For its first few days measles does not look like a rash illness. It looks like a bad cold: high fever, cough, runny nose, red watery eyes. The rash comes later, and by the time you see it the person has been contagious for several days. So the most important thing here is a phone call, BEFORE you take them in to be seen.
Recognising measles before the rash
According to CDC, symptoms begin about one to two weeks after exposure to the virus: high fever, cough, runny nose, red watery eyes. It is those four TOGETHER that is worth noticing — a cold rarely makes both eyes red and watery alongside a high fever.
Two or three days after the symptoms start, small white spots may appear inside the mouth, called Koplik spots. This sign is very specific — if you see it, tell the doctor straight away. But it appears early and disappears quickly, so not seeing Koplik spots does NOT rule out measles.
Then the rash appears, and the direction of spread is a sign
The rash appears about three to five days after the symptoms begin. According to CDC, it is flat red spots starting on the face at the hairline and then spreading DOWN the neck, body, arms, legs and feet; small raised bumps may appear on the flat areas, and the spots can join into patches.
Where families read it wrongly: the measles rash appears while the fever is still high, and the fever can even climb higher just as the rash comes out. Seeing the rash does not mean the illness is ending. An ordinary viral rash is the other way round: it appears as the fever is settling or has just settled, and it starts on the trunk. Chickenpox is fluid-filled blisters appearing in waves, with new spots, blisters and dried scabs present at the same time — the measles rash is flat, does not blister and does not scab in waves.
What to do first: the first thing is a phone call
If you suspect measles, PHONE AHEAD to the medical facility; do not take the person in and sit them in a waiting room. According to CDC: the person is contagious from four days before to four days after the rash appears; the virus stays in the air for up to two hours after they have left the room; and up to nine out of ten people nearby without immunity will catch it.
- A separate, airy room; whoever is caring for them wears a mask; separate towels, cups, bowls and chopsticks. Keep them away from newborns, pregnant women and anyone with weakened immunity.
- Off school and off work while they are still contagious — let the doctor confirm the date for going back.
- Anyone in the household who is unvaccinated and has just been near the person who is ill: ask a doctor the same day, do not wait to see whether a fever appears. Protection after an exposure only works within a very short window, and the doctor chooses it.
- Write down the first day of fever, the day the rash appeared, and who has been near the person; find the whole family's vaccination records.
- Give fluids steadily in small sips, let them rest, keep the room softly lit because the eyes are inflamed. Watch for: are they still able to drink, are they passing urine, are they alert or lethargic, is the breathing faster.
- If you need something for fever, ask a doctor or pharmacist: paracetamol (acetaminophen) is a commonly used option, but how to use it is theirs to decide.
What NOT to do
- Do NOT avoid bathing, avoid fresh air, or wrap the person up to make them sweat. Heat and sweat make them feel worse, and it hides the rash.
- Do NOT put anything on the rash: leaf poultices, toothpaste, turmeric, medicated balm, ink, limewater, talcum powder. They do not make the rash fade faster; they erase the colour and shape of the rash that the doctor needs to see.
- Do NOT buy antibiotics yourself: measles is caused by a virus so antibiotics have no effect, and they are only used when a doctor establishes that there is a bacterial infection alongside it.
- Do NOT buy vitamin A yourself. According to CDC, vitamin A may be used in children with measles, but it is prescribed and monitored by a doctor — not something to buy at a pharmacy and give on your own.
- Do NOT give aspirin to children or teenagers with a fever from a virus: it is linked to Reye's syndrome, a severe complication affecting the liver and brain. Aspirin is in many cold remedies, so read the label.
The complications are the reason to be seen
There is no specific antiviral medicine for measles; care is supportive. What needs a doctor is the complications. According to CDC: about 1 in 10 children with measles develops a middle ear infection; up to 1 in 20 develops pneumonia — the commonest cause of death from measles in young children; and about 1 in 1,000 develops encephalitis.
It is more severe in children under five, in adults, in pregnant women, in people with weakened immunity and in malnourished children; according to CDC, about 1 in 5 unvaccinated people who get measles is admitted to hospital. Measles in pregnancy can lead to premature birth or a baby with low birth weight — anyone pregnant who has been near a suspected case should call their obstetrician the same day, even with no symptoms.
When you must go to hospital
GO TO EMERGENCY CARE, or call 115 (the emergency number in Vietnam), NOW if there is: fast breathing, difficulty breathing, indrawing of the chest, blue lips; drowsiness and hard to rouse, confusion, seizures; a stiff neck, severe headache with projectile vomiting; repeated vomiting, unable to drink anything, no urine for many hours; a rash that does not fade when you stretch the skin, or purple spots under the skin; a baby under three months with a fever. — BE SEEN THE SAME DAY if: measles is suspected and a doctor has not confirmed it; the fever settled and then returned; the cough is getting worse, there is ear pain or pus from an ear; the eyes hurt, there is marked sensitivity to light or blurred vision; the rash has faded but the person feels worse than before; the person is in one of the groups above at risk of severe illness. — Remember to PHONE AHEAD before going in, and if you are not sure, call and ask rather than deciding alone.
Families usually need two things that take a clinician: a test to establish whether this really is measles, and someone watching for complications over the following days — a Y Te Xanh (GreenCare) doctor or nurse can do both at your address, and coming to you means nobody has to sit in a waiting room.
The figures in this article follow the public guidance of the US CDC on measles; this article does not replace being examined. Citing CDC here does not imply that CDC endorses Y Te Xanh or our services.
Need personalised advice for your loved one? Call our hotline 094 368 81 15 (24/7) — calling to ask a question or to book costs nothing. GreenCare has doctors who come to examine, nurses who carry out doctor's orders (injections, infusions, dressing changes), remote consultation by video call, and a review of the medicines you are taking; an in-depth remote consultation, or any one after the first, is a paid service. For children we take examination and acute care only — not long-term care at home, and not newborns or expectant mothers. We confirm we have staff in your area and provide transparent pricing before we begin.
Sources
- CDC — About Measles
