What is measles?

Measles is a very infectious disease caused by a virus. Measles spreads very easily through the air by sneezing or coughing, and can also be spread by contact with contaminated surfaces (from an infected person’s nose and throat secretions). Measles is potentially serious, with complications including diarrhoea, ear infections, pneumonia, encephalitis (brain inflammation), brain damage, and death. Measles is also known as rubeola and morbilli.

Who gets measles?

Those at risk of getting measles:

• babies and young children [see ‘Childhood immunisation’ further below]
• older children and adults who have not been immunised against measles (or who have not had the disease)
• children and adults with immune system deficiencies
• unvaccinated pregnant women, both for their unborn baby and their own health [see ‘Pregnancy and measles’ further below].

Adults born before 1969 are assumed to be immune.

What are the symptoms of measles?

Symptoms usually begin to show about 10 to 14 days after infection with the virus (though can take up to 18 days to appear). Early symptoms include fever, runny nose (or blocked nose), cough, loss of appetite, and conjunctivitis (red, sore eyes). Tiny white/blue spots are usually visible on the inside of the mouth (called ‘Koplik spots’).

After three to five days, a blotchy red rash appears. The rash starts on the head or face, often at the hairline or behind the ears, and then spreads to the body and then to the arms and legs. The child or person usually feels most unwell a day or two after the appearance of the rash. The rash lasts about four to six days. Treatment is discussed further below.

Possible complications

Complications of measles can be very serious, including diarrhoea (which can also lead to dehydration), ear infections, and pneumonia. Pneumonia is the main cause of measles deaths. Inflammation of the brain (encephalitis) occurs in one in 1000 measles cases, with some of these cases dying and one-third being left with permanent brain damage. The overall death rate from measles is about one to two per 1000 cases.

How to prevent measles?

Vaccination is the only way to prevent getting the disease. However, if immunisation rates are low, measles outbreaks can occur in New Zealand and other countries.

Vaccine introduced in 1969
The measles vaccination was introduced to New Zealand in 1969, and before that time the majority of the population would have had measles by the age of 20. People born before 1969 are therefore considered to have already had the disease or exposure to it, and so to be immune.

Vaccination helps prevent spread of the disease, and also helps protect those people who cannot be immunised.

Childhood immunisation against measles

Children are currently given two doses of measles vaccine as part of the National Immunisation Schedule. The first dose is at age 15 months and the second dose at age four years. The measles vaccine is given as part of the combined MMR (measles-mumps-rubella) vaccine. The Immunisation Advisory Centre (IMAC) advises that having two doses of MMR vaccine is 99% effective in preventing measles.

Although the age for first dose of measles vaccine is 15 months; in a measles outbreak, babies 12 months old or possibly younger may be immunised – check with your doctor. Also, if other children are immunised on time it lowers the risk of babies getting measles.

Auckland immunisation rates low
The Auckland Regional Public Health Service reports (July 2011) that the percentage of children who have received one dose of MMR by age 18 months in the Auckland region is low, at 78%. Also, Maori children in the Auckland region are particularly at risk as the percentage of 18-month-old Maori children who have received one dose of MMR is only 67%.

Side effects from vaccine

Possible side effects of the MMR vaccine include fever, and a mild, non-infectious rash about 5-12 days after vaccination. More serious side effects are possible, but the risk of side effects from the vaccine is considered to be much lower than the risks of getting measles (or mumps and rubella). For example, in measles disease, inflammation of the brain (encephalitis) occurs in one in 1000 cases, whereas with the MMR vaccine, encephalitis occurs in one in one million cases. Discuss possible side effects or concerns with your doctor or nurse before vaccination. The MMR vaccine does not contain thiomersal (or mercury).

Adult vaccination

Older children and adults who have not been immunised against measles and who have not already had the disease, can also be immunised. As well as protecting themselves, this also helps protect the spread of measles to young children and other groups, such as pregnant women, who cannot have the vaccine.

The Immunisation Advisory Centre also advises the MMR vaccine for adults who:

• were born after 1969 (when the measles vaccine was introduced to New Zealand) who lack evidence of immunity to measles. (Adults born before 1969 should be immune)
• do not have immunity to measles and are travelling to a country/area where measles is common.

People who should NOT receive the measles (MMR) vaccine:

• pregnant women [see ‘Pregnancy and measles’ further below]
• people with weakened immune systems (including people receiving treatment for cancer)
• anyone who has had an anaphylactic reaction (extreme allergic reaction) to a previous dose of the MMR vaccine or to any mumps vaccine, or to gelatin or neomycin
• anyone who has received another live vaccine, including varicella and BCG within the previous month
• anyone who has received immunoglobulin or a transfusion within the last 11 months.

Get advice
Anyone who is unsure if they have an immune deficiency or who is taking medication to suppress their immune system - should get more advice before having the vaccine.

Contact your GP or Healthline (0800 611 116) if unsure about whether you or your child can have the vaccine.

Pregnancy and measles

Women who have not been immunised: If women who have not previously been immunised become ill with measles during pregnancy, this increases the risk of miscarriage, premature labour and low birthweight infants.

Contact GP or LMC if exposed: Pregnant women who think they have measles or who have come into contact with someone with measles, are advised to call their GP or lead maternity carer as soon as possible.

No measles vaccine during pregnancy: Women should not have the measles (MMR) vaccine during pregnancy, but close contacts of pregnant women can be immunised, to help protect both mother and unborn baby from exposure.

