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The Informed Parent

Question & Answer: Measles

by Louis P. Theriot, M.D., F.A.A.P.
Published on Jan. 01, 2000

My 15 month old had a high fever last week that lasted for around 3 days. She then developed a rash that lasted for a few days. Both sets of grandparents were convinced that she had measles. Is this possible even though she had her measles shot at a year? She really wasn't very sick either. Could you tell me a little about measles as I don't know anything about it?

From what you have mentioned, it seems very unlikely that your daughter had measles for a couple of reasons. First, since the advent of the MMR (measles, mumps, and rubella) vaccine, the incidence of measles has decreased tremendously. In some areas of the country it is possible to complete a three year residency in pediatrics and never see a case of measles. A child who receives a MMR vaccine stands a greater than 95% chance of not getting measles. Although the protection may not be lifelong, a second MMR is given in adolescence to insure protection through young adulthood.

Since your daughter did get her vaccine, the chances of her having measles would be very slim.

Secondly, measles usually follows a very characteristic course. You described your daughter as having a fever followed by a rash, with no other symptoms. This is very unlike measles. With measles there is an incubation period of around 6-10 days during which there may be a low grade fever. This is followed by a prodromal period lasting 3-5 days during which there is fever, hacking cough and conjunctivitis (pink eye). The cough may become severe and even lead into pneumonia. There may also be a thick yellowish nasal discharge.

Then comes the rash phase which is usually accompanied by a high fever (104-105 ) and a very sick appearing child. The rash starts as a flat red rash on the neck, behind the ears and on the cheeks. Within 24 hours the rash spreads over the entire face, chest and upper arms. Then over the next couple of days the rash spreads down-wards over the abdomen and legs. Interestingly, the severity of the disease is felt to be directly proportional to the degree of the rash.

In addition to the cough, a child with measles often has large swollen lymph nodes behind the ears and in the neck, may also have an ear infection, and may have a pneumonia.

Measles is a very serious illness in children. They are extremely ill and may have serious complications from the measles. In your daughter's case, measles would be very unlikely because she did receive her MMR, and the illness you described just doesn't fit for measles. It sounds like she may have actually had rosoela which is a childhood virus that causes a few days of high fever with no other symptoms. Then the fever suddenly breaks after which the child develops a lacy type of rash. I urge you to discuss this possibility with her doctor.

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