Measles: why it still matters in India, and how to recognise it

Recognising it

It begins with three to four days of high fever, a harsh cough, a runny nose and red watery eyes — the child looks genuinely unwell before any rash appears, which is one way it differs from milder viral rashes.

Small white spots may appear inside the cheeks (Koplik spots) a day or two before the rash. Then a flat red blotchy rash starts at the hairline and behind the ears and spreads downward over the body across a few days, often merging into patches.

It is extremely infectious — one of the most infectious diseases known — and spreads through the air. A child is infectious from about four days before the rash to four days after it appears, and the virus can linger in a room after the child has left.

Why it is taken seriously

Complications are common rather than rare: ear infections, diarrhoea, pneumonia — which is the usual cause of measles deaths in children — and, uncommonly, encephalitis, an inflammation of the brain.

Measles also suppresses the immune system for weeks to months afterwards, leaving a child vulnerable to other infections. It is particularly dangerous in undernourished children, in babies under one, and in children with vitamin A deficiency.

Treatment is supportive: fluids, fever control, and rest. Vitamin A is given as treatment in measles under WHO and Indian guidance and reduces complications — a doctor will give it. Antibiotics are used only if a bacterial complication develops.

The vaccine

India's national schedule gives Measles-Rubella (MR) vaccine at nine months and again at 16-24 months, free at government facilities. Both doses are needed; one is not enough for reliable protection.

Outbreaks in India consistently trace back to pockets of unvaccinated and partially vaccinated children. If your child missed a dose, catch it up — there is no age at which it becomes too late.

A mild fever and a faint rash five to twelve days after the vaccine is a known, harmless reaction and is not measles.

Rubella, the R in MR, is a mild illness in children and a devastating one in pregnancy — it causes serious birth defects. Vaccinating children protects pregnant women around them, which is a large part of the point.

When to see a doctor

See a doctor the same day for any suspected measles, particularly in a child under five or one who is unvaccinated or undernourished — and tell the clinic before you arrive, since they will want to avoid the waiting room.

Emergency: fast or difficult breathing, chest sucking in, a fit, drowsiness or confusion, a stiff neck, severe headache, a child who cannot drink, dehydration, or ear pain with discharge. Call 108 for breathing difficulty.

This article is general information, not medical advice, and is no substitute for personal medical advice. For any decision about your or your child's health, please consult your doctor.

Frequently asked questions

Q: My child is vaccinated. Can they still get measles? — It is much less likely, and when it happens the illness is usually far milder. Two doses give strong protection.

Q: Is the rash of measles the same as a heat rash or a viral rash? — No. Measles comes with a genuinely unwell child, high fever, cough and red eyes for days before the rash, and the rash spreads downward from the head. Any rash with a very unwell child needs a doctor.

Q: Should I keep the child in a dark room? — That tradition comes from the light sensitivity measles causes. A dimly lit comfortable room is kind; total darkness is unnecessary.

Q: We missed the nine-month vaccine. — Catch it up now. Government facilities give it free and will not turn you away for being late.