Overview

Measles is a highly contagious viral disease that primarily affects children, particularly those who are unvaccinated or under-vaccinated. Symptoms include high fever, cough, runny nose, red eyes, white spots inside the mouth and a characteristic rash that spreads across the body.

It is a serious airborne disease that can lead to severe complications and death.

Vaccination is the most effective way to prevent measles infection and spread.

Robust surveillance systems are essential to identify and address immunity gaps.

Increased awareness, timely intervention and adaptive preventive measures are crucial in addressing measles, particularly in settings where access to health care and resources are limited.

Transmission

Measles is a highly contagious disease caused by a virus. It spreads easily when an infected person breathes, coughs or sneezes. It can also spread by direct contact with nasal or throat secretions of infected persons.

Its highly infectious nature means measles can quickly become widespread within communities, especially among unvaccinated populations.

Measles can linger in the air and on surfaces for up to 2 hours after an infected person has left, making it possible to contract the virus without direct person-to-person contact.

The virus can begin spreading 4 days before the onset of the rash and continues to be contagious until 4 days after the rash emerges.

Symptoms

Symptoms typically begin 10–14 days after exposure to the measles virus.

Early symptoms (4–7 days):

runny nose;

cough;

red and watery eyes; and

small white spots inside the cheeks.

Rash development:

The rash usually appears 7–18 days after exposure, starting on the face and upper neck.

It spreads over a period of about 3 days, eventually reaching the hands and feet.

The rash typically lasts 5–6 days before it begins to fade.

Complications of measles

Common complications:

diarrhoea and related dehydration;

pneumonia and other severe respiratory problems;

blindness;

encephalitis (brain swelling that can lead to brain damage); and

ear infections.

Pregnancy risks

Contracting measles during pregnancy can lead to an increased risk of serious maternal and fetal complications, including low birthweight, spontaneous abortion, intrauterine fetal death and maternal death.

Who is at risk?

Any non-immune person (not vaccinated or under-vaccinated) can become infected.

Immunocompromised patients, pregnant women, individuals with vitamin A deficiency or poor nutritional status, and individuals at the extremes of age are at a high risk of developing complications.

Measles weakens the immune system significantly, increasing vulnerability to other infections.

Treatment and management

Vitamin A supplementation:

Measles can deplete vitamin A levels even in well-nourished individuals. Two doses of vitamin A are recommended for suspected measles cases in children under 5 years of age.

Vitamin A may be given to adults with measles, particularly when patients may have vitamin A deficiency. Women of reproductive age in whom vitamin A deficiency is suspected must be treated with lower but more frequent doses of Vitamin A because of possible teratogenic (causes an abnormality following fetal exposure during pregnancy) effects.

Vitamin A supplements can help prevent serious complications such as eye damage and blindness and can reduce the death rate associated with measles.

Supportive care:

Focus on relieving symptoms, ensuring comfort and preventing complications since there is no specific treatment for measles.

Care must be taken to avoid complete airway collapse and asphyxiation.

Nutrition: monitor the weight and intake of children daily. Encourage breastfeeding for infants and small frequent meals for children. Consult a dietician and treat malnutrition if present. Avoid giving children spicy foods.

Hygiene: wash mouth with clean salted water at least 4 times a day.

If infected mouth ulcers appear, consult a doctor.

Monitor eyes for change in discharge quality. If there is anything other than a clear watery discharge, such as cloudy discharge or pus, seek medical advice. Clean the eye carefully using a clean cloth dipped in clean water or sterile gauze. Consult eye specialists as needed. Do not use steroid ointment on infected eyes.

Ensure skin is kept clean and dry and monitor for signs of infection.

Hydration: encourage consumption of sufficient water to replace fluids lost to diarrhoea or vomiting. Use any available safe water source and consider using oral rehydration packets to replace lost fluids. Where there is limited availability of drinking water, seawater or saline water can be used for cleaning, toilet flushing and bathing to save supplies of drinking water.

Antibiotic use:

While antibiotics do not treat measles, they may be prescribed to treat secondary bacterial infections such as pneumonia and ear and eye infections among measles patients.

Prevention

Isolation measures:

Immediately isolate anyone suspected of having measles to prevent virus spread. Use makeshift barriers if necessary and inform local health authorities so they can initiate response protocols.

If not admitted to a health facility, patients should remain in isolation at home for 4 days after rash onset, preferrable in a single room.

If a patient is admitted to hospital, airborne transmission precautions should be taken for 4 days after the onset of rash in otherwise healthy patients and for the duration of illness in immunocompromised patients.

If tolerated, wear a mask for source control. Masks must not be worn by children under 5 years.

Always practice respiratory etiquette and hand hygiene after contact with respiratory secretions – blowing nose, sneezing or coughing – to reduce the spread of infection.

Health care personnel requirements: only medical staff likely to be immune to measles, either through vaccination or previous infection, should care for patients suspected of having measles.

Vaccination:

Strengthen immunization programmes with a special focus on high-risk groups:

Prioritize vaccination and nutritional support for displaced populations who are at increased risk of measles outbreaks. Vaccination should commence as soon as possible upon displacement.

Community engagement and health care coordination

Building strong community awareness and education on measles symptoms, transmission and prevention helps in the early detection and control of outbreaks.

Engage community leaders and health care workers in outreach programmes to spread knowledge and enhance community readiness.

Share vital information about hygiene practices, symptom recognition and the importance of immediate health care consultation within your community.

Sources

WHO and UNICEF. Infection prevention and control and water, sanitation and hygiene measures in health-care settings and shelters/congregate settings in Gaza: technical note, 22 February 2024 (https://iris.who.int/handle/10665/376082).

WHO Measles Fact Sheet (https://www.who.int/news-room/fact-sheets/detail/measles).

WHO Measles outbreak guide (https://www.who.int/publications/i/item/9789240052079).

WHO Measles Outbreak Toolkit (https://www.who.int/emergencies/outbreak-toolkit/disease-outbreak-toolboxes/measles-outbreak-toolbox).