Measles, a highly contagious viral disease, is on the rise again in the United States. While measles was declared to be eradicated from the U.S. in 2000, outbreaks continue to occur, primarily due to declining immunization coverage in some communities.
In this article, you’ll find an overview of the disease, symptoms and prevention strategies. We also include a 5-step guide for emergency responders handling potential measles cases, including:
- PPE requirements
- Symptoms assessment
- Scene management
- Supportive care guidance
- Post-incident decontamination
If you think you or someone you know has contracted measles, or you believe you may have come into contact with someone infected by the virus, read on to learn what to look for and when to seek medical help.
What is measles?
Measles has been a known disease for centuries, with cases documented as early as the 9th century, according to the CDC. In the U.S., measles was once a common childhood illness, with nearly every child contracting the virus before the age of 15. Prior to the introduction of the measles vaccine in 1963, the country saw an estimated 3-4 million cases annually, resulting in about 500 deaths, 48,000 hospitalizations and 1,000 cases of encephalitis each year.
The widespread use of the measles-mumps-rubella (MMR) vaccine led to a dramatic decline in cases. By 2000, measles was declared eliminated in the U.S., meaning there was no continuous transmission of the disease for over a year. However, due to global travel and vaccine hesitancy, outbreaks have occurred in recent years, particularly in under-immunized communities. Notable surges include the 2014 outbreak linked to Disneyland and the 2019 outbreaks in the Pacific Northwest and New York City, which resulted in the highest number of cases since 1992.
What does measles look like?
Because the virus progresses in stages, with each stage presenting different physical symptoms, you can estimate how long until the illness has run its course based on how the infection is currently presenting.
Get an idea as to how measles symptoms present on different areas of the body below:
What are the symptoms of measles?
Measles symptoms typically appear several days after infection and progress through several stages:
- STAGE 1 — Infection and incubation: Lasting 10-14 days, there are no signs or symptoms as the measles virus spreads through the body.
- STAGE 2 — Mild initial onset: The first measles symptoms mimic a mild cold, with a moderate fever, runny nose, cough and sore throat being the most common symptoms. This stage lasts 2-3 days, and is also accompanied by Koplik’s spots — tiny white spots surrounded by a red background found on the inner lining of the cheek inside the mouth.
- STAGE 3 — Rash and high fever: A red, blotchy rash emerges around the hairline and face before spreading downward to the chest, arms, legs and feet. As the rash spreads, the fever rises, reaching as high as 105°F. This stage typically lasts 6-7 days.
- STAGE 4 — Recovery: When the measles rash recedes, so does the high fever. The rash will disappear in the same way it appered, beginning with the face and working down the body. This stage may last up to 10 days, with the couch lingering and the rash darkening and/or peeling as it disappears.
What should parents should watch for in kids infected with measles?
Parents should be vigilant for:
- High fever that persists for several days
- Worsening cough or difficulty breathing
- Severe dehydration (dry mouth, lack of urination, sunken eyes)
- Signs of complications such as ear infections, pneumonia or encephalitis (seizures, confusion, or lethargy)
- Rash progression and persistence
If a child exhibits difficulty breathing, persistent high fever or neurological symptoms, parents should seek emergency medical care immediately.
Is measles deadly?
Yes, in very rare cases, measles can be fatal. According to Johns Hopkins University, “measles kills between one and three of every 1,000 infected children.”
How is measles spread?
Measles is highly contagious and is spread through respiratory droplets when an infected person coughs, sneezes or talks. The virus can remain airborne for up to an hour in a confined space. Prevention strategies include:
- Vaccination: The MMR vaccine is 99% effective at preventing measles when both doses are administered. The CDC recommends children receive the first dose at 12–15 months and the second dose at 4–6 years.
- Isolation: Anyone infected should stay home for at least 4 days after the rash appears and avoid public places.
- Good hygiene: Covering coughs and sneezes, handwashing and disinfecting surfaces can help limit virus spread.
As an adult, if I had measles as a child, should I get the vaccine?
If you had measles as a child, you do not need a measles vaccine. Your body has already built up an immune defense to the virus and you are not at risk of being infected again. Most people born before 1957 are considered to have “presumptive evidence” of immunity, due to the virus being so widespread prior to the vaccine become available, that nearly everyone had been infected at some point.
If I was vaccinated for measles, do I need a booster?
If you received one dose of the MMR vaccine as a child, your immunity is estimated at 97% against viral infection, and 99% if you received two doses. This is considered to provide lifetime immunity, and no booster shots are necessary.
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5 steps for EMS response to measles
If your agency is called to respond to a suspected case of measles, take adequate precautions to protect both the patient and yourself.
Don personal protective equipment (PPE) in accordance with your agency’s policy
Measles is highly contagious and spreads via airborne droplets, so proper PPE is critical to minimize exposure. Before approaching the patient, responders may be required to wear an N95 respirator, gloves, eye protection or gown if available.
Assess the patient for measles symptoms
Look for classic measles symptoms, which include:
- High fever (often over 101°F)
- The “3 Cs": Cough, coryza (runny nose), conjunctivitis
- Koplik spots
- Red, blotchy rash starting on the face and spreading downward
Gather travel history or exposure risk, especially if the patient has been in contact with someone with measles or has recently traveled to areas with outbreaks.
Isolate the patient from vulnerable individuals
Because the virus is so easily transmitted, if measles is suspected, isolate the patient from anyone on scene who is not immune or is vulnerable to infection. If transporting in an ambulance, ensure negative pressure ventilation (if available) or open windows for airflow, and limit the number of responders who have direct contact with the patient.
Provide supportive care
As there is no specific antiviral treatment for measles, so care is supportive:
- Hydration: Encourage fluids if the patient can drink.
- Fever management: Use cool compresses; avoid aspirin in children (risk of Reye’s syndrome).
- Monitor airway and breathing: If respiratory distress or hypoxia occurs, provide oxygen therapy as needed.
- Avoid pharmaceuticals: Do not administer steroids or antibiotics unless there is a secondary bacterial infection.
Decontaminate equipment and notify the local public health officials
Measles virus can remain airborne for up to 2 hours after an infected person leaves the area. After patient care:
- Disinfect all equipment and surfaces with appropriate hospital-grade disinfectants.
- Report the case to local health authorities immediately.
The future of measles in the U.S.
Measles is a preventable but serious disease that can cause severe complications, especially in young children and immunocompromised individuals. While the U.S. has made significant progress in measles control, outbreaks remain a threat due to declining vaccination rates. Parents, healthcare professionals and emergency responders must remain vigilant in recognizing symptoms, preventing transmission and ensuring high immunization coverage to protect public health.
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