Symptoms of the measles appear 9 to 11 days after the infection begins, and last up to 14 days. The condition is most infectious after the first symptoms have appeared, and before the rash has developed.
Treatment for the measles is normally not necessary because the body's immune system (defence against viruses) can usually fight off infection in a couple of weeks. Typically, once somebody has fought of the measles infection, they develop immunity to it.
Complications of measles include pneumonia, ear and eye infections, and croup (an infection of the lungs and throat). More serious complications, such as inflammation of the brain (encephalitis), are rarer but can be fatal. There are one million deaths world-wide from the measles every year.
MMR Vaccine
The most effective way of preventing measles is the measles-mumps-rubella (MMR) vaccine, which also provides protection against two other potentially fatal childhood conditions - mumps and rubella. The success of the MMR vaccine means that, in the UK, cases of measles are rare.
However, in recent years, the number of cases of measles has been increasing. For example, there were 739 cases in 2006, compared with 70 cases during 2001.
It is thought that the rise in the number of cases of measles is the result of parents not getting their child vaccinated with the MMR vaccine. This is probably due to speculation linking MMR to autism (a condition that effects the development of the brain, and can lead to problems in communication and social interaction).
Publicity in 1998 highlighted a report claiming a link between the MMR jab and autism. However, numerous studies undertaken to investigate this claim found no link between the MMR vaccine and autism.
Symptoms
Around 9 to 11 days after getting the measles infection, the following symptoms begin to appear:
 Cold-like symptoms, such as runny nose, watery eyes, swollen eyelids, and sneezing.
Red eyes and sensitivity to light.
A mild to severe temperature, which may peak over 40.6C (105°F) for several days. After several days temperature may fall, but may go up again when the rash appears.
Tiny greyish-white spots (called Koplik's spots) in the mouth and throat.
Tiredness, irritability and general lack of energy.
Aches and pains.
Poor appetite.
Dry cough.
Red-brown spotty rash that appears 3 to 4 days after first symptoms, and last for up to eight days. The spots usually start behind the ears, spread around the head and neck, and after 2 to 3 days spread to the legs and the rest of the body. The spots start small but quickly get bigger and often join up together. Similar looking rashes may be mistaken for measles, but measles has a range of symptoms, not just a rash.
Most childhood rashes are not measles but you should consult your GP without delay if:
* you suspect it is measles,
* symptoms worsen,
* temperature increases to above 38°C,
* temperature stays high after other symptoms have gone, or
* there are signs of other related illnesses (see 'complications' section below).
Causes
Measles is caused by infection with the rubeola virus. Once infected, the virus lives in the mucus of the nose and throat. Physical contact, coughing and sneezing can spread the infection. Infected droplets of mucus may also land on a surface where they remain active and contagious for around two hours.
Once inside your body, the virus multiplies in the back of your throat and lungs, before spreading throughout your body, including your respiratory system and the skin.
It takes between 6-21 days for the virus to establish itself (the incubation period), but people usually show symptoms after about 10 days. Someone with measles is infectious for 2 to 4 days before the red rash appears and for about five days after it appears.
Anyone who has not had measles before can be infected. However, cases of re-infection after having had the virus are extremely rare because the body will have built up immunity to the virus.
About 90% of people, who are not immune from measles and are sharing a house with somebody who is infected, will develop the condition.
Diagnosis
Your GP will usually be able to diagnose measles from the combination of symptoms, such as the characteristic rash and the small spots inside the mouth. A simple blood or saliva test can confirm a diagnosis and identify the rubeola virus.
Doctors have a duty to notify the local authority of all reported and suspected cases of measles. They will also notify the child's school if necessary. Your child should not return to school until at least five days after the appearance of the rash.
Treatment
In most cases of children who have measles, rest and simple measures to reduce a fever are all that are needed for a full recovery. If there are no complications, symptoms will usually disappear within 7 to 10 days.
There is no specific treatment for measles. Once the rash starts it is a matter of treating the symptoms until the body's immune system fights off the virus. However, you might find the advice outlined below useful.
Check the child's temperature and, if it is high, try to lower it. Keep the child cool but not cold.
