A virtual appointment had been set up by my office manager for 18-month-old patient Maya. It seems that Maya's family had flown to San Francisco to visit relatives. Shortly after they arrived, she had a high fever for a few days. Then she developed a red splotchy rash on her trunk. Mom reported that there never was a cough or congestion. Once the fever broke, she seemed fine but just had this rash. The critical element was the fact that Maya's rash started after the fever broke. In other words, she never had fever and a rash. Given the history, I explained that Maya did not have measles and I would be glad to see her in person. She inevitably had Roseola, which is a common viral illness that virtually all young infants get. It is self-resolving and is not a concern. I have recently written an article for The Informed Parent on Roseola.
What Is Measles?
Measles, or rubeola, is one of the most highly contagious viruses. When exposed to measles, 90% of unvaccinated people will become infected. The symptoms of measles are as follows:
- 7-14 days after one becomes exposed and infected, the symptoms begin.
- There is usually a high fever that can reach 105 degrees.
- A harsh and brassy dry cough.
- Runny nose and congestion (coryza).
- Red and weepy eyes (conjunctivitis).
- Enlarged lymph nodes in the neck and the back of the head.
Once the symptoms start, the person with measles feels miserable. They are truly sick.
Koplik Spots
Two-to-three days after the symptoms start, it is common to find what are called Koplik spots inside the mouth. This is pathognomonic, meaning it only occurs in measles. It can be seen in 60-70% of infected individuals. Koplik spots are small red areas with a whitish center, usually 2-3 millimeters in size. In the old literature they are described as a grain of sand on a red base. They can occur on the palate but are typically seen on the inside of the mouth opposite the second molar. They last a day or two.
The Measles Rash
Three-to-five days after the onset of symptoms the rash occurs. It is a red or brownish (rusty) rash of spots that start in the back of the neck. They travel from the hairline and behind the ears to spread from the face, to the trunk. It continues down the arms and legs, all the way to the feet. The red spots may coalesce into a blotchy looking rash. Eventually this slowly fades away, but it may take a number of days.
Treatment
Unfortunately, there is no specific treatment for measles. One can only treat the symptoms and try to make the patient comfortable.
- Tylenol or Ibuprofen can be given for the fever.
- It is important to be sure the patient stays well-hydrated.
- Cough medicine may help the cough.
- Claritin or Zyrtec may help the runny and congested nose.
The body just has to run its course.
Complications
There are many potential complications from measles.
- 10% of infected individuals will get an ear infection.
- 10% will get diarrhea.
- One in twenty will get a pneumonia.
- One in a thousand will get encephalitis.
- Worldwide, one to three out of a thousand children will die from measles.
The MMR Vaccine
The good news is that there is a very effective vaccine against measles that has been around for decades. The MMR (measles-mumps-rubella) is typically given at one year of age, and then again between 4 and 6 years of age. Many schools require this vaccine. After receiving one MMR, 93% of individuals are fully protected. After the second dose, the number of fully protected individuals goes up to 97%.
The vaccine is not given before a year of age because most newborn infants have received antibodies from their mother and are protected. This protection wanes after 6 months so a MMR vaccine given during this time would not elicit protection.
There are instances whereby an infant may be traveling internationally to an area where there is a measles outbreak. In these cases, it is reasonable to give an infant between the ages of 6-to-11 months a MMR. If so, they will still need to receive a MMR at one year and then again between 4 and 6 years. If an older patient has never had a MMR or is known to not have antibodies against measles, they can receive 2 MMR's, given at least one month apart.
A Note From Dr. Theriot
I have been in private practice for 42 years and luckily have had no case of measles in the office. The last case I saw was when I was a resident at LA County-USC Medical Center. I fear that with the resistance to vaccines and the influx of immigrants from all over the world, it is just a matter of time. In all of 2025, there were 2208 cases of measles in the United States. As of June 18, 2026, there have already been 2104 cases reported.