What is the case-fatality rate of a natural measles infection?

Medical Advisory BoardAll articles are reviewed for accuracy by our Medical Advisory Board
Educational purpose only • Exercise caution as content is pending human review
Article Review Status
Submitted
Under Review
Approved

Last updated: February 19, 2026 • View editorial policy

Personalize

Help us tailor your experience

Which best describes you? Your choice helps us use language that's most understandable for you.

Risk of Death from Natural Measles Infection

The case-fatality rate from natural measles infection is approximately 1 in 1,000 cases (0.1%) in developed countries with adequate healthcare, but this rate increases substantially to 1-3% in resource-limited settings and can reach 5-30% in emergency or outbreak situations with poor healthcare access. 1, 2, 3, 4

Historical Context in the United States

Before measles vaccination was introduced in 1963, the mortality burden was substantial:

  • Approximately 500,000 measles cases were reported annually in the United States, resulting in approximately 500 deaths per year (0.1% case-fatality rate) 1
  • An additional 48,000 persons required hospitalization annually 1
  • Another 1,000 persons suffered permanent brain damage from measles encephalitis each year 1

It is critical to note that these historical U.S. figures likely underestimate true mortality, as reporting was incomplete and many deaths in resource-poor communities went undocumented. 5

Modern Era Case-Fatality Rates

United States (2001-2008)

During the modern vaccination era with high healthcare access, mortality remained low but present:

  • Among 557 confirmed measles cases, 2 deaths occurred (0.36% case-fatality rate) 1
  • 23% of cases required hospitalization, with at least 5 patients admitted to intensive care 1

Global Burden (Contemporary Data)

The global case-fatality rate is substantially higher than in developed nations:

  • Worldwide, approximately 20 million measles cases occur annually with approximately 164,000 deaths (0.82% global case-fatality rate) 1
  • More recent 2023 data shows 10,341,000 estimated cases with 107,500 deaths (approximately 1% case-fatality rate) 6
  • In low- and middle-income countries from 1990-2015, the mean case-fatality ratio was 2.2% (95% CI 0.7-4.5%) 3

Community-based studies show lower mortality (1.5%) compared to hospital-based settings (2.9%), reflecting selection bias toward more severe cases requiring hospitalization. 3

High-Risk Populations with Elevated Mortality

The risk of death is not uniform across all age groups and populations:

Age-Related Risk

  • Infants and children under 3 years face the highest mortality risk 1, 2, 7
  • Adults ≥20 years also experience elevated risk compared to older children and adolescents 1, 2, 7
  • Age-specific case-fatality rates are highest among infants, then decline progressively with age 8

Immunocompromised Individuals

  • Persons with leukemias, lymphomas, or HIV infection face substantially higher risk of severe and prolonged infection with increased mortality 2

Pregnant Women

  • Measles during pregnancy increases rates of spontaneous abortion, premature labor, low birth weight, and both maternal and fetal mortality 1, 2, 7

Malnourished Children

  • Malnutrition significantly increases mortality risk, particularly in developing countries where case-fatality rates can exceed 5% 4, 8

Fatal Complications

The primary causes of measles-related death are:

Pneumonia

  • Pneumonia is the most common cause of measles-related death 2, 7

Acute Encephalitis

  • Occurs in approximately 1 per 1,000 measles cases (0.1%) 1, 2
  • Represents a leading cause of measles mortality 2, 7
  • Encephalitis or death follows measles disease in approximately 1 in 1,000 cases, with the highest risk among infants and adults 1

Subacute Sclerosing Panencephalitis (SSPE)

  • A rare but invariably fatal late complication appearing years after initial measles infection 2
  • Occurs in approximately 4-11 per 100,000 measles-infected individuals 9
  • Primary risk factor is early age at initial measles infection and lack of measles vaccination 9

Geographic and Healthcare System Variations

Case-fatality rates vary dramatically based on healthcare infrastructure:

  • Developed countries with robust healthcare: 0.1-0.4% 1, 3
  • Low- and middle-income countries: 1.5-2.9% 3
  • Emergency settings or outbreaks with poor healthcare access: 5-30% 5, 4
  • Community studies in India showed median case-fatality rates of 3.7% in outbreak studies, with lower rates (0.1%) in areas with available healthcare facilities 8

Critical Clinical Caveat

The substantial difference in mortality between settings with and without adequate healthcare access underscores that measles deaths are largely preventable through:

  • Timely supportive care and treatment of complications 8
  • Vitamin A supplementation for all children with clinical measles 2
  • Prompt treatment of secondary bacterial infections with antibiotics 2
  • Oral rehydration therapy for diarrhea 2

Most importantly, measles vaccination remains the only truly effective prevention strategy, having averted an estimated 60.3 million measles deaths globally during 2000-2023. 6

References

1
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

2
Guideline

Measles Fatality Risk

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2026

4
Research

History of measles.

Presse medicale (Paris, France : 1983), 2022

6
Research

Progress Toward Measles Elimination - Worldwide, 2000-2023.

MMWR. Morbidity and mortality weekly report, 2024

7
Guideline

Measles Mortality and Complications

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2025

8
Research

Measles mortality in India: a review of community based studies.

The Journal of communicable diseases, 1994

9
Guideline

SSPE Pathogenesis and Risk Factors

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2026

Related Questions

What is the estimated annual number of measles fatalities worldwide?
What is the recommended management for an adult diagnosed with measles, considering potential complications and the need for symptom relief?
What is the most likely outcome of untreated measles in a child with Koplik spots and fever?
What causes measles in children and how is it transmitted?
What is the most likely mode of transmission of measles in a household with multiple siblings presenting with similar symptoms?
What alternative therapy can be used for ocular hypertension instead of a combination of a beta‑blocker and acetazolamide?
How should I evaluate and manage an 8‑year‑old male with diagnosed ADHD and suspected autism spectrum disorder?
In a 47‑year‑old woman with systemic lupus erythematosus, past infectious mononucleosis, and ADHD who has persistent intra‑labial lesions despite valacyclovir and a newly enlarged cervical lymph node, what is the most likely diagnosis and recommended management?
What is the best initial diagnostic test for a patient presenting with right ankle swelling and pain?
In a 40‑year‑old woman with cyclic pelvic, low‑back, and breast pain that worsens during her menstrual cycle, and with negative pelvic MRI and ultrasound except for a resolving right ovarian cyst, what differential diagnoses should be considered?
What is the most appropriate, cost‑effective strategy to reduce elevated glycated hemoglobin in a 65‑year‑old man with type 2 diabetes mellitus, hypertension, and coronary artery disease who discontinued sitagliptin‑metformin due to expense and is currently on basal insulin glargine?

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.

Have a follow-up question?

Our Medical A.I. is used by practicing medical doctors at top research institutions around the world. Ask any follow up question and get world-class guideline-backed answers instantly.

Ask Question