Measles is one of the most contagious diseases known: one infected person can infect up to 9 out of 10 unvaccinated close contacts. WHO and the US CDC have reported large increases in measles cases and outbreaks in recent years as vaccination coverage dropped during and after the COVID-19 pandemic. Most deaths are in children under five in low- and middle-income countries, often from complications such as pneumonia, diarrhoea and malnutrition. Nursing care and vaccination save lives.
Recognising measles
- Prodrome (2–4 days): high fever, cough, runny nose (coryza), red watery eyes (conjunctivitis) — the “three Cs”.
- Koplik spots: tiny white spots on the inside of the cheeks, just before the rash.
- Rash: red-brown, blotchy, starting on the face and behind the ears and spreading down the body over several days. On darker skin it may be harder to see and may look darker than surrounding skin.
People are infectious from about 4 days before to 4 days after the rash appears.
Infection control
- Measles is airborne. Isolate suspected cases immediately, ideally in a single room with the door closed or an airborne isolation room, and don’t leave them in a crowded waiting area.
- Only staff with evidence of immunity (two doses of measles vaccine or confirmed immunity) should care for patients. Wear a respirator according to policy.
- Notify public health authorities: measles is notifiable in most countries.
- Identify exposed contacts, especially infants, pregnant women and immunocompromised people, who may need post-exposure vaccine or immunoglobulin.
Vitamin A: give it to every child with measles
WHO recommends two doses of vitamin A, 24 hours apart, for all children diagnosed with measles, to reduce complications and deaths:
| Age | Dose (each day, for 2 days) |
|---|---|
| Under 6 months | 50,000 IU |
| 6–11 months | 100,000 IU |
| 12 months and older | 200,000 IU |
Complications and nursing care
- Pneumonia: the most common cause of measles deaths. Count the respiratory rate, look for chest indrawing, check SpO₂; give oxygen and antibiotics as prescribed.
- Diarrhoea and dehydration: ORS and zinc; see the rehydration plans in our cholera guide.
- Malnutrition: measles worsens it, and malnourished children have more severe measles. Encourage feeding and breastfeeding; screen with MUAC.
- Eye complications: clean eyes regularly, give vitamin A, watch for corneal ulceration, which can cause blindness.
- Mouth ulcers: mouth care; soft foods; pain relief.
- Ear infections.
- Encephalitis (rare): seizures, reduced consciousness.
- Fever: paracetamol and fluids.
Vaccination: the real solution
- Two doses of measles-containing vaccine are needed; at least 95% coverage with two doses is required to stop outbreaks.
- Use every contact to check and update children’s vaccination status.
- Remember: reconstituted measles vaccine must be discarded after 6 hours or at the end of the session. See our immunisation safety guide.
- Health workers should check their own immunity.
Related: IMCI danger signs · Severe acute malnutrition · Airborne precautions
Based on WHO measles fact sheets, WHO guidance on vitamin A for children with measles, and the IMCI chart booklet. Educational content: follow national guidelines.