Measles: Not Just a Little Rash

“Out of sight, out of mind” can be a good thing, like when you rid the house of high-calorie snacks to help you stick to a healthy diet. But sometimes, “out of sight, out of mind” can be a problem. When a disease like measles is rare in the United States, for example, it can be easy to forget how severe complications from the illness can be. That is, until there is an outbreak. Often it is only then that we remember that measles can be serious and vaccination is the best protection.

Measles typically begins with high fever, cough, runny nose, and red, watery eyes. Two or three days later, tiny white spots may appear inside the mouth. Three to five days after symptoms begin, a rash breaks out. The rash 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 spots, and the spots may become joined together as they spread. When the rash appears, a person’s fever may spike to more than 104° F.

Mild complications of measles include ear infections and diarrhea. However, measles can cause serious health complications, especially in children younger than 5 years and adults older than 20 years of age, and in persons with weakened immune systems (due to a disease such as cancer or a medical treatment such as steroid drugs or radiation). About 1 in 5 people in the U.S. who get measles will be hospitalized. As many as 1 out of every 20 children with measles gets pneumonia, the most common cause of death from measles in young children. One out of every 1,000 people with measles will develop brain swelling, which could lead to convulsions and can leave the child deaf or with intellectual disability. Out of 1,000 people with measles, 1 to 3 will die, even with the best care. In rare cases, seven to 10 years after seemingly recovering from measles disease, a person can develop signs of a progressively disabling brain and spine disorder called subacute sclerosing panencephalitis (SSPE), which has only a five percent chance of survival.


Measles is still common in many parts of the world. Every year, measles is brought into the United States by unvaccinated travelers (Americans or foreign visitors) who get measles while they are in other countries.

Measles is also very contagious; it spreads through the air when an infected person coughs or sneezes. It is so contagious that if one person has it, up to nine out of 10 people around the person will also become infected if they are not protected. A person can get measles just by being in a room where a person with measles has been, even up to two hours after that person has left. An infected person can spread measles to others even before knowing they have the disease—from four days before developing the measles rash through four days afterward. Anyone who is not protected against measles is at risk.

The measles, mumps, and rubella (MMR) vaccine is the best protection against measles. Two doses are about 97% effective at preventing measles if exposed to the virus. One dose is about 93% effective.