Measles: How to Spot It

There have been 228 cases of measles in the US since January 1, 2019. That’s more cases of measles in 2019 than there were in 2016 and 2017 combined. This is particularly shocking to me, since measles was declared, “eliminated from the US,” in 2000.


So far this year, outbreaks have been reported to the CDC in New York, Washington, Texas, Illinois, and California. The outbreaks are primarily a result of imported illness spreading in unvaccinated people here in the states. This is not a vaccination blog. Science has supported routine immunizations for healthy kids, time and time again. Instead, let’s talk about what measles looks like, and how to keep your cool in the midst of media fear mongering.


Epidemiology (or “where does it come from?”)


We have known about measles for a really long time. The CDC says we’ve known about it since 1757, so a REALLY long time. At this point, these are the people who are at risk of catching the disease:

  1. Kids too young to be vaccinated
  2. People who are unvaccinated for medical or other reasons
  3. Those who haven’t received a second dose of the vaccine
  4. People for whom the vaccine failed to elicit a protective immune response (a very small fraction of people)


Transmission (or “how is it spread?”)


Measles is super contagious. Just like other respiratory viruses (like the flu), it is spread by person-to-person contact, and airborne droplets. However, unlike the flu, measles takes up residence higher up in the respiratory tract and can get out much easier and faster. As a matter of fact, if someone has the measles, then 90% of the (susceptible) people around him or her will also get it. And as if that wasn’t enough, the virus can stay airborne for up to 2 hours.


Clinical Manifestations (or “what does it look like?”)


The signs and symptoms of measles show up about 1 -2 weeks after someone is exposed. It starts with typical symptoms: fever, cough, red watery eyes, and runny nose. Some people get “Koplik spots” inside their mouths, which is actually diagnostic for the disease. They are round, white spots inside the mouth, usually on the inside of the cheeks. Very unusual looking, and very different from thrush, I might add. About 2 -4 days after the fever, the rash starts. It’s a red bumpy and patchy rash that starts on the face and head, and spreads downward. About 6 days later, the rash fades in the same order it appeared.


Diagnosis (or “how do I test for it?”)


The CDC tells me to suspect measles in anyone who has a fever+rash illness, with “clinically compatible symptoms.” Now, in kids, fever+rash happens ALL. THE. TIME. However, I do not suspect measles all the time. This is where it’s super important to have your child checked by a pediatric specialist, rather then an adult provider, or heaven help us, Dr. Google. If everything points towards measles, then I am required to get a nose swab, and a blood sample to send to the CDC for testing. They even ask that I get a urine sample, as well, just to be thorough. So, you see? I don’t just, willy nilly, test every child.


Ultimately, with measles, prevention is key. Get vaccinated, or stay away from people and places with measles. If you are worried about your child’s symptoms, your best first option is your child’s pediatrician. However, as we all know, kids don’t get sick when it’s convenient. So, always remember, the pediatric experts at KidMed are here to help. Because, peace of mind is worth it.




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