Measles is a very contagious viral illness with fever, cough, nasal congestion, characteristic rash, and irritation of the mucous membranes (Koplik's spots).

There is a 7-10 day incubation period following exposure. The initial symptoms are flu-like, with nasal itching, fever, dry hacky cough and inflammation of the conjunctiva. 

• 2-4 days later, Koplik's spots appear. These look like white grains of sand, surrounded by raised, red areas on the inside of the mouth or lips.
• 3-5 days after initial symptoms, the rash appears. These are raised, red skin lesions, starting on the sides of the neck and spreading downward over the next 24-48 hours to the trunk and ultimately to the extremities. This head-downward spread is characteristic of the disease.

At this stage, the host appears to be quite ill, with high fever (up to 104), mild itching, coughing, and sensitivity to light. After 3-5 days of discomfort, the fever goes away, the rash rapidly disappears, and recovery is prompt.

In otherwise healthy individuals, there is a very low mortality rate, and most complications are due to bacterial superinfections (particularly streptococcal). This may include pneumonia, otitis medica or pharyngitis. During the illness, the immune system is pre-occupied and reactivation of latent diseases (eg TB) can occur.

In immunocompromised individuals, the disease may be more lengthy, the risk of superinfection is increased, and the usually rare complications of myocarditis, pericarditis, glomerulonephritis, coma and encephalitis are increased. Also at risk are children less than 5 years old, and those with Vitamin A deficiency.

It is spread by aerosol contamination from the nose or mouth in tiny droplets. Infected individuals are contagious starting 4 days before the rash appears and continuing until the rash disappears.A previous infection normally confers life-time immunity. Nearly as effective is active immunization. Newborn infants of mothers who are immune receive temporary, passive immunity from the placenta, lasting the better part of the first year of life.

Measles is sometimes confused clinically with:

Immunization is with a weakened form of the virus which leads to a clinically mild (or absent) illness that is not contagious. In fewer than 5% of individuals, a temperature of 101 degrees and rash develop 5-12 days after immunization. Immunization should not be done to pregnant women, immunocompromized individuals, or those with widespread malignancy. Those already exposed may be immunized, but this should be within 2 days of exposure to be effective.

Treatment is generally supportive, but Vitamin A, 400,000 IU orally seems to reduce the morbidity and mortality of the illness, particularly in malnourished or undernourished populations.

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Operational Medicine 2001

Health Care in Military Settings

*This web version is provided by The Brookside Associates Medical Education Division.  It contains original contents from the official US Navy NAVMED P-5139, but has been reformatted for web access and includes advertising and links that were not present in the original version. This web version has not been approved by the Department of the Navy or the Department of Defense. The presence of any advertising on these pages does not constitute an endorsement of that product or service by either the US Department of Defense or the Brookside Associates. The Brookside Associates is a private organization, not affiliated with the United States Department of Defense.

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