First Fever, Then Rash: The Symptoms Of Measles Parents Need To Know

The measles rash doesn't actually appear until about a week after symptoms first start.
Jure Gasparic / EyeEm via Getty Images

Measles might sound like an illness from the past, but it’s very much still around – yet more and more children are not being vaccinated for it globally.

In 2021, a record high of nearly 40 million children missed a measles vaccine dose, the World Health Organisation (WHO) has warned.

In the UK, one in 10 children under the age of five are not fully protected from measles and are at risk of catching it.

The global health body has warned the “situation is grave” as measles is one of the most contagious human viruses, but is almost entirely preventable through vaccination.

More than 140,000 people worldwide died from measles in 2018 – and most of these were children under the age of five.

Here’s what parents need to know about it.

What’s the situation in the UK?

Before the introduction of the measles vaccine in 1963 and widespread vaccination, major epidemics occurred approximately every 2–3 years and measles caused an estimated 2.6 million deaths each year.

Since 2016, 10 countries that had previously eliminated measles experienced outbreaks and reestablished transmission, according to the WHO. The UK is one of them.

Data shows measles cases in the UK dropped during the height of the pandemic between 2020 and 2021, however since restrictions have lifted, cases are slowly on the rise again. In those testing positive, most are unvaccinated.

In September, the UK Health Security Agency (UKHSA) urged parents and guardians to ensure their children are up to date with all their routine childhood immunisations including measles, mumps and rubella.

This is because data showed vaccination coverage for young children fell again last year – a pattern witnessed over several years.

Only 89.2% of children at 24 months had completed their first dose of the MMR vaccine, a decrease from 90.3% in the previous year, while coverage for the second dose was also down by nearly 1%.

To achieve herd immunity and ‘eliminate’ measles, 95% or greater of two doses of measles-containing vaccine is needed.

Since the introduction of the measles vaccine in 1968 it is estimated that 20 million measles cases and 4,500 deaths have been prevented in the UK.

How is measles spread?

Like flu, the measles virus is spread in tiny droplets of mucus which become airborne when an infected person coughs or sneezes.

It is highly contagious disease with a basic reproduction number (R0) of 12-18. This means that one measles case can infect 12-18 cases over the course of its infectious period.

What are the symptoms of measles?

The first sign of measles is usually a high fever, which begins about 10 to 12 days after exposure to the virus, and lasts four to seven days.

A runny nose, a cough, red and watery eyes, and small white spots inside the cheeks can develop in the initial stage.

After several days, a rash erupts, usually on the face and upper neck. Over the course of about three days, the rash spreads, eventually reaching the hands and feet.

The rash lasts for five to six days, and then fades. On average, the rash occurs 14 days after exposure to the virus (within a range of seven to 18 days).

Can measles kill?

Sadly, yes. Most measles-related deaths are caused by complications associated with the disease, according to the WHO, and serious problems are more common in children under the age of five, or adults over the age of 30.

The most serious complications include blindness, encephalitis (an infection that causes brain swelling), severe diarrhoea and related dehydration, ear infections, or severe respiratory infections such as pneumonia.

When is the measles vaccine given?

Children in the UK typically receive their first dose of the measles vaccine as part of their MMR (measles, mumps and rubella) jab at one year of age. The second dose is given at three years and four months.

Parents are usually reminded to book in for vaccines by the NHS however if you don’t think your child has had theirs, call your local GP who will be able to help.

The NHS is currently running a MMR catch-up campaign so some parents may be contacted directly.

Why is measles on the rise again globally?

Declines in vaccine coverage, weakened measles surveillance, interruptions and delays in immunisation activities due to Covid-19, as well as persistent large outbreaks in 2022 have meant that measles is an “imminent threat”, says the WHO.

Director-general Dr Tedros Adhanom Ghebreyesus says: “The paradox of the pandemic is that while vaccines against Covid-19 were developed in record time and deployed in the largest vaccination campaign in history, routine immunisation programmes were badly disrupted.”

Getting immunisation programmes back on track is “absolutely critical,” he said.

Since international travel has resumed closer to pre-pandemic levels, it is more likely that measles will be brought to the UK from countries that have higher levels of the disease and cause outbreaks, according to UKHSA.