If you thought we had virtually eradicated measles from our country years ago, you’re right. But with the recent upswing in parents choosing not to vaccinate their children, the once rare viral infection is back in a startling way. Here’s important information on measles and how you can best protect your family. 

What is measles?

Measles is a viral infection that used to be very common but had been largely eliminated from our country over the past decades due to high vaccination rates. It is characterized by a fever and a distinctive rash, which may sound like chicken pox and therefore seem benign, but the rate of complications from measles is higher than other childhood rash illnesses, such as chickenpox.

We fear the measles because of its rate of severe complications, the contagiousness of the disease and the period of time that it’s transmissible without being recognizable.

How is measles spread?

Measles is one of a small number of infections that spread by a truly airborne route. Measles virus particles come out of the mouth and nose of an infected patient and can remain in the air for up to two hours Anyone who breathes in one of those virus particles who is not immune has a 90 percent chance of developing the measles. 

What are the symptoms of measles?
During the first two to four days, the symptoms are very general and resemble other viruses: fever, cough, runny nose and red, swollen eyes – easily mistaken for ordinary conjunctivitis.

After two to four days of these symptoms, the distinctive rash appears. Small red spots, which may be raised slightly, break out, first on the face and especially along the hairline and behind the ears. The spots cluster and give the skin a blotchy appearance.

Even if you don’t have complications, measles can make you feel very ill. The rash itself is not itchy or painful, but the disease wipes people out. Think about how you feel if you’ve had the flu, but make it worse and last longer – 10 or more days.

If a parent or child has the measles, what are the first steps they should take?

If you think you or someone has the measles, the first thing to do is to stay out of public spaces and away from other people. Call your physician right away and tell them you’re concerned that you may have the measles. If they can’t feel comfortable that you don’t have measles, they’ll arrange for you to be evaluated while minimizing possible exposure to other people.

How is measles diagnosed?

Measles is diagnosed by a combination of blood tests and a viral culture from a swab of the nose and throat. Typically, the blood test results are available in a day or two. The culture takes longer.

How is measles treated? And what are serious signs to look for that may require hospitalization?

There is no specific anti-viral medication to treat measles; you can only use comfort measures to try and lessen the symptom impact. If you do develop complications, there’s no treatment either, just supportive care. The best way to deal with it is to avoid getting it, through vaccination.

Signs of more serious measles that might require hospitalization are the same kinds of things that you would already pay attention to: difficulty breathing, poor fluid intake, delirium or unusual behavior, and so on.

Read more about measles prevention and outbreaks on the next page. 

Why is measles prevention important?

Measles is not treatable. Once you have it we can provide “supportive care,” but there’s no antiviral compound that will stop it. Measles has a relatively high rate of complications, including some very serious ones, such as pneumonia and encephalitis. Sadly, there are quite a few people who can’t protect themselves against it with vaccination. This includes people with a variety of medical problems or those on medications that suppress their immune system, as well as infants below the age of 12 months. These people can’t get the vaccine; they can only be protected by a “ring of immunity” around them, or what I like to call “community immunity.” In addition, while the measles vaccine is one of our most effective vaccines with 99 percent protection after two doses, measles is so contagious that even the 1 percent of people who’ve been immunized but don’t develop good immunity are at risk. We can protect all of these people who aren’t immune by making sure that everyone who can be immunized is immunized.

If a parent does not know if they’ve been vaccinated, how can they find out?

The first and best course is for parents to see if they can find their vaccination records – either in their family’s records or in medical records from their physician. If you can confirm you’ve had two measles vaccines with the appropriate spacing, you’re presumed immune. There is a blood test, but unfortunately it’s not perfect. If the blood test is positive, it’s convincing evidence of immunity; but if it’s negative, it doesn’t necessarily mean you’re not immune. If you can’t obtain your vaccination records, then you can contact your primary care provider to discuss the blood test.

If a measles outbreak occurs in your area, what can you do to protect your family from measles?

Of course, the first thing is to make sure that all the family members who can be vaccinated are vaccinated. The next best way to protect your family is to urge everyone around you who’s not vaccinated to get vaccinated. “Community immunity” is our best defense, meaning we need about 95 percent of people in the community immunized to avoid spreading measles. There are some parents who are asking parents of potential playmates if their children are vaccinated and won’t permit playdates if not (just as some parents ask about cigarette smoking or guns in the house before allowing their kids to go a friend’s house).

Ben Kruskal, M.D. is chief of infectious disease at Harvard Vanguard.