Use liquid baby paracetamol, or ibuprofen, to relieve fever and aches and pains. Do not give aspirin to children under the age of 16.
Closing curtains, or dimming lights, can help reduce light sensitivity.
Damp cotton wool can be used to clean away any crustiness around the eyes. Use one piece of cotton wool per wipe for each eye. Gently clean the eye from inner to outer lid.
Cough medicines are of little help. Placing a bowl of water in the room will make the atmosphere more humid which can help relieve a cough. Children over 12 months old may benefit from a teaspoon of lemon juice and two teaspoons of honey in a glass of warm water. Note that honey should not be given to babies under the age of 12 months.
Avoid dehydration. Feverish small children rapidly lose water, and this makes a cough worse. Children should drink as much as possible to prevent dehydration.
While antibiotics are of no use to treat the virus, they may be prescribed for any secondary bacterial infections that develop. In severe cases of measles, particularly when there are more serious complications, hospital treatment may be required.
Complications
Complications resulting from measles are more likely to develop in children with a weakened immune system, such as those with leukaemia, or AIDS. Children with a poor diet are also more likely to develop complications. Complications are also more likely in children under the age of five, or adults who are over the age of 20.
Some of the common complications of measles are:
diarrhoea,
vomiting,
eye infection (conjunctivitis), and
inflammation of the voicebox (laryngitis).
Inner ear infection and inflammation (otitis media), which often causes earache, may also be a complication of measles.
Fits which are caused by a fever (febrile convulsions), are also possible complications of measles. However, the fits, although alarming, are not usually dangerous.
Less common complications of measles are listed below.
Meningitis.
Pneumonia (lung infection) - signs are fast, laboured breathing, chest pain, and deteriorating condition.
Hepatitis (liver infection).
Encephalitis (inflammation of the brain) - which can be fatal, so you should watch for drowsiness, headache, and vomiting.
Low platelet (white blood cell) count - known medically as thrombocytopenia, which affects the blood ability to clot.
Bronchitis and croup (infection of the airways) - characterised by a hacking, or barking cough.
Squint - the virus may affect the nerves and muscles of the eye.
Rarely, measles can lead to the conditions that are outlined below.
Serious eye disorders, such as an infection of the optic nerve (the nerve that transmits information from the eye to the brain). This is known as optic neuritis and can lead to blindness.
Heart and nervous system problems.
A serious brain complication, known as subacute sclerosing panencephalitis (SSPE), can occur, sometimes several years after getting measles. Although the condition is fatal, it is very rare, occurring in only 1 in every 100,000 cases of measles.
If you are planning to get pregnant, and you have not had measles yet, you should arrange with your GP to have the MMR vaccine. If you catch measles during pregnancy, it can be passed on to your baby, and can be very damaging, or even fatal. Measles in pregnancy can cause miscarriage, premature labour, or a baby with low birth weight. The MMR jab cannot be given during pregnancy.
Prevention
If you think that your child may have the measles infection, you should isolate them from other children for at least five days until after the rash has appeared. Immunised children, and anyone who has already had measles, are extremely unlikely to catch measles.
The first MMR vaccination should be given to all children at around 13 months of age, with a booster dose given before they start school (when they are between 3-5 years old). Between 5-10% of children are not fully immune after the first dose, so the booster jab helps to increase protection, and results in less than 1% remaining at risk.
If a child who is younger than 13 months of age is exposed to the measles virus, the action taken to prevent them developing the disease will depend on whether they are under, or over, six months of age.
Children who are aged between 6-13 months - the MMR vaccine can be given to children from the age of six months, so the child will normally be given the MMR vaccine to protect them.
Children under six months - if the child's mother has had measles in the past, the child will usually be immune to the measles infection because the mother's protective antibodies will have been passed to the baby in the womb. However, if the mother has not had measles, the child may be given an injection of human normal immunoglobulin (HNIG). HNIG is not a vaccine, it is a special concentration of antibodies which can give short term, but immediate, protection against measles.
Although there are not many cases of measles in England, there are around 30 million cases worldwide, and around one million deaths every year. Without immunisation, measles would spread and cause an epidemic.
The World Health Organisation (WHO) has set a goal to globally eradicate measles by 2010. This will require 95% of the world's population to be immunised.
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