Measles

Key points 

1. Measles is easily spread – just being in the same room as someone with measles can lead to infection if you are not immunised. 
2. Measles can cause serious complications including diarrhoea, ear infections, pneumonia and encephalitis (swelling of the brain). About 1 in 10 people with measles will need hospital treatment.
3. Measles during pregnancy increases the risk of miscarriage, early labour and low birth-weight babies. 
4. A person with measles is infectious from 5 days before and until 5 days after the rash appears (about 10 days in total). During this time the infected person needs to stay away from other people. Children need to be kept home from school and adults from work, do not invite other children or visitors to your house. Calculate your quarantine period
5. If you suspect you have measles, it is important to see your doctor but phone ahead first. This helps to ensure people with measles do not end up sitting in a waiting room, potentially spreading the illness to others. You can get free health advice from a registered nurse 24 hours a day from Healthline on 0800 611 116 if you have any questions.

What is measles?

Measles is a viral illness that causes a skin rash and fever. The virus spreads easily through the air by sneezing or coughing. It can also be spread by contact with surfaces contaminated with an infected person’s nose and throat secretions (snot and saliva).

One person with measles can pass on the disease to 13 other people who have not been immunised.

Why is vaccination so important?

Vaccination is the best way to prevent measles

The combination measles, mumps and rubella (MMR) vaccine is highly effective at preventing measles. Just one dose of MMR gives you a 95% chance of being protected against measles, two doses increased this to 99%. No measles-only vaccine is available in New Zealand. 

• MMR vaccine is funded for all children from 12 months of age and adults, born on/after 1 January 1969, who have not completed a two-dose course of MMR vaccine.
• It is part of the childhood immunisation schedule for children at 15 months and 4 years of age.
• Having only one dose of the MMR vaccine is not adequate protection against measles – you need to have two. 

Herd immunity helps protect the vulnerable in our community

Some people in our community can't be vaccinated. This might be because they are too young or too sick. You can help protect these vulnerable people by keeping your and your family’s vaccinations up to date. When enough people in the community are vaccinated, the spread of a disease slows down or stops completely. If enough people are vaccinated, the disease can't spread. This is called herd immunity.

Read more about the MMR vaccine and reasons to vaccinate.

Where can I get vaccinated?

The best place to go for vaccinations is your family medical clinic. They have your medical records and can check to see if you’ve already had the MMR vaccination. Either your doctor or a nurse can give the vaccination. 

What are the symptoms of measles?

Symptoms usually begin to show about 10 to 14 days after infection with the virus (though it can take up to 18 days to appear) and tend to appear in 3 stages.

What are the complications of measles?

Most people will recover from measles after 7–10 days, but sometimes it can lead to serious complications, even death.

Common complications that affect about 1 in every 15 cases include:

• ear infections
• diarrhoea, which can also lead to dehydration
• fits caused by fevers (febrile seizures)
• pneumonia – this is the main cause of deaths from measles.

Inflammation of the brain (encephalitis) occurs in about 1 in 1000 measles cases, with some of these people dying and 1 in 3 being left with permanent brain damage. It is estimated that complications resulting from measles infection lead to death in approximately 1–2 per 1000 measles cases.

Measles and pregnancy

Pregnant women who become ill with measles during pregnancy are at risk of miscarriage, going into labour early (premature labour) and having babies with low birthweight. If you are pregnant and think you may have measles, or if you have come into contact with someone with measles, call your doctor or lead maternity carer as soon as possible. Pregnant women should not be given the measles vaccine during pregnancy but close contacts of pregnant women can be vaccinated to help protect both the mother and unborn baby from exposure.

Who is at risk of getting measles?

Anyone who hasn’t been vaccinated for measles or who has not had measles previously is at risk of being infected. Those most at risk of getting the infection include:

• babies who are too young to receive the MMR vaccine
• people travelling in countries/regions where there are current outbreaks of measles.
• people born overseas in countries where appropriate vaccination is less likely.

People who are at increased risk of potentially fatal measles complications include:

• anyone with a chronic illness or a weakened immune system
• children younger than 5 years.

Who is considered to be immune to measles?

If you have had two doses of the MMR vaccine, have had the measles previously or were born before 1969, you are considered to be immune to measles.

• Children aged 12 months or older are considered fully immunised against measles when they have two documented MMR vaccinations, received when aged 12 months or older. 
• Adults born in 1969 or later are considered fully immunised against measles when they have two documented MMR vaccinations, received when aged 12 months or older. Don’t rely on memory – if you have no record of receiving both the MMR vaccines from 12 months of age and a minimum of 28 days later, it’s recommended you get catch-up MMR vaccinations.
• Adults born before 1969 are considered immune to measles as the disease common at that time and circulating widely prior to the introduction of a measles vaccine in 1969. 

How is measles treated?

There are no specific treatments for measles and symptoms usually improve after 7 to 10 days. There are things you can do to ease your symptoms such as:

• using pain relief, such as paracetamol or ibuprofen, to reduce pain and discomfort
• drinking adequate water or other fluids to avoid dehydration. 
• treating sore eyes by wiping the crustiness from the eyelids and lashes using cotton wool and water (use a separate piece of cotton wool for each eye) and avoiding bright light.

How can I prevent the spread of measles?

If you have measles, it’s important to reduce the risk of spreading the infection to others. You should do the following:

• Stay home from work, school or daycare for 5 days after the rash appears.
• Do not invite other children or visitors to the house.
• Your public health service will tell you when your child can return to school or childcare. 
• Wash your hands regularly. Just as you would to prevent germs at any time, use soap and water and scrub for at least 20 seconds then dry well. Remind others in your home to do the same.

If you suspect you have measles, phone your GP or Healthline free on 0800 611 116 for advice. Because measles is so infectious (easily passed on to other people), ring first rather than just turning up at your doctor’s clinic.

If you come into contact with someone who has measles AND you have never had measles or not been fully vaccinated for it:

• You should be in quarantine at home. This means you cannot attend early childhood centres, school, work, sporting events, social activities or shopping malls or use public transport for that time.
• The quarantine period starts 7 days after your first contact with an infected person, lasting until 14 days after your last contact. Read more about measles information for contacts and measles quarantine calculator.

Overseas travel

• Vaccination is particularly important if you are planning to travel overseas as there may be outbreaks in those countries.
• If you have been overseas, or had contact with an overseas visitor in the last 3 weeks and develop the symptoms described above, you could have measles.

Learn more

The following links provide more information on measles

Measles Ministry of Health, NZ
Quick guide to measles Auckland Regional Public Health Service
Information for people with suspected measles Auckland Regional Public Health Service
Information for close contacts exposed to measles Auckland Regional Public Health Service 
People at high risk in a measles outbreak Auckland Regional Public Health Service
Measles The Immunisation Advisory Centre, NZ
Measles worldwide incidence World Health Organization

References

1. Measles Immunisation Handbook 2020, NZ
2. Measles: what to be aware of during an outbreak BPAC, NZ, 2014
3. Measles DermNet, NZ
4. Measles overseas and New Zealand The Immunisation Advisory Service, NZ