Measles, also called rubeola, is a virus-borne respiratory infection that is potentially highly dangerous and easily spread by contact. Rubeola should not be confused with German measles (rubella), which is a different viral infection. Measles has become rare in the USA and Western Europe in recent years with children usually protected by vaccinations, but there are still an estimated twenty million cases around the world each year. Since it is a viral illness, there are no treatments. Infected children require plenty of bed rest. They need to drink sufficient fluids and stay quarantined as long as the measles remains contagious. The risks posed to adults who never had the illness in childhood are much more serious than the risks to children.

Symptom-free incubatory stage

It is natural to assume that measles begins when its characteristic body rash appears, but the medical profession recognizes that it also has an initial stage without any obvious signs. They describe this as the incubator stage. It begins when the patient first catches the virus. It can last up to two weeks without any visible indications appearing. Although the patient remains asymptomatic, the incubation phase has some medical relevance because whoever was in contact with this patient during these days is at high risk of becoming infected.

Reddish-brown body rash

There is no disputing the fact that the measles reddish-brown body rash is the most obvious sign of this illness. It usually appears about 14 days after the patient has been exposed. Usually, it starts in the form of flat reddish spots on the patient’s forehead, and behind the ears. Sometimes the spots merge into large freckled patches. It can be quite itchy at times but scratching the spots may leave pockmarks. The rash spreads from the forehead to cover all of the body right down to the feet. It spreads in just a couple of days. Normally, it lasts for a week or so, and then it fades away.

Spots appear inside the mouth

Sometimes the appearance of spots in the patient’s mouth precedes the appearance of the better-known body rash. These mouth spots appear small and red with a grey to white in the center. They usually do not last more than a few days. If a patient has mouth spots and then a few days afterward a body rash breaks out, this is a firm indication they have measles. Although the mouth spots are quite common outbreaks of measles, they do not always follow this pattern.

Running a high fever

At the start of the illness, patients often experience a high fever. This fever can easily get as high as 104 to 105.8 F (40 to 41 C). It is difficult to come to a definite diagnosis at this stage while other characteristic signs of measles are absent. The link between this fever and measles may therefore only be realized when the spots appear on the forehead. Usually, the patient’s fever rises dramatically as the rash develops and this resolves any doubts about the diagnosis of measles.

Dry cough

A very dry cough is another possible sign of measles. Some describe this as a “hacking cough.” Since the cough precedes the appearance of the measles rash, it may not be sufficient in its own right to make a definite diagnosis. Coughs have many other possible causes and so additional evidence is necessary. The doctor may suspect it is measles, but only when the rash appears a few days afterward do they get clear proof that this cough was a measles symptom.

Reddish eyes

The redness in the eyes also called conjunctivitis, is another typical symptom of measles, but it is hard to know for sure without the presence of other obvious symptoms. Conjunctivitis due to other causes is not a rare affection in young children. Nevertheless, statistics show that children with measles often suffer from conjunctivitis so a doctor is likely to suspect that this might be the cause.

Runny nose

A runny nose symptom is such a common feature of childhood illness it is easy to understand why a doctor might be hard-pressed to diagnose it as a sign of measles immediately. They might have grounds for suspicion and be particularly concerned if the parents did not get the child inoculated. The doctor could also recommend that the child is kept isolated from contact with others for a few days, to observe if a rash develops.

Sore throat

A runny nose and conjunctivitis may accompany a sore throat in some patients. However, in the absence of a typical rash, the child needs to be under close observation for a few days to see if any other sign appears.

Fatigue with loss of appetite

Patients with measles feel extremely tired. They are unable to eat and often become very easily irritated. They also frequently suffer from various aches and pains that only exacerbate their general sense of discomfort. While none of these symptoms are exclusive to measles, in combination they help make the right diagnosis.

Extremely contagious

Measles is a classic case of a very contagious disease. Patients are considered to be contagious from 4 days before to 4 days after the rash appears. Somebody who never received a vaccination has as high as a 90% chance of catching it from close contact.