Measles: Signs, symptoms and prevention

As cases grow across the UK, here is how to spot the early symptoms – and keep your family safe

It’s a centuries-old contagious disease that, until recently, had faded to a distant threat in the UK. But now it is on the rise with hospitals in Birmingham dealing with their biggest outbreak in years.
The UK Health Security Agency has declared a national incident with its chief executive Dame Jenny Harries stating that, “We need a long-term concerted effort to protect individuals and to prevent large measles outbreaks.”Health experts have warned that unless more children are vaccinated against measles, more hospital admissions can be expected with experts warning that cases are rising daily. 
The NHS estimates that one in five cases of measles results in a hospital visit. More than 3.4 million children under the age of 16 are either unprotected or not fully protected and at risk of becoming ill from the disease, according to NHS England. So, how worried should parents be, and what should you look out for?
The first symptoms of measles are no different to a typical cold or flu and begin roughly 10 to 14 days after exposure to the virus. “Typically, measles first presents as a cold,” says Dr Radhika Vohra, GP at Spire Gatwick Park Hospital. “So it’s a few days of cold-like symptoms – a high temperature, a runny or blocked nose, sneezing, a cough, red, sore, watery eyes, and then you could develop spots in your mouth [these usually appear in the inside of the cheeks or on the back of the lips] or you could also get a rash a few days later – mainly on your face and ears, and then it spreads down the body.”
The measles rash appears a few days after cold-like symptoms begin. “It usually begins as small, flat red spots that gradually multiply and merge together,” says Dr Jeremy Harris, senior partner at The Private GP Group. “It typically starts on the face and then spreads downward to the neck, trunk, arms, legs and feet. The rash may be slightly raised and can feel rough or bumpy to the touch. It generally lasts for about five to six days before fading.”
Low uptake of the MMR vaccine is to blame for the rise in cases. “Over the past 20 or so years, uptake of the triple vaccine that covers measles, mumps and rubella – given to children aged one and just before they go to school – has dropped,” explains Dr Radhika Vohra, GP at Spire Gatwick Park Hospital. “In the London area, herd immunity [the group protection given by good overall vaccine coverage in a population] is not as high as it needs to be.”
Those aged 19 to 25 could also be particularly vulnerable, as uptake “dipped in the early 2000s after there were claims about risks of the vaccine that have been completely discredited since,” says Vohra.
Most parents of 20-somethings will remember the now-discredited findings of Andrew Wakefield, the doctor who claimed there was a link between the MMR shot and autism. His paper in The Lancet, which has since been redacted, triggered a global health scare and caused vaccination rates to slump.
The Covid pandemic and the fact that people are complacent about measles has also contributed to lower vaccination rates. “People [say] we don’t see it, it’s not a huge thing, so uptake has dropped,” says Vohra.
“If you’re fully vaccinated, you are 99 per cent protected,” says Vohra. “We’re trying to make efforts to prevent people getting measles – the NHS has launched a campaign to encourage parents to check their children’s red books and vaccination status, and also started programmes within schools to get those who have missed vaccinations caught up.”
The WHO classes measles as one of the world’s most infectious diseases. “Children should stay off nursery or school for at least four days from when the rash first appears. The same advice applies as with other viruses,” says Vohra. “Anyone who is infected  should try to avoid contact with people who are vulnerable: babies, pregnant women, people with weakened immune systems.”
Measles is a viral infection, so there is no specific treatment to cure it. The NHS advises that most cases of measles improve in about a week and should be treated at home with rest, plenty of fluids, paracetamol and ibuprofen. Complications are rare, but call 999 or go to A&E if your child has shortness of breath, a high temperature that does not come down after taking paracetamol or ibuprofen, confusion or seizures (fits).
Parents should check their children have had two doses of MMR by looking in their red book (otherwise known as a Personal Child Health Record) or by checking with their GP practice or on the NHS app. If not, get them vaccinated, as this offers lifetime protection.
“The two doses are free, whatever your age, and there are catch-up programmes and community clinics starting where you can drop in and get that done,” says Vohra. “Ensure you are fully vaccinated before you travel overseas – part of the problem is that people are travelling to or from areas that might have higher measles levels.”
Jane Clegg, regional chief nurse for the NHS in London, said: “It’s really important that people check that they, and their children, are up to date with their jabs and protected against MMR – and if you have any questions or concerns, please get in touch with your GP practice or local pharmacist for advice. Now is the time to act to protect yourself and loved ones from measles.”
According to government data, in some areas and groups in London, coverage of the first MMR dose at two years of age is as low as 69.5 per cent. About 10 per cent of children in the UK are unprotected from measles by the time they start school, with the rate in London at about 20 per cent.
“If your child is showing symptoms that could indicate measles, it’s important to contact a healthcare professional promptly,” says Harris. As per NHS advice, it is wise to make a GP appointment or call NHS 111 if you suspect you or your child has measles, or if you have been in contact with someone who has measles and you haven’t had two doses of the MMR vaccine, are pregnant, or have a weakened immune system.
CLARIFICATION: An earlier version of this article originally reported NHS England wording that ‘more than 3.4 million children under the age of 16 ‘are unprotected against measles, mumps, and rubella’ NHS England has amended its wording to say ‘more than 3.4 million children aged 12 months to 16 years are ‘eligible for either one or two doses of the MMR vaccine but have yet to receive it’. We happy to clarify.
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