Measles: The “Bucket of Rash” That’s Not Just a Rash

Welcome to a Big ol’ Fact Sheet on Measles

You may be here because you’re doing a research project for a class, you want more information for yourself or a loved one, or maybe you’re a neighbor or clinician. Either way, you’ve come to a great starting point. I’ll be covering a brief history of the measles virus; epidemiology, pathophysiology, presentation, treatment & prevention; what elimination status is; some (not so) fun facts; and what public health professionals could potentially do (and you, too, dear reader, if you’re not in public health) as we face the ever-changing landscape of the media & trust.

Disclaimer: This is not medical advice; DO NOT TREAT IT AS SUCH. Please seek further information and guidance from your primary care doctor or other medical specialists available to you. Call 911 for emergencies, 988 for mental health support, or your local help line (such as 311).

We all share a similar sense of values, and it’s only visible when you actually talk to one another

Chandra Marlow, Medical Illustrator, Graduate Research Assistant, OHSU | PSU – SPH

History of the Measles

The measles was first described in the 7th century, and later on in the 10th century, proclaimed to be “worse than smallpox” by the Persian physician Rhazes. There is 1 antigenic type, meaning there is only one name for measles, unlike the Flu virus in comparison, which may be denoted as Influenza A or Influenza B. It is an enveloped, single-stranded, negative-sense ribonucleic acid (RNA) virus of the genus Morbilivirus; family of Paramyxoviridae. Although studies have been reporting changes in the H protein, as the measles virus has been spreading, those changes are still not epidemiologically significant (aka, the vaccines are still effective).

Some other quick things about the measles virus

• It is rapidly inactivated by heat, sunlight, acidic pH, ether, and trypsin
• It encodes 6 structural proteins and 2 non-structural proteins (more to come in the next section on that, and with a picture!)

What’s Inside the Measles Virus?

The measles virus encodes 6 structural proteins and 2 non-structural proteins. The structural proteins include: Nucleoprotein (N), Phosphoprotein (P), Matrix (M), Fusion (F), Haemagglutinin (HA), and Large protein (L). The non-structural proteins include: virus protein C and V. Most importantly, the H protein is responsible for the virus’s attachment to the host cell (aka, you).

Epidemiology of the Mealses Virus

Unfortunately, the epidemiology of measles varies across the globe and is entirely dependent on immunization levels that are achieved within a particular area. Before widespread vaccination campaigns occurred and subsequent uptake of the vaccines, measles accounted for about 2.6 million deaths. As of 2023, around the world, there have been 107,500 deaths, which mostly occurred in under and unvaccinated children under the age of 5 years old. As of May 2026, the current hospital cases in the United States can be found below (these are from the CDC website).

Other Epidemiological Facts:

• Reservoir: Humans
• Transmission: Person to Person via large respiratory droplets; Airborne in closed areas for up to 2 hours
• Temporal Pattern: Mainly late winter and spring
• Communicability (How Long You’re Contagious For): 4-5 days before rash presents, and 4 days after rash presents
• Highly Contagious: Per person who is actively infected, measles infection can be the cause of 14-18 secondary cases among susceptible populations. For example, compared to COVID-19, it had only 1-6 secondary cases per person actively infected.
• Near 100% Contagion Index
• Complication rate of up to 30%
• In 2022, globally, the incidence in 2022 was about 29 cases per million people.
• Measles can be eliminated if 95% of the population is either vaccinated or immune, AND measures are taken to limit the spread. But, as of 2021, worldwide immunization sits around 81%, which is down from the 86% that it was in 2019.

Pathophysiology of the Measles Virus

The measles virus is spread through the inhalation (breathing in) of an exposed/infected person’s droplets from their breathing, speaking, coughing & sneezing. It initially infects the respiratory tract’s lymphocytes, dendritic cells, and alveolar macrophages. From there, it continues to nearby lymphoid tissues and disseminates through the bloodstream, leading to the virus’s spread to other organs.

TL;DR

Virus → dendritic cells & lymphocytes (lymph cells) → epithelial cells in your respiratory tract → shed and expelled in droplets when you cough & sneeze → infection spreads → rinse and repeat

The measles virus can induce immunosuppression that can last for a few weeks or up to many years. The guess as to why this happens is that the measles infection induces a rapid increase in measles-specific lymphocytes, which then replace previously established immune memory cells, leading to something called immune amnesia.

