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Measles: Causes, Epidemiology, Symptoms, and Complications

Introduction

Measles is a highly contagious viral disease caused by the measles virus, a member of the Paramyxoviridae family. The disease spreads mainly through respiratory droplets or direct contact with secretions from infected individuals. Common signs include fever, cough, red eyes, small white Koplik spots inside the mouth, and a red rash that begins on the face and spreads to the rest of the body.

Although measles often resolves on its own, it can lead to severe complications such as pneumonia, ear infections, encephalitis, and even death. Children under five, malnourished individuals, and people with weakened immune systems are at the highest risk. There is no specific antiviral treatment, but supportive care—such as fever control, good nutrition, and high-dose vitamin A—can help. Vaccination remains the most effective way to prevent measles.

 

Cause of the Disease

The measles virus has only one serotype, which makes vaccination highly effective. While fragile and easily destroyed by heat, sunlight, or disinfectants, the virus can survive for up to two hours in the air or on contaminated surfaces. Humans are the only natural hosts.

Epidemiology

  • Transmission: About 90% of unvaccinated people exposed to measles will develop the illness. It can remain airborne in enclosed spaces for up to two hours after a patient has left. A person is contagious from a few days before symptoms appear until four to five days after the rash begins.
  • High-risk groups: Unvaccinated children are most vulnerable, but anyone without immunity can get sick.
  • Global situation: In 2023, measles caused around 10.3 million cases and more than 107,000 deaths, mostly among children under five. Vaccination prevented over 60 million deaths from 2000 to 2023.
  • Vietnam in 2025: By March, over 42,000 suspected cases had been reported nationwide, with several deaths, mostly in the southern region.

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  • Pathogenesis

    After entering the body, the virus infects respiratory cells and spreads through the blood to organs such as the skin, eyes, lungs, and liver. This leads to the rash and Koplik spots. Once recovered, people gain lifelong immunity. However, measles weakens the immune system for weeks, increasing vulnerability to other infections such as tuberculosis or pneumonia.

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    Clinical Symptoms

    The course of measles usually follows four stages:

  • Incubation (7–21 days): No obvious symptoms.
  • Prodrome (2–4 days): High fever, fatigue, cough, runny nose, red eyes, and Koplik spots inside the mouth.

  • Atypical cases may be mild and unnoticed, or severe with unusual rashes, swelling, and pneumonia.

  • Rash stage (2–5 days): A red rash begins on the face, spreading to the trunk and limbs, while fever decreases.

  • Recovery: Rash fades, leaving dark patches and peeling skin. Cough may persist for 1–2 weeks.
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  • Complications

  • Around 30% of measles patients experience complications, especially young children and adults over 20. Common complications include: diarrhea, ear infections, pneumonia (the leading cause of measles-related death), etc. 

  • Pregnant women face higher risks of miscarriage, premature birth, and low birth weight. Other serious complications may include seizures, encephalitis, a rare but fatal brain condition (SSPE), and sepsis. Malnutrition, vitamin A deficiency, and weak immunity significantly increase the risk of severe illness.

 

Conclusion

Measles remains a dangerous disease with serious health risks. Although vaccines have saved millions of lives, outbreaks still occur when vaccination coverage is low.

Protect your children and the community: make sure all children receive measles vaccination on schedule. Vaccination saves lives!

References

  1. 1. Infectious Diseases, Medical Publisher, 2020.
  2. 2. World Health Organization. "Manual for the laboratory diagnosis of measles and rubella infection." Geneva: WHO (2007).
  3. 3. J. Blaser. Mandell, Douglas, and Bennett's principles and practice of infectious diseases E-Book: 2-volume set. Elsevier health sciences, 2019.
  4. 4. Wang, C‐H. "Image gallery: measles revival: Koplik's spots." British Journal of Dermatology 182.1 (2020): e4-e4.
  5. 5. Kliegman RM, Weiss SL, Tissières P, et al. Measles. In: Kliegman RM, editor.  Nelson Textbook of Pediatrics. 22nd ed. Philadelphia: Elsevier; 2024. Volume 1.  Part VII, Chapter 293. p. 1958-1963.
  6. 6. Executive Summary of the Second International Guidelines for the Diagnosis and Management of Pediatric Acute Respiratory Distress Syndrome (PALICC-2): Erratum. Pediatr Crit Care Med. 2024 Mar 1;25(3):e175.
  7. 7. Bhalla, Anoopindar, et al. "Monitoring in pediatric acute respiratory distress syndrome: from the Second Pediatric Acute Lung Injury Consensus Conference." Pediatric Critical Care Medicine 24. Supplement 1 2S (2023): S112-S123.
  8. 8. Coughlin, Melissa M., et al. "Perspective on global measles epidemiology and control and the role of novel vaccination strategies." Viruses 9.1 (2017): 11.
  9. 9. https://www.who.int/news-room/fact-sheets/detail/measles?utm_source

      10. https://vneconomy.vn/bo-y-te-dich-soi-van-trong-tam-kiem-soat.htm?utm_source

 

MPharm. Kim Ngoc Son

MPharm. Nguyen Hieu Minh

 

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