Once you contract the measles virus, it multiplies in the back of your throat and lungs, and then spreads throughout your body.1 To better understand how this illness progresses, learn the chronological stages of measles, which normally take place over a period of two to three weeks.
This is the time between becoming infected and developing symptoms. You have no signs of infection during this stage.2 It usually takes about 10 to 14 days after you have been exposed to the virus before symptoms appear.
Nonspecific Signs and Symptoms of Measles
The initial symptoms may include mild to high fever, tiredness, a runny nose, sore throat, inflamed eyes (conjunctivitis) and photophobia (eye discomfort in bright light).3,4,5
Tiny white spots with bluish-white centers on a reddish bump usually appear inside your mouth on the inner lining of the cheek — this is also called Koplik’s spots, and are unique to measles infection. Your throat also becomes red, sore and swollen.6,7
Acute Illness and Rash
Between three to five days after the onset of your first symptoms, a blotchy skin rash develops, which typically starts on your face at the hairline and spreads downward to the neck, trunk, arms, legs and feet.8
The rash starts out as flat, red patches, but eventually develops some bumps.9 It takes two to three days to cover most of your body and lasts between four to seven days.10 When the rash breaks out, your fever may spike sharply, sometimes reaching as high as 104 degrees Fahrenheit (40 degrees Celsius).11
After five to six days, your fever may subside and the rash gradually recedes, fading first from your face and last from your thighs and feet.12 As your rash fades, it turns brown and tends to leave the affected skin dry and flaky.13
The measles virus can be transmitted to others for about eight days, from roughly four days before the rash becomes visible to four days after the rash appears.14,15 Most people will recover from measles in around seven to 10 days.16
However, measles can be a serious disease, and in about 30 percent of cases, one or more complications can arise.17 Globally, an estimated 314 people die from measles-related complications every day, or 13 deaths every hour.18
Who Is Most at Risk of Complications?
Certain groups of people are more at risk of measles complications, including:18,19
• Infants and children younger than 5 years old
• Malnourished young children (5 years old and below) with vitamin A deficiency, or a weakened immune system, such as those with leukemia and AIDS
• Adults older than 20 years of age
• Pregnant women
Common Complications of Measles
• Diarrhea — The most common complication of measles that occurs in 8 percent of cases, particularly in young children.20
• Ear infection — This occurs in 1 out of 10 cases, which may result in significant or total hearing loss.21
• Pneumonia — It accounts for 60 percent of measles-related deaths. Having a compromised immune system can increase your risk of developing a dangerous and potentially fatal type of pneumonia. Typical symptoms include fast or difficult breathing, chest pains and generally becoming more ill.22,23
Rare but Severe Complications of Measles
• Blindness — Vision loss due to measles is the single leading cause of blindness among children in low income countries, accounting for an estimated 15,000 to 60,000 cases per year.24
• Febrile fit (convulsion) — A convulsion that occurs in a child who is having a spike in temperature greater than 100.4 degrees Fahrenheit (38 degrees Celsius).25,26 Febrile convulsion due to measles occurs in about 1 out of 200 cases.
• Brain inflammation (encephalitis) — Measles-induced encephalitis occurs in roughly every 1 in 5,000 cases. It typically causes drowsiness, headache and vomiting seven to 10 days after the onset of rash. Encephalitis may also lead to mental retardation and death.27
• Subacute sclerosing panencephalitis (SSPE) — A very rare but fatal brain disease that generally develops seven to 10 years later after a person has acquired measles. It only typically occurs in 1 out of every 25,000 cases.28
If you are pregnant, you need to take extra care to prevent measles as it can increase the risk of miscarriage, premature labor and low-birth-weight infants. More recent research has also shown that, depending on the gestational age of the pregnancy at the time the woman acquires measles, the fetus may suffer serious complications such as congenital measles.29
Because measles is a potentially serious illness, being wary of the early symptoms of the disease can make a big difference between a fast recovery and developing complications.