What Measles Looks Like

This might seem silly when you read it, but the measles rash presents differently depending on the melanin content of the skin. Yes, I could say “if you’re white, it will present one way, and if you’re not white, it will present another”; however, it’s more specific than that. Quite literally, depending on the melanin content in your skin, this will cause the rash to present very differently, as the virus interacts with the melanocytes in the skin differently. Some examples of this can be found below. For those who have less melanin content in their skin, the rash may present more red & splotchy. As the melanin content in someone’s skin increases, the rash may appear more pinkish/orange, all the way up to a white, or almost bumpy presentation. The rash is not like the chicken pox where it itches, but is instead more of the presentation of severe inflammation in the skin due to the measles virus.

Marlow Med Illustrate © 2026

Clinical Features of the Measles

Treatment and Prevention of the Measles

Unfortunately, there is no specific treatment for measles outside of supportive care. This means, if you get sick, your options are hydration therapy (aka, drinking water and electrolytes, other clear liquids like broth and jello), taking Tylenol (acetaminophen), and or Advil/Motrin (NSAIDs) as needed and appropriate, handwashing & hygiene, as well as isolating to prevent further spread of the virus. As I said at the beginning of this article, this is not medical advice. If you think you may have measles or have been exposed to someone who has measles, please contact your doctor immediately for further guidance.

FOR MALNOURISHED CHILDREN: The WHO and American Academy of Pediatrics (AAP) recommended administering daily Vitamin A supplements for 2 days (or longer for, again, malnourished children), as it has been shown to reduce complications resulting from infection with the measles virus. Excessive Vitamin A supplementation can cause dangerous neurologic and hepatic complications. It does not contain an antiviral agent and isn’t a preventative or treatment strategy in most cases.

Vitamin A supplementation should be conducted under the supervision of a medical professional, and with their advice to do so. All information is based on research and literature from the WHO, CDC, and AAP, and is not a replacement for regular primary care, emergency, or other healthcare visits. Seek medical and other advice from your PCP or other healthcare professionals. This is not medical advice.

At this point, you may be like “ok, we get it,” but if you’re that one person thinking about doing anything without guidance and referencing this article, or me, especially if things go wrong, don’t. I am not a doctor, and this is not medical advice. Now, back to the facts!

The one sure-fire way to prevent measles is by getting the MMR vaccine. “But Chandra, you mentioned that vaccination or immunity can help!” The measles isn’t like other viruses, and should not be treated as such. If you contract measles, there are rare but dangerous complications that can develop later on in life that lead to severe disability and death. Another thing that can happen, as mentioned before, the measles virus can cause your body to lose its memory storage of immunity for other things, making you vulnerable to things you may have already fought off. This will then lead to you becoming immunocompromised, making it even more important for those around you to be vaccinated against typical viruses, as you have a heightened risk of contracting and sustaining severe infections.

Outside of that, if we as a community (locally and globally) can get vaccination numbers up to 95%, we will protect the most vulnerable and reestablish elimination status. Before we had the Measles or MMR vaccine, measles was responsible for 7-8 million childhood deaths globally per year. Luckily, the MMR vaccine we enjoy today, due to scientists’ hard work, is 97% effective at preventing disease after 2 doses are administered, typically in childhood. Secondary vaccine failure (waning immunity) rates sit around 5% within 10-15 years post vaccination. Breakthrough infections are very rare and typically occur after prolonged exposure to the measles virus.

Elimination Status: What Does That Mean?

In 2000, the United States reached elimination status for the measles virus (aka, the interruption of endemic measles virus transmission). The Pan American Health Organization (PAHO) is the one that determines the elimination status of diseases. Because of the rates of infection from the past 12-24 months in the country, we risk losing that status. This is a direct result of the decline in uptake of the MMR vaccine due to misinformation, disinformation, and the continued narrative about how the MMR vaccine causes Autism (plot twist, it does not cause Autism).

This highlights why public health promotion messaging, research, and other communication materials are so important. The wrong messaging, or fraudulent messaging, can and does lead to the death and injury of marginalized and at-risk communities (i.e. BIPOC, disabled, immunocompromised, children, and elderly, and so on).

(Not So) Fun Facts About the Measles

• 1 in 1000 children will develop life-threatening encephalitis as an early complication of measles infection.
• 5-10 in 100,000 children develop late-appearing measles sequela (consequence or complication of previous disease, injury or trauma) → subacute sclerosing panencephalitis:
  • a rare, progressive, & fatal degenerative brain disorder caused by a dormant, persistent, and mutated measles virus that hangs out in the central nervous system (CNS) after the initial infection.
• Pneumonia is the leading cause of death due to measles infection.
• Keratoconjunctivitis (inflammation of both cornea and conjunctiva) and otitis media (inflammation of the middle ear) as a result of measles infection can lead to blindness and hearing loss.
• In 1961, research was being conducted for the Measles vaccine; by 1963, Merck and Pfizer provided the first approved Measles vaccines in the US (Rubeovax and Pfizer-Vax Measles—K, respectively). They had 2 vaccines, one was a “live virus” vaccine, and the other was Inactivated. The inactivated vaccine was discontinued at the time because it failed to provide long-term immunity. People who received this vaccine who haven’t gotten a re-up may need to in order to prevent getting the measles (aka, getting the MMR vaccine or getting a titer test done to see if they have immunity to measles).

