What are the symptoms of measles (rubeola)?

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From the Guidelines

Measles symptoms typically begin with a prodrome, followed by a rash, and can be complicated by severe conditions such as diarrhea, middle ear infection, bronchopneumonia, and encephalitis, as reported in a study by the Advisory Committee on Immunization Practices (ACIP) 1. The incubation period of measles averages 10-12 days from exposure to prodrome and 14 days from exposure to rash, with a range of 7-18 days 1. Some common symptoms and complications of measles include:

  • Diarrhea
  • Middle ear infection
  • Bronchopneumonia
  • Encephalitis, which occurs in approximately one of every 1,000 reported cases 1
  • Death, which occurs in 1-2 of every 1,000 reported measles cases in the United States, with the most common causes being pneumonia and acute encephalitis 1 The risk for death from measles or its complications is greater for infants, young children, and adults than for older children and adolescents 1. In developing countries, measles is often more severe and the case-fatality rate can be as high as 25% 1. It is essential to note that vaccination is the most effective prevention method, and the MMR (measles, mumps, rubella) vaccine provides excellent protection against the disease.

From the Research

Symptoms of Measles (Rubeola)

The symptoms of measles (rubeola) include:

  • Fever combined with one of the following: cough, coryza, conjunctivitis 2, 3, 4, 5, 6
  • Koplik's spots may appear on the buccal mucosa providing an opportunity to set the diagnosis even before the emergence of rash 2, 4
  • Rash typically appears 3-4 days after the onset of fever, initially on the face and behind the ears 2, 4
  • Maculopapular rash, which classically begins on the face and becomes more confluent as it spreads cephalocaudally 4, 5
  • At least one of cough, coryza, or conjunctivitis, although vaccinated individuals can have milder or even no symptoms 5

Complications of Measles

Measles can lead to various complications, including:

  • Pneumonia, which is one of the most lethal complications 2
  • Otitis media, laryngotracheobronchitis, stomatitis, and diarrhoea 5
  • Neurological complications, such as acute disseminated encephalomyelitis, measles inclusion body encephalitis, and subacute sclerosing panencephalitis 5
  • Bacterial superinfections, which should be properly treated with antibiotics 4

References

Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

Research

Measles pneumonitis.

Advances in respiratory medicine, 2019

Research

An Update and Review of Measles for Emergency Physicians.

The Journal of emergency medicine, 2020

Research

Measles: a disease often forgotten but not gone.

Hong Kong medical journal = Xianggang yi xue za zhi, 2018

Research

Measles.

Lancet (London, England), 2022

Research

Measles.

Lancet (London, England), 2017

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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