Wait one month before getting pregnant: Women of childbearing age (who are not pregnant) who receive a dose of the measles vaccine, should avoid getting pregnant for one month afterwards.

What to do if exposed to measles?

Already vaccinated: If your child and/or yourself are already vaccinated, have already had measles, or were born before 1969, you should be able to carry on as normal. Note, however, there is a very small chance of still getting measles after being immunised, so if your child seems to develop signs of measles, contact Healthline on 0800 611 116 or phone your GP for advice. If your child is aged at least three years, but has not yet had their second dose of MMR vaccine (scheduled for age four years), you could contact your GP to see whether the second MMR dose can be given earlier (especially if exposed to measles, or during a measles outbreak). There must be at least one month inbetween doses.

Not vaccinated: If your child has not already had at least one dose of measles vaccine (MMR), contact your GP about receiving this as soon as possible. If given within 72 hours of exposure to measles virus, the MMR vaccine may give protection to those who are not immunised.

• Under 15 months: The first dose of MMR on the Immunisation Schedule is at age 15 months, but may be given at age 12 months or possibly at a younger age in outbreak situations.
• Over 15 months: If the child is over 15 months and not vaccinated, catch-up vaccination can be given.
• Four years: Children should receive their second dose of measles vaccine at age four years. Having this second dose of the vaccine is recommended, as it raises the level of protection against measles. Catch-up vaccination can be given if the child has not already had their first dose.
• Adults under 40 years: Adults born after 1969 who have not received any measles vaccination should receive one dose.

Unimmunised children (who do not want vaccination): The Immunisation Advisory Centre advises that, in the event of a measles outbreak, unimmunised children (who have not had measles) who have contact with measles cases are advised NOT to attend school or early childhood services (or be in public places) until notified. This may be for a period of 14 days. Phone your GP or Healthline for advice.

Phone first if symptoms develop

Because of the highly infectious nature of measles, it is advisable to phone your GP or Healthline (0800 611 116) for advice, before going to the medical centre.

The treatment for mild cases of measles is usually rest and symptom relief. Hospital or other treatment may be needed for severe cases and/or if complications occur. More on treatment is given further below.

Infectious period: The child or person is usually infectious from about five days before the rash appears through to about five days after the rash starts (about 10 days in total). Children will need to be kept home from school and away from other people during this time (follow your doctor’s advice).

Treatment for measles

As measles is caused by a virus, treatment is to provide symptom relief and support to the child (or person) with measles. The child should stay in bed or rest quietly on the couch. As he or she will be infectious for around 10 days, do not invite other children or visitors to the house.

Offer plenty of clear drinks throughout the day - especially if he or she has a temperature, or has diarrhoea. Don't worry if your child does not feel like eating, this is normal, however, it is very important to keep up their fluid intake to prevent dehydration.

If you feel your child is getting worse, if they remain very unwell after the rash has started to fade, or you are worried they are developing complications, phone your GP or Healthline for advice (also see ‘Symptoms needing medical advice’ further below).

People with severe cases of measles may need to be admitted to hospital. Antibiotics are not routinely given for measles, but will be needed if a bacterial infection (like pneumonia) develops as a result of having measles.

Cough – symptom relief

If the cough is dry (not coughing up any phlegm) and is causing your child distress, cough medicines may give some relief. However, most cough medicines have ingredients that are not recommended for children under age 6 years; ask your pharmacist for product advice for young children.

You may find that he or she gets good relief from the cough by sitting in a steamy room. This can be done simply by using a vaporiser, a special machine which produces a fine, moist mist. Vaporisers can be bought at pharmacies. However, sitting in the bathroom (with the doors and windows closed) while the shower is running can also be effective. Do not leave a young child unattended when doing this.

Fever - symptom relief

Paracetamol will help to reduce the fever and control headaches. Follow the instructions on the bottle carefully and do not give more than the recommended dose for the age of the child. When your child has a fever, dress him or her lightly, and cover only with a sheet. If he or she feels cold and shaky, cover them up until the shakes stop and they feel comfortable, then remove the clothes and blankets again.

Close all the curtains in the room, and let them lie quietly in the dark if the light hurts their eyes.

Sticky eyes - symptom relief

Wash sticky or itchy eyes with a mixture of previously boiled water (500ml) and salt (1 tsp). Use disposable eye make-up pads or a very clean flannel to do this. If the sticky pus around the eyes turns green or dark yellow/cream, take your child to the doctor as he or she may have developed a bacterial infection and require antibiotics.

Symptoms needing medical advice

In some children (or adults) measles can cause very serious illness - like pneumonia or encephalitis (swelling of the brain).

Contact your child's doctor or get urgent medical advice if they:

• are having trouble breathing
• are complaining of a stiff neck
• are very drowsy or you cannot wake them up
• are coughing up green or yellow thick sputum or are complaining of pain in their back
• are complaining that they have sore ears
• have a fit
• have not passed urine for 10 hours.

You can also contact Healthline free (within New Zealand) on 0800 611 116 for advice.

More information on immunisation

For more information on vaccination against measles, contact the Immunisation Advisory Centre (details under 'Further information and support' below).

Related topics

Also see Childhood immunisation and Vaccination - how it works and Measles - the return?

Written by Anna Mickell RCpN. Edited and updated by everybody, July 2011.