From the Guidelines
The expected course of measles typically spans about 14 days from exposure to recovery, with an 8-12 day incubation period before symptoms appear, and patients are contagious 4 days before the rash to 4 days after the rash appears. The illness begins with prodromal symptoms including high fever, cough, runny nose, and red, watery eyes (conjunctivitis), lasting 2-4 days, as described in the study published in Pediatrics 1. Koplik spots (small white spots) may appear inside the mouth during this period. Around day 3-5 of symptoms, the characteristic red, blotchy rash develops, starting on the face and spreading downward to cover the entire body over 3-4 days. Fever typically peaks when the rash appears. As the rash progresses, symptoms gradually improve, with fever subsiding and the rash fading in the same order it appeared. Most uncomplicated cases resolve within 7-10 days after symptom onset. Complications can include ear infections, pneumonia, and rarely encephalitis, with a case-fatality rate of 1-2 per 1,000 reported cases in the United States, as reported in the study published in MMWR Recommendations and Reports 1. Recovery typically confers lifelong immunity. Supportive care with rest, fluids, fever reducers like acetaminophen, and vitamin A supplementation (especially in malnourished children) is the mainstay of treatment. Isolation is essential during the contagious period, which extends from 4 days before to 4 days after rash onset, as highlighted in the study published in Pediatrics 1.
Some key points to consider in the management of measles include:
- The importance of vaccination in preventing measles outbreaks, with up to 5% of people who have received a single dose of vaccine at 12 months or older experiencing vaccine failure 1
- The need for isolation during the contagious period to prevent the spread of the disease
- The potential for complications, such as ear infections, pneumonia, and encephalitis, and the importance of prompt medical attention if these occur
- The role of supportive care, including rest, fluids, and fever reducers, in managing symptoms and preventing complications.
From the Research
Expected Course of Measles
The expected course of measles can vary, but it is often characterized by several complications.
- Pneumonia is a common complication, with a lower incidence in children who receive antibiotics 2
- Other complications include:
- Purulent otitis media, which is significantly lower in children receiving antibiotics (OR 0.34; 95% CI 0.16 to 0.73) 2
- Tonsillitis, which is also significantly lower in children receiving antibiotics (OR 0.08; 95% CI 0.01 to 0.72) 2
- Conjunctivitis, which shows no significant difference in incidence between children receiving antibiotics and those who do not (OR 0.39; 95% CI 0.15 to 1.0) 2
- Diarrhea, which also shows no significant difference in incidence (OR 0.53; 95% CI 0.23 to 1.22) 2
- Croup, with no significant difference in incidence (OR 0.16; 95% CI 0.01 to 4.06) 2
- In rare cases, measles can present with atypical features, such as primary measles pneumonia, which can be more prevalent among immunosuppressed patients but can also occur in immunocompetent individuals 3
- Measles can also lead to more severe complications, such as hepatitis and extensive pneumonia with respiratory failure, especially in cases where the diagnosis is delayed or the patient's vaccination status is unclear 3