Measles - recognize, treat, prevent

Measles is a highly contagious viral infection, often easily recognized by a typical rash with a high fever. Vaccinations protect, which is why vaccination is now compulsory

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The measles virus is shown graphically in high magnification (based on electron microscope images).

© imago images / Science Photo Library

In short: measles

  • The virus is spread around the world and is highly contagious.
  • The symptoms resemble a cold or flu with a high fever. If the typical rash breaks out, you have been contagious for several days.
  • Therapy consists of bed rest and pain medication if necessary.
  • In some cases, complications such as otitis media, pneumonia or encephalitis occur.
  • There is a vaccination against measles. On November 14, 2019, the Bundestag decided to make vaccinations against measles mandatory.

What are the symptoms of measles?

If you have contracted measles, it can take eight to ten days for the first symptoms to appear. This period is also called the incubation period.

Preliminary stage (also catharral stage)

This is the first phase of the disease. It begins with general symptoms that initially seem like a strong cold:

  • runny nose
  • to cough
  • high fever
  • Exhaustion, tiredness
  • a headache
  • stomach pain
  • Watery and red eyes (conjunctivitis), which can make those affected sensitive to light
  • Inflammation in the nasopharynx

From the onset of symptoms, it takes about three to seven days for the measles rash to appear. But you are already contagious. At this point in time, it is often unclear whether you have caught a severe cold or flu, or whether you are infected with measles. The only peculiarity that can then indicate measles are the so-called Koplik spots. These are small stains that look like splattered lime on the inside of the cheeks at the level of the molars. They do not occur in all sick people. Overall, however, you see them in 60 to 70 percent of the cases. Then they are a clear indication of the infection. The spots are named after their discoverer, the American pediatrician Henry Koplik.

Exanthema stage and further course

After about two to three more days, the fever will drop briefly. Now the skin rash typical of measles, the measles rash, appears. The crimson spots usually form behind the ears initially. At the same time, the fever rises very high again and those affected suffer from a pronounced feeling of illness. The spots then spread further over the body:

  • symmetrical on the face
  • to the neck
  • on the same side on the fuselage
  • on arms and legs
  • up to the palms and feet

It can also lead to swelling of the lymph nodes and diarrhea.

After a few days, the rash turns dark red to brownish and then fades back in the order in which it appeared after three to four days. Often the skin then flakes in a "bran-shaped" manner in delicate small scales. Usually four days after the rash occurs, one is no longer contagious. The fever also goes down about a week after the onset of the illness.

The classic measles rash

© Your Photo Today / BSIP

What causes measles?

Measles is caused by a virus that belongs to the paramyxovirus family. Unlike bacteria, viruses cannot multiply without other living things. Viruses need the cells of another living being as a host in order to be able to multiply and spread. The measles virus occurs worldwide. Its only natural host is humans, only here does it survive in the long term, can multiply and be passed on.

How do you get infected with measles?

Infection occurs through droplets. These smallest particles are transmitted during the

  • to cough
  • Sneeze
  • Speak
  • Use of common dishes

The next person in turn absorbs the infectious droplets through their own mucous membranes in their mouth and nose. The viruses can also penetrate through the conjunctiva of the eyes. An infection can take place over a distance of several meters; it is sufficient to be in the same room with a sick person. If you are not immune yourself, there is a nearly 100 percent chance of being infected; this is the so-called contagiousness index. The disease then breaks out in 95 percent of those infected.

The greatest risk of infection is during the initial stage and up to four days after the rash appears.

Measles in adulthood

Before the vaccination was introduced, most people were infected with measles as early as infancy due to its high transmission capacity. This earned the disease the name "childhood disease". Since most children receive at least one vaccination against measles, the time of infection has now shifted towards adolescence and adulthood. Over half of the sick people are now children over the age of ten or adults. The older they are at the time of infection, the more severe the disease is in adults. The risk of complications and death also increases with age. Worldwide there are around 165,000 measles deaths per year.

Superinfections and Complications in Measles

Measles Complications Overview:

  • Complications occur in approximately ten to 20 percent of measles infections.
  • The older an infected person is, the greater the risk of complications.
  • 0.1 percent of measles cases in developed countries are fatal.
  • In small children, around one in 10,000 measles cases are fatal or cause serious complications.
  • In adults, one in 2000 measles cases ends with death.
  • The most important complications are pneumonia and brain infections caused by the measles virus.


