Symptoms of Measles

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measles symptoms
© Verywell, 2018

Measles isn't an illness we see a lot of these days, but it has been making a comeback in recent years. Symptoms and signs, such as fever, dry cough, sensitivity to light, and rash, generally appear more than a week after exposure. Given the risk of ear infection, pneumonia, and other potential complications, it's important to know these and other characteristics of measles and seek medical attention if you think you're affected. This, obviously, is mostly a concern for those who are not vaccinated. Though measles is uncommon in the United States, outbreaks can occur and the virus can be contracted when traveling to other countries.

Frequent Symptoms

It's unlikely that you can rely on firsthand knowledge of measles, and there's a good chance your doctor has never diagnosed it. Because of this, studying up on the virus can be particularly helpful.

About 10 to 12 days after exposure to someone with measles (though this incubation period can range from seven to 21 days), people without immunity to measles can develop measles symptoms, some of which are similar to the flu, including:

  • Fever, which usually starts out low grade and continues to increase each day, peaking at 104 or 105 degrees on the fourth or fifth day of being sick and breaking a few days later
  • Dry cough
  • Runny nose, sneezing, and congestion
  • Red, watery eyes from conjunctivitis
  • Photophobia (sensitivity to light)
  • Poor appetite
  • Swollen glands
  • Koplik spots, small, bright red spots with a bluish-white central dot that are often found inside the mouth, on the inside of cheeks, and on the soft palate

Two to four days later, after the fever and other measles symptoms begin, a person with measles will develop the classic measles rash.

Measles is contagious from four days before the rash appears through four days after it appears.

Measles Rash

Although many childhood viral infections are associated with a rash, the measles rash has some characteristics that make it different from those viral rashes. For one thing, unlike many other viral infections, such as roseola and chickenpox, which typically start on the trunk, the measles rash starts on the face and head.

Other things to watch for regarding the measles rash:

  • This red, blotchy rash will spread down your or your child's body over the next three days, eventually reaching your hands and feet after starting around your hairline.
  • It usually lasts about five to six days.
  • After three to four days, the rash may no longer turn white when you push on it.
  • Areas, where the measles rash was most severe, may start to peel.
  • Once the rash begins to go away, it will fade in the same order that it started. It will begin to go away around your hairline and face first, trunk next, and extremities last.

Also, unlike some other viral infections, fever with measles usually continues when the rash develops. In fact, you or your child may appear most ill during the first few days that the rash appears, and may not feel better until a few days later when the fever breaks.

Complications

Although some people continue to claim that measles is a mild infection, it can have severe complications. In fact, one or more complications occur in around 30 percent of cases. Because of the high fever and irritability, many children end up requiring hospitalization. Most people do recover from measles without treatment, but some do have complications that require treatment, and unfortunately, a few people who get measles, usually children, die.

People who are at the highest risk for developing complications include:

  • Children under age 5 
  • Adults over age 20
  • Pregnant women
  • People with compromised immune systems

Common complications that can occur when you have measles include:

  • Ear infections: These occur in around 1 out of every 10 kids and can result in hearing loss.
  • Diarrhea: This occurs in fewer than 1 in 10 kids and can lead to dehydration.

More severe complications from measles include:

  • Pneumonia: This lung infection is the main cause of measles death in children. Approximately 1 in 20 kids with measles develop pneumonia.
  • Encephalitis: This is an inflammation of the brain that occurs in about 1 in 1,000 people. It involves more severe symptoms, such as fever, headache, vomiting, stiff neck, meningeal irritation, drowsiness, convulsions, and coma. This complication of measles usually begins about six days after the start of the measles rash and can lead to death, deafness, or permanent brain damage.
  • Pregnancy issues: Measles can lead to preterm labor, low birth weight, and even pregnancy loss.
  • Subacute sclerosing panencephalitis (SSPE): This is a deadly, but rare complication caused by defective measles virus. About seven to 10 years after having measles, children and young adults with SSPE develop progressive neurological symptoms, including memory loss, behavior changes, uncontrollable movements, and even seizures. As symptoms progress, they may become blind, develop stiff muscles, become unable to walk, and eventually deteriorate to a persistent vegetative state. Children who had measles before age 2 seem to be more at risk of developing this complication. People with SSPE usually die within one to three years of first developing symptoms. Fortunately, as the number of measles cases has been dropping in the post-vaccine era, so have the number of SSPE deaths.
  • Seizures: In 0.6 percent to 0.7 percent of people, seizures with or without fever can occur as a complication of measles.
  • Death: In the United States, measles is fatal in about 0.2 percent of cases.

Measles can cause complications involving your eyes as well, including:

  • Keratitis: This is an infection or inflammation of the cornea, the clear dome-like structure on the front part of the eye. Symptoms of keratitis are blurred vision, pain, redness, light sensitivity, and tearing. You may feel like there's a piece of sand in your eye. Keratitis can be a more serious complication of measles because related scars on your cornea, if present, can permanently damage your vision.
  • Corneal ulcers/scarring: If your keratitis becomes worse, it may turn into a corneal ulcer, an open sore that appears as a white dot on the cornea. An ulcer can develop either from the measles virus itself or from a bacterial infection caused by measles. It can become painful and lead to scarring of your cornea, resulting in significantly decreased vision or blindness.
  • Retinopathy: Thankfully, measles-induced retinopathy is rare, but there have been documented cases of substantial vision loss because measles has destroyed the retina. In this type of retinopathy, the blood vessels appear thinned, the optic nerve swells, and fluid builds up in the retina, causing a star-like pattern. This can cause temporary or permanent loss of vision.
  • Optic neuritis: This is an inflammation of the optic nerve, the large nerve cable that connects your eye to your brain. Though this complication is fairly rare, it can occur in people who develop measles-induced encephalitis. Optic neuritis can cause temporary or permanent vision loss.
  • Blindness: In developing countries where children aren't immunized as frequently, measles is one of the major causes of childhood blindness. It's caused by one or more of the above complications, which are made worse by malnutrition.

When to See a Doctor

If you think you or your child has been exposed to measles or there's a rash present that you suspect is measles, call your doctor right away. He or she may need to make special arrangements to see you without running the risk of spreading the disease to other susceptible people. Stay home so you don't put others at risk, and talk to your doctor about when you can go back to work or school.

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