Measles: symptoms, treatment, and the vaccine that prevents it

Measles is one of the most contagious diseases we know — one infected person spreads it to 12-18 others in an unvaccinated group. It kills children through pneumonia, dehydration from diarrhoea, brain inflammation, and lasting immune damage.

Two doses of the measles vaccine give 99% protection. Ethiopia gives them free at 9 months and 15 months on the EPI schedule.

On this page

• How measles spreads
• Symptoms — the four stages
• When to go to a health post
• Treatment
• Complications
• The vaccine
• If someone in your house has measles

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How measles spreads

Measles is a virus. It floats in the air for up to 2 hours after an infected person coughs, sneezes, or even breathes in a room. You do not have to touch the person.

An infected person is contagious from 4 days before the rash until 4 days after. That’s why measles spreads so fast — people spread it before they know they have it.

Anyone who has not had two doses of the vaccine and has never had measles can catch it — including adults.

Symptoms — the four stages

Days 1-4: like a bad cold

• High fever (often 39-40°C)
• Runny nose, sneezing, cough
• Red, watery eyes; sensitive to light
• Child is miserable, tired, off food

Day 2-3: tiny white spots inside the mouth (Koplik spots) — small white dots on the inside of the cheeks. These are unique to measles. If you spot them, tell the health worker.

Days 3-5: the rash appears

• Flat, red-brown patches
• Starts at the hairline and behind the ears
• Spreads down the face, neck, chest, back, arms, legs over 2-3 days
• Patches often merge into larger blotches
• Fever peaks at the same time (up to 40°C)

Days 6-10: recovery

• Rash fades in the same order it appeared
• Skin may peel like sunburn
• Cough can linger 1-2 weeks
• Child is tired for another week or two

When to go to a health post

Go to the health post today if you think your child has measles. Testing confirms the diagnosis and lets the health system trace and vaccinate contacts to stop the outbreak. Treatment is free.

::: urgentAdvice severity=“emergency”

Emergency — go to a hospital now if your child has measles AND:

• Trouble breathing or very fast breathing (pneumonia is the leading cause of measles death)
• Cannot drink or breastfeed
• Very sleepy, hard to wake, or unusually confused
• A seizure
• Rash that is dark or turning black (severe measles)
• Yellow skin or eyes
• Severe dehydration (no urine, sunken eyes)

Untreated severe measles can kill within 24-48 hours in a young child. Do not wait. :::

Treatment

There is no medicine that kills the measles virus. Treatment supports the child through the illness:

• Vitamin A — high-dose vitamin A capsules given on two consecutive days reduce complications and death by 50%. Free at any health post. This is the single most effective thing you can do.
• Fluids — ORS if diarrhoea, plenty of breastmilk/water
• Paracetamol — for fever, at the correct child dose
• Antibiotics — only if bacterial complications (pneumonia, ear infection). Not for the measles itself.
• Isolation — keep the child at home away from unvaccinated people until 4 days after the rash appears
• Rest, cool sponge for fever, dim lighting for sensitive eyes

Do NOT give aspirin to a child with measles.

Complications

Measles is dangerous because of what comes with it:

• Pneumonia — the leading cause of measles death in Ethiopia. Watch for fast breathing.
• Diarrhoea + dehydration — see diarrhoea article
• Ear infection — pain, poor hearing, fluid from the ear
• Encephalitis — brain inflammation, 1 in 1000 cases; causes seizures, permanent brain damage
• Blindness — from vitamin A deficiency worsening after measles
• Immune amnesia — measles wipes out the immune system’s memory of past infections for 2-3 years, making the child vulnerable to other diseases

Most complications happen in children under 5, adults over 30, pregnant women, and anyone with weakened immunity (HIV, severe malnutrition).

The vaccine

The measles vaccine is on the Ethiopian EPI schedule at:

• Measles-1 at 9 months
• Measles-2 at 15 months

Two doses = 99% lifetime protection. One dose = 93%. That’s why the second dose matters.

::: doList

Do — vaccinate

• Take your child at 9 months even if they have a mild cold or teething
• Come back at 15 months for the second dose
• If you missed doses — go now. Catch-up is available for children up to 5 years, and free.
• Adults born after 1980 who never had measles or a second dose can also get vaccinated at a health centre
• Pregnant women should NOT get this vaccine — get it before pregnancy or after birth
• People with severe egg allergy — tell the health worker first :::

::: dontList

Don’t

• Do not skip the 15-month second dose — one dose isn’t enough
• Do not believe “measles is a normal childhood illness” — it kills
• Do not delay for a mild fever or cold
• Do not accept advice against vaccines from anyone on social media — check with a health worker :::

::: factBox

The vaccine is safer than the disease

Measles vaccine side effects: mild fever (5-15% of children), mild rash (5%), sore arm.

Measles disease: 1-3 in 1000 children die. 1 in 1000 gets brain inflammation. 1 in 20 gets pneumonia. Immune damage lasts years.

The vaccine has been given billions of times worldwide. It does not cause autism — this myth came from a 1998 paper that was retracted in 2010 after being proven fraudulent. :::

If someone in your house has measles

• Isolate the sick person to one room if possible
• Keep unvaccinated children and infants under 9 months in a different room
• Tell the health post — they will offer post-exposure vaccine to household contacts within 72 hours
• Wash hands often
• Cover coughs and sneezes
• The virus can linger in the air for 2 hours — ventilate rooms after the sick person leaves

If anyone in the household is unvaccinated and pregnant, immune-compromised, or under 9 months old, they need special attention — talk to the health worker.

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Reviewed by Dr. Hanna Alemayehu, MD, MPH — Family medicine, Addis Ababa

Sources: WHO Measles fact sheet 2024; Ethiopian MoH EPI schedule; WHO position paper on measles vaccines 2017.

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Draft notes: ~1100 words · grade 7 · isTimeCritical true · Ethiopian context: EPI 9+15 months, vitamin A capsules at every health post, catch-up available, addresses vaccine misinformation directly and cites retraction · Cross-references diarrhoea article.