The measles virus significantly weakens the immune system for at least six weeks. The body is therefore particularly susceptible to so-called superinfections. Mostly these are bacterial infections, which spread more pronounced and faster than usual. During or after a measles infection, these can often be:

  • Otitis media
  • Inflammation of the airways (bronchitis)
  • [45319] Pneumonia
  • Diarrhea

In the event of an inflammation of the deer, surveillance in the intensive care unit may be necessary.

© istock / sudok1

Acute post-infectious encephalitis

Acute post-infectious encephalitis, an inflammation of the brain, is a particularly feared and dangerous after-effect of measles. It occurs about four to seven days after the rash starts in about 0.1 percent of measles sufferers and goes hand in hand with it

  • Headache
  • fever
  • Impairment of consciousness up to a coma
  • Paralysis or seizures

In ten to 20 percent of cases it is fatal, in 20 to 30 percent of the sick it leads to permanent damage to the central nervous system. This can include paralysis or intellectual disability.

SSPE (subactual sclerosing panencephalitis)

Even after many years, measles can cause another serious complication, subacute sclerosing panencephalitis (SSPE). Translated, this means "delayed generalized hardening encephalitis". It occurs on average six to eight years after the measles infection. The SSPE affects an average of four to eleven people in 100,000 people with measles.

In the group of children under five, the rate increases to 20 to 60 SSPE cases out of 100,000 measles infections. The encephalitis begins with psychological and mental abnormalities. Those affected appear changed in their nature or have muscle twitches. In the course of this, neurological disorders and failures occur, until finally brain functions are completely lost. The SSPE always ends fatally.

Measles can be reliably detected using special tests.

© istock / Bogdanhoda

Do I need medical treatment for measles?

Yes. Because of the severe course measles can take and the risk for contact persons of developing the disease as well, medical advice should be sought if measles is suspected.In this way, possible complications can be identified and treated and the contact persons can be advised on further precautionary measures. It is also possible to detect measles with tests. That goes with:

  • Measles antibodies in the blood - special, tiny molecules that only appear in a measles infection
  • direct detection of virus genes in saliva or urine by means of polymerase chain reaction (PCR)

If these tests are positive, an infection is certain.

Notification for measles

Measles has been required to be reported in Germany since 2001. This means that you can recognize more quickly when the infections are increasing in a region and take appropriate precautionary measures. This includes, for example, closing community facilities.

If you have measles, you have to be isolated. That means:

  • You are not allowed to visit community facilities. This includes all types of care facilities and training facilities for children and adults.
  • Family members and roommates who are not adequately protected are also not allowed to visit these facilities.

After the symptoms have subsided, but no earlier than five days after the rash has appeared, you are no longer considered to be contagious and no longer need to be isolated.

Is there a therapy for measles?

No. There is no drug against the virus itself. In contrast to bacteria, antibiotics are ineffective here. There are a few things you can do to relieve symptoms:

  • bed rest
  • Darkened room if the inflamed eyes are sensitive to light
  • Inhalations and cough suppressants for inflammation of the upper respiratory tract and cough
  • Antipyretic medication for very high fever (e.g. paracetamol, ibuprofen)! Please ensure the correct dosage and administration. You can get advice from your general practitioner or pharmacy.
  • sufficient fluid in the event of a fever and heavy sweating. Elderly patients with kidney or heart problems should seek medical advice as to what amount is best for them to drink.

If there is also an infection with bacteria, such as a middle ear or pneumonia, antibiotics are used.

Vaccination: the safest protection against measles infection even for adults

© W & B / Achim Graf

Protection against measles: correct vaccination

The measles vaccination

The best thing you can do to avoid infection is to get vaccinated. Those who have antibodies against the measles virus have protection against measles. These are made by the body when you go through an infection, and they are retained afterwards. A renewed illness is therefore not possible. But you can also stimulate the body to produce these antibodies with a vaccination. The measles vaccination is a live vaccination, which is usually combined with the vaccination against mumps and rubella and sometimes also against chickenpox (varicella) in one syringe (MMRV vaccination). This means that the vaccines consist of "living" but severely weakened pathogens.

The vaccination schedule

The Standing Vaccination Commission of the Robert Koch Institute (STIKO) recommends the following vaccination schedule:

  • first MMRV vaccination at 11 to 14 months
  • Second vaccination at 15 to 23 months
  • One-time vaccination for adults who were born after 1970 and either do not know their vaccination status, have only been vaccinated once or have not been vaccinated at all

In special situations, for example if the child is to be admitted to the crèche or daycare center, the vaccination can be brought forward to at least ten months of age.