Can measles be fatal?

Measles Fatality Risk

Yes, measles can be fatal, with death occurring in 1-2 per 1,000 reported measles cases in the United States, and the case-fatality rate can be as high as 25% in developing countries. 1, 2

Mortality Risk Factors

• The risk for death from measles or its complications is greater for infants, young children, and adults than for older children and adolescents 1, 2
• Immunocompromised individuals, particularly those with certain leukemias, lymphomas, or HIV infection, face higher risk of severe and prolonged infection 1, 2
• Pregnant women experience increased rates of premature labor, spontaneous abortion, and low birth weight infants when infected with measles 1, 2
• Malnutrition significantly increases mortality risk, particularly in developing countries 2

Common Fatal Complications

• Pneumonia is the most common cause of measles-related death 1, 2
• Acute encephalitis occurs in approximately 1 per 1,000 cases and is a leading cause of measles mortality 1, 2
• Subacute sclerosing panencephalitis (SSPE) is a rare but fatal late complication that appears years after measles infection 1, 2
• Secondary bacterial infections contribute significantly to mortality due to measles-induced immunosuppression 3

Epidemiological Impact

• Before measles vaccine was licensed in 1963, approximately 500,000 cases and 500 measles-associated deaths were reported annually in the United States 1
• During the 1989-1990 measles resurgence in the US, a provisional total of 130 measles-associated deaths was reported 1
• Despite the availability of an effective vaccine, measles still causes considerable mortality worldwide, with estimates that >100,000 fatal cases occur annually 4
• Case fatality ratios vary dramatically between industrialized countries (<0.01%) and developing countries (>5%) 4

Prevention of Fatalities

• Vaccination is the cornerstone of measles prevention, with the first dose of MMR vaccine recommended at 12-15 months and the second dose at 4-6 years 2
• Vitamin A supplementation is recommended for all children with clinical measles to reduce mortality risk 2
• Prompt treatment of secondary bacterial infections with appropriate antibiotics can prevent fatal outcomes 2
• Oral rehydration therapy should be used for diarrhea to prevent dehydration 2

Special Considerations

• In developing countries, intensive exposure and cross-sex transmission may be important determinants of measles mortality 5
• The immunosuppressive effects of measles can last for weeks to months, increasing vulnerability to other potentially fatal infections 6
• Measles in pregnancy increases the risk of maternal and fetal mortality 1, 2
• Healthcare workers born before 1957 should not be presumed immune, as studies indicate up to 9.3% may be susceptible to measles 1

Measles remains a significant cause of preventable death worldwide despite the availability of a safe and effective vaccine. The wide disparity in case fatality rates between developed and developing countries highlights the importance of both vaccination programs and adequate supportive care in determining outcomes.