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Rubeola, or measles, is a viral infection that's serious for small children but can be prevented by the vaccine. It's spreadable by air through coughing or sneezing.
What is measles?
Rubeola, more commonly known as measles, is a virus that causes a set of symptoms including fever, rash, and cough. Rubeola primary affects children and is the fifth most common cause of death in children younger than five years of age worldwide. Rubeola is very contagious and is transmitted through person-to-person contact and the air.
Symptoms usually develop sequentially leading up to the rash, and may also include diarrhea, shortness of breath, and neurological symptoms such as a headache, confusion, seizures, and coma even after the virus has seemed to resolve.
It is imperative that children receive both doses of the recommended vaccine in order to be fully protected from developing rubeola. Adults should receive at least one dose of the vaccine if they are unsure of their vaccination status. There is no way to cure rubeola once you have been infected; however, some supportive treatments are available for both children and adults.
You should visit your primary care physician within 72 hours since nonimmunized people, including infants may be given the measles vaccine after being exposed. Otherwise there is no treatment to get rid of an established measles infection.
Symptoms of rubeola typically develop six to 21 days after a person is infected. The vast majority of people (approximately 90 percent) who get infected with the rubeola virus will develop symptoms. Symptoms usually develop in a sequential pattern.
People with rubeola will usually first develop these symptoms, which are likely to progressively worsen for a few days until the rash becomes present:
- Fever: The fever can be as high as 104 degrees Fahrenheit (40 degrees Celsius).
- Loss of appetite
- Feeling unwell
Symptoms following the fever
Following the period of fever, people may develop these symptoms:
- Red eyes
- Eye irritation
- Runny nose
Symptoms developing around 48 hours prior to the rash
Some people may develop "Koplik's spots" around 48 hours before the rash is present and can be described by the following details.
- White/gray spots on the inside of the mouth: These usually appear as white or gray spots with surrounding redness, and are located on the inside of the sides of the mouth or on the roof of the mouth.
- Spots that disappear once the rash occurs
Most people with rubeola will eventually develop a rash, which will usually last for four to five days and then darken and disappear. Details include:
- Red-colored spots and bumps: The rash will begin on the face and spread to the body and the arms and legs.
- White when pressure is applied: The rash will turn white when pushed upon.
- Skin peeling: The skin may peel in some areas as the rash fades.
Other symptoms occurring at the same time as the rash
Other symptoms that may occur in cases of rubeola include:
- Swollen lymph nodes: These may be in the neck and/or throughout the body.
- Diarrhea: This is considered a complication of the infection.
- Persistent cough and shortness of breath: These symptoms suggest that the individual may have developed a lung complication of rubeola such as pneumonia (lung infection).
In rare cases, these symptoms can occur at the time of the rash due to the infection itself, or two weeks after the development of the rash due to an immune response. In other rare cases, neurologic symptoms can develop seven to 10 years after the episode of measles for unclear reasons. These neurologic symptoms include:
- Seizures and brain swelling (encephalitis)
Rates of rubeola infection in the United States have decreased dramatically since the availability of a vaccine that is recommended for all children. Steady vaccination rates are necessary in order to limit current and future cases. Rubeola is unfortunately still common in some areas of the developing world where access to the vaccine is limited. Causes and risk factors for developing rubeola include not getting the vaccine, traveling to areas of risk, and being in a crowded area with an infected person.
Not getting the recommended vaccination for rubeola
People who have not received the recommended vaccinations for rubeola are much more likely to get the disease. Since 2000, the measles vaccine has been estimated to have saved more than 20 million lives worldwide. In the United States, a combined vaccine (MMR vaccine) for rubeola along with two other diseases (mumps and rubella) are recommended in two separate doses and in the following scenarios:
- At 12 to 15 months of age
- Again at four to six months of age: Children who only get one dose of the vaccine (93 percent safe from contraction) are more at risk for developing rubeola than children who get both doses (97 percent safe from contraction).
- Adults who are unsure of their immunization status: You should receive at least one dose of the vaccine in order to limit widespread risk for both yourself and others.
Traveling to developing areas or where rubeola is common
Traveling to areas where rubeola is common or coming in contact with travelers from those areas can increase the risk of developing rubeola. Many of these areas are located in the developing world, where immunization for rubeola is not widespread.
Being in a crowded place with someone who was infected
Being in a crowded place with someone who is infected with rubeola increases the risk of developing rubeola. It can stay in the air for up to two hours after the infected person was present. Example areas of risk include:
- Crowded living spaces or shopping areas
- Airports, airplanes, or other methods of public transportation
Treatment for measles
The most important aspect of managing rubeola is to prevent its transmission by getting the recommended vaccine. There is no cure for the rubeola virus once a person is infected, and one in four people infected will be hospitalized. Therefore, treatment for anyone with rubeola focuses on supportive treatment and vitamin A supplementation to improve outcomes.
Children and vaccination
The best way to prevent rubeola is to receive the recommended vaccines. In the United States, this is available as the MMR vaccine (immunization for rubeola, mumps, and rubella), which is given in two doses to all children at the age of 12 to 15 months and at four to six years.
Adults and vaccination
Adults who are unsure of their immunization status should receive at least one dose of the vaccine. Adults who are university students, healthcare workers, international travelers, are infected with HIV or have had a bone marrow transplant should receive two doses of the vaccine.
There is no cure for the rubeola virus. Therefore, the primary method of managing a rubeola infection is to provide supportive treatment. This includes:
- Providing fluids by mouth or intravenously: To ensure proper hydration
- Giving medication: Acetaminophen (Tylenol) may be used to reduce fevers
- Managing any complications: Such as difficulty breathing or seizures
Vitamin A for children with Rubeola
Children who develop rubeola may benefit from receiving vitamin A. This is because rubeola can cause vitamin A deficiency, and giving children vitamin A has been shown to improve outcomes. Therefore, all children who develop rubeola are recommended to receive vitamin A as a liquid by mouth.
When to seek further consultation for measles
If you or your child develop symptoms of rubeola such as the typical rash, you should go to your physician right away. This is especially important if you or your child has not received the rubeola vaccine. Your physician can order laboratory tests to determine if you or your child has rubeola, and then offer the appropriate treatment as well as help prevent the spread of infection.
Questions your doctor may ask to determine measles
- Are you sick enough to consider going to the emergency room right now?
- How severe is your fever?
- Is your fever constant or come-and-go?
- How long has your fever been going on?
- Has your fever gotten better or worse?
Self-diagnose with our free Buoy Assistant if you answer yes on any of these questions.
Dr. Liu received his medical degree from the University of Pennsylvania Perelman School of Medicine and is pursuing a career in ophthalmology. He graduated Phi Beta Kappa from Swarthmore College with a BA in biology. He has published research in multiple ophthalmology and healthcare journals and has received awards from Research to Prevent Blindness. In his free time, he enjoys running, biking, and spending time with his friends and family.
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- Measles: Overview. Mayo Clinic. Published September 7, 2018. Mayo Clinic Link
- Berezow A. Measles vaccine has saved more than 20 million lives globally since 2000. American Council on Science and Health. Published November 1, 2017. ACSH Link
- Top 4 things parents need to know about measles. Centers for Disease Control and Prevention. Updated February 5, 2018. CDC Link
- Frequently asked questions about measles in the United States. Centers for Disease Control and Prevention. Updated April 2, 2018. CDC Link