Executive summary
- Measles is a notifiable disease. Any suspected case must be reported to your local health protection team (HPT) by telephone the same day — do not wait for laboratory confirmation.
- The prodrome is the infectious window: fever, coryza, cough, and conjunctivitis (the 4 Cs) appear 2–4 days before the rash and the patient is infectious from prodrome onset until 4 days after rash appearance.
- Complications can be severe: pneumonia is the commonest cause of death; encephalitis occurs in ~1 in 1,000 cases; subacute sclerosing panencephalitis (SSPE) is a rare but fatal late complication.
- Post-exposure window matters: MMR within 72 hours or HNIG within 6 days can prevent or attenuate disease in susceptible contacts.
Recognition
- Prodrome (days 1–4): High fever (often ≥38.5 °C), profuse coryza, dry cough, and conjunctivitis. The child or adult looks and feels genuinely unwell — not a typical URTI.
- Koplik spots (pathognomonic): White/grey spots on erythematous buccal mucosa, opposite the lower molars. Appear 1–2 days before the rash and fade as the rash spreads. Absence does not exclude measles.
- Rash: Erythematous maculopapular rash, beginning on the face/hairline on day 3–5 of illness, spreading cephalocaudally over 2–3 days, becoming confluent on the trunk. Spares the palms and soles (unlike secondary syphilis).
- Fever pattern: A brief improvement may occur as the prodrome ends, followed by fever spike as the rash appears.
Immediate actions
- Isolate immediately: Do not have the patient sit in a waiting room. Measles is highly contagious (R₀ ~15). Use a side room if available; ask them to wear a surgical mask in transit.
- Notify the local HPT by telephone the same day — measles is a statutory notifiable disease under the Health Protection (Notification) Regulations 2010. Formal written notification (form) should follow.
- Arrange salivary swab (oral fluid test): Contact your HPT for a salivary testing kit. Paired oral fluid for measles/rubella PCR and IgM. Serum IgM is an alternative. Do not delay notification pending results.
- Advise strict isolation: The patient should stay at home and avoid contact with unvaccinated individuals, pregnant women, and immunocompromised contacts for at least 4 days after rash onset.
Management
- Supportive care: Adequate fluid intake, paracetamol/ibuprofen for fever, rest. Reassure that the rash and fever typically resolve within 7–10 days of rash onset in uncomplicated cases.
- Vitamin A: Not routinely recommended in the UK but may be considered by specialists for children with severe disease or known deficiency.
- Antibiotics: Only if secondary bacterial infection is confirmed or strongly suspected (e.g., otitis media, pneumonia) — measles is viral and antibiotics are not prophylactic.
- When to escalate urgently: Respiratory distress, stridor, oxygen saturation <94%, neurological symptoms (seizure, altered consciousness, severe headache), inability to maintain hydration, or any immunocompromised patient with suspected measles.
Post-exposure prophylaxis (PEP)
- Identify susceptible contacts: Those without documented 2-dose MMR vaccination or no prior measles disease. The HPT will assist with contact tracing.
- MMR vaccine (within 72 hours of exposure): Offer to susceptible contacts aged ≥6 months who are not immunocompromised and are not pregnant. One dose counts; schedule a second at appropriate age.
- Human Normal Immunoglobulin (HNIG) (within 6 days of exposure): Offer to susceptible high-risk contacts — infants under 6 months, immunocompromised individuals, and pregnant women who are non-immune. Arrange urgently via HPT or hospital.
- Pregnant non-immune contacts: Refer urgently to obstetric team. Measles in pregnancy carries risks of miscarriage, premature delivery, and maternal mortality.
Frequently asked questions
The child had one MMR dose — are they protected?
One dose provides approximately 93% protection against measles; two doses provide approximately 97%. A single-dose recipient is substantially protected but not fully, and should receive their second dose at the appropriate scheduled time. For unvaccinated susceptible contacts post-exposure, a first-dose MMR within 72 hours is the priority.
When should I notify the HPT — before or after testing?
Before. Notification is a legal requirement on clinical suspicion alone; do not wait for laboratory results. The HPT needs to act on contact tracing and PEP provision urgently.
Can a fully vaccinated adult get measles?
Vaccine failure is rare but possible. Two-dose MMR provides ~97% protection, meaning a small proportion of vaccinated individuals remain susceptible. Consider measles even in vaccinated patients if the clinical picture is compelling and notify the HPT.
What is SSPE and how do I counsel about it?
Subacute sclerosing panencephalitis is a progressive fatal neurological disease caused by persistent measles virus infection of the brain, occurring years after the original infection. It is rare (approximately 1 in 10,000–100,000 measles cases, higher risk in those infected under 2 years). There is no cure. It is a key reason vaccination matters.
Transparency
This page is an educational, clinician-written summary of publicly available NICE guidance intended for trained healthcare professionals. It uses original wording (not copied text) and should be used alongside the full NICE source, local pathways, and clinical judgement. Doses provided are for general reference; always check the BNF/SPC.