So What Can We Do About the Measles?

For starters, make sure you and your family are up to date on your vaccinations, and if you fall within the community from (Not So) Fun Facts, talk to your doctor about checking for your immunity against measles using a titer test. Outside of the cursed individual responsibility, there are some things that we can do as people, whether you fall on the spectrum of public health professional, clinician, or friendly neighbor.

• Creation of a media advocacy campaign that focuses on community over individualism.
  
• Vaccination clinics in communities where the uptake is lower than the recommended level (< 95%) to help restore elimination status and keep our friends, family, and community members safe. Also, focusing on the gain perspective. As you could see in this article, there were a lot of death rates and other info about all that. But at the end of the day, what can we gain from protecting each other? Leave a comment on what your community would gain if we had higher rates of vaccination. I would love to hear from you!
  
• Talking with friends, family, and neighbors about your thoughts, and being open to listening to different perspectives, as if you might be wrong. We all share a similar sense of values, and it’s only visible when you actually talk to one another. You’d be surprised at what we have in common, so don’t close the doors just because you have a difference in opinion.
  
• With that, too, make sure you are informed with proper information. There is so much disinformation and misinformation on the internet that it can be hard to discern between the two sometimes.

Overall, this could really help so many people. Parents, those who may have received the OG measles vaccine (pre-MMR in 1963-1966), vaccine-hesitant community members, and really, everyone at this point. Parents are already navigating an ever-changing, active disinformation campaign in the U.S. They could use all the help they can get. Also, people who are 100% against vaccination are still people. They’re still your neighbors, your friends, your community members. Continuing to address concerns as well as meeting people where they are – it’s important. Finding shared values can go a long way! Finally, the older populations are at a heightened risk of experiencing complications even with day-to-day infections. Helping keep them, as well as babies and people who are immunocompromised, safe is a great way to contribute to your community.

In Conclusion, the Measles Suck

With all this info, you may be thinking, “What can all these things lead to if we were able to make a positive impact on our communities?” Whether you’re in the U.S. or abroad, the following can be addressed:

• Long-Term Inflammation & Injury
• Loss of Life
• Continuation of the disruption in infection transmission -> Keeping Elimination Status
• Other harmful biological changes (immune amnesia -> immunocompromised individuals)

We covered a lot, and I hope you found some value in this, whatever brought you here today. We traversed history, virus components, epidemiology, and pathophysiology, what probably felt like a ploy to get you to go get vaccinated, but rest assured, it’s all based on researched literature, lol, and finally, what we all can do as members of our communities to help keep each other safe in these very trying times. If you have questions, comments, or other anecdotes, please feel free to comment below at the end of this article, or you can send me an email or DM on social media to continue the conversation. As always, stay safe, love each other, and be well (and spooky, of course. Gotta keep it on brand!)

Resources

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Hendriks, J., & Blume, S. (2013). Measles Vaccination Before the Measles-Mumps-Rubella Vaccine. American Journal of Public Health, 103(8), 1393–1401. https://doi.org/10.2105/AJPH.2012.301075

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Huiming, Y., Chaomin, W., & Meng, M. (2005). Vitamin A for treating measles in children. The Cochrane Database of Systematic Reviews, 2005(4), CD001479. https://doi.org/10.1002/14651858.CD001479.pub3

Kondamudi, N. P., Tobin, E. H., & Waymack, J. R. (2026). Measles. In StatPearls. StatPearls Publishing. http://www.ncbi.nlm.nih.gov/books/NBK448068/

Mathis, A. D., Clemmons, N. S., Redd, S. B., Pham, H., Leung, J., Wharton, A. K., Anderson, R., McNall, R. J., Rausch-Phung, E., Rosen, J. B., Blog, D., Zucker, J. R., Bankamp, B., Rota, P. A., Patel, M., & Gastañaduy, P. A. (2022). Maintenance of Measles Elimination Status in the United States for 20 Years Despite Increasing Challenges. Clinical Infectious Diseases : An Official Publication of the Infectious Diseases Society of America, 75(3), 416–424. https://doi.org/10.1093/cid/ciab979

Matysiak-Klose, D., Mankertz, A., & Holzmann, H. (2024). The Epidemiology and Diagnosis of Measles. Deutsches Ärzteblatt International, 121(26), 875–881. https://doi.org/10.3238/arztebl.m2024.0211

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