles (Rubeola) – Top 4 Things Parents Need to Know about Measles (Web Page). Atlanta, GA: Centers for Disease Control and Prevention (CDC). https://www.cdc.gov/measles/about/parents-top4.html [Accessed: 01/06/21]
CDC (2021) Measles, Mumps, and Rubella (MMR) Vaccination: What Everyone Should Know (Web Page). Atlanta, GA: Centers for Disease Control and Prevention (CDC). https://www.cdc.gov/vaccines/vpd/mmr/public/index.html#:~:text=One%20dose%20of%20MMR%20vaccine%20is%2093%25%20effective%20against%20measles,and%2088%25%20effective%20against%20mumps [Accessed: 01/06/21]
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: 01/06/21].
The Immunisation Advisory Centre (2020). Measles (Web Page). Auckland: University of Auckland. http://www.immune.org.nz/diseases/measles [Accessed: 01/06/21]
Mayo Clinic (2020). Measles (Web Page). Rochester, IL: Mayo Foundation for Medical Education and Research. http://www.mayoclinic.org/diseases-conditions/measles/basics/definition/con-20019675 [Accessed: 01/06/21]
Ministry of Health (2020). 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: 01/06/21]
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]
O’Toole, M.T. (Ed.) (2017). Measles. Mosby’s Dictionary of Medicine, Nursing & Health Professions (10th ed.). St Louis, MN: Elsevier.

Updated: June 2021

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