Measles (Rubeola)


What Is It?

Measles, also known as rubeola, is a very contagious respiratory infection that causes cold symptoms, fever and a characteristic rash. It is caused by the measles virus, which usually spreads from person to person through coughs and sneezes, and through contact with used tissues, shared drinking glasses, dirty hands that touched a runny nose, or other contaminated surfaces. Once the virus enters the body, the infection spreads throughout the respiratory tract to the skin and to other body organs.

In the respiratory tract, the measles virus damages the lining of the breathing passages, causing a runny nose, nasal congestion and cough. In the skin, the virus triggers the typical measles rash. A person with measles is contagious (can infect others) from one to two days before any symptoms begin (or three to five days before the rash) to four days after the rash appears.

Measles typically causes moderate illness. In younger children, fairly common complications include middle-ear infection (otitis media), pneumonia, croup and diarrhea. In adults, the illness tends to be even more severe. It is not unusual for older patients to require hospital treatment for measles-related pneumonia. In one of every 1,000 cases, measles produces encephalitis (brain infection), with an immediate risk of seizures, coma and death, and a long-term risk of mental retardation, epilepsy or subacute sclerosing panencephalitis, an extraordinarily rare chronic form of measles encephalitis that causes brain damage. In unusual cases, measles also can directly attack the digestive organs (including the liver), the heart muscle or the kidneys. A pregnant woman who is infected with measles has an increased risk of premature labor, miscarriage or delivery of a low-birth-weight infant.

Before an effective vaccine was available, there were at least 400,000 cases of measles reported each year in the United States, with probably more than 3 million unreported cases. Now, the number of cases has decreased by more than 99 percent. Only 116 cases were reported in the United States in 2001, with most involving people who came to the United States from other countries.


Measles symptoms begin about eight to 12 days after exposure to a contagious person. The first symptoms include cough, runny and stuffy nose, a general, sick feeling (malaise), red eyes with tearing (conjunctivitis), and a fever up to 105 degrees Fahrenheit. Within two to four days, these symptoms can be followed by the appearance of Koplik’s spots in the mouth. These are blue-white or gray spots with a red background, located inside the cheeks near the back molars. They develop at about the same time or just before the measles rash.

The measles rash usually is characterized by pink or bright red spots that are not itchy. It typically begins at the hairline and behind the ears, then spreads downward to the neck, trunk, arms and legs, palms and soles. The rash begins to fade about four days later in the same order that it appeared, first from the head and neck, then the trunk and arms and legs. The fading rash may leave behind a temporary brownish discoloration or flakiness that clears two to three days later. Some patients also have enlarged lymph nodes (swollen glands), diarrhea and vomiting.

Patients with HIV, or certain types of leukemia or lymphoma, are at increased risk of severe complications from measles, but may not develop the typical measles rash.


The doctor will check for signs of a congested nose, red eyes, Koplik’s spots and the typical measles rash. Your doctor will ask if you have been exposed to anyone who has measles or an undiagnosed rash. Even if you did not have face-to-face contact with an infected person, your doctor will want to know if you attend the same school, live in the same household or dormitory or work in the same building. Your doctor also will check your medical records to see if and when you were immunized against measles, and the number of doses of measles vaccine, often given as part of the measles-mumps-rubella vaccine or MMR shot.

To confirm the diagnosis, your doctor may order blood tests to look for specific antibodies against the measles virus. Antibodies are substances made by the immune system to protect against an infection. The virus itself can be detected in samples of urine or respiratory fluids. However, this test more often is used to track the spread of cases from person to person than for diagnosis.

Expected Duration

The symptoms of measles usually last about 10 days.


You can prevent measles with the measles vaccine, which is usually given as part of the MMR combination vaccine. In the United States, most children receive two doses of the MMR vaccine, the first at 12 to 15 months of age and a booster dose at 4 to 6 years. If a child has not been immunized against measles and has been exposed to the disease, the vaccine may provide protection if it is given within 72 hours of the exposure. If the exposure occurred between three and six days earlier, the child can receive an injection of immune globulin (IG). IG contains ready-made antibodies to protect against the measles virus and can prevent or at least minimize the symptoms of a measles infection. IG also can be used after exposure to measles in infants less than 6 months of age and in people who have HIV or other conditions that weaken the immune system.


There is no specific treatment for measles. In people who are otherwise healthy, measles symptoms are treated with acetaminophen (Tylenol) to reduce fever and relieve discomfort, bed rest, and a cool-mist humidifier to soothe respiratory passages and relieve cough. Aspirin should not be used in children with measles because of the risk of Reye’s syndrome. This rare liver and brain problem can develop in children who have had certain viral illnesses and have been treated with aspirin. Children and adults who develop a middle-ear infection or bacterial pneumonia are treated with antibiotics.

In patients hospitalized with measles and its complications, especially children 6 months to 2 years, some doctors prescribe high doses of vitamin A. Low levels of this vitamin have been found in children with severe cases of measles. The World Health Organization recommends that vitamin A be given to all children diagnosed with measles in communities where vitamin-A deficiency is common.

In patients with weakened immune systems or who are severely ill from measles, the antiviral medication ribavirin, sold under the brand name Virazole, occasionally has been used, but no controlled trials have proven its benefits. The U.S. Food and Drug Administration has not approved the use of ribavirin (Virazole) to treat measles.

When To Call A Professional

Call your doctor if you or your child develops symptoms of measles, even if there is a record of measles immunization. Also call your doctor to review the status of your measles immunity if a measles outbreak occurs in your school or workplace. If you are considering becoming pregnant, contact your obstetrician to ensure that you are immunized against measles and other infectious diseases that can affect your unborn child. Always check with your child’s doctor at each visit to be sure he or she is up-to-date for all immunizations.


Most healthy patients recover completely from measles. About 3 percent of adults with measles develop symptoms of pneumonia severe enough to require hospital treatment. Death from measles complications such as pneumonia or encephalitis occurs in one to two of every 1,000 cases, more commonly in infants, older adults or people with weakened immune defenses.

Johns Hopkins patient information

Last revised:

Diseases and Conditions Center

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All ArmMed Media material is provided for information only and is neither advice nor a substitute for proper medical care. Consult a qualified healthcare professional who understands your particular history for individual concerns.