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  1. Education
  2. How to recognise and...
  3. How to recognise and manage measles
Practice Practice Pointer

How to recognise and manage measles

BMJ 2025; 388 doi: https://doi.org/10.1136/bmj-2024-079895 (Published 11 February 2025) Cite this as: BMJ 2025;388:e079895
  1. Chris Bird, consultant in paediatric emergency medicine12,
  2. Frances Dutton, general practitioner13
  1. 1Emergency Department, Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham B4 6NH, UK
  2. 2Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
  3. 3Small Heath Medical Practice, Birmingham, UK
  1. Correspondence to: C Bird christopher.bird2{at}nhs.net

What you need to know

  • Measles is a highly contagious virus primarily spread through airborne droplets from coughing, sneezing, and touching contaminated surfaces

  • Careful attention to symptoms and the timing of their appearance can help distinguish measles from other common acute respiratory infections

  • Healthcare workers play a vital role in educating families around the proven safety of the MMR vaccine. Alongside an effective public health response, vaccination is key to halting a measles outbreak

Measles is caused by Morbillivirus hominis, a member of the Paramyxoviridae family (which includes mumps, parainfluenza, and Nipah viruses).1 Spread is airborne through aerosol and respiratory droplets, or through touching a surface contaminated with infected droplets (fomites). Infection normally results in lifelong immunity.2

Measles is highly infectious, with an estimated R0 of 12-18 (basic reproduction number, in which one case will go on to infect 12-18 other people), approximately 10 times higher than for covid-19 or influenza.3 Infection can have serious consequences for vulnerable patients (including those who are immunosuppressed or pregnant) but also causes transient immune suppression that can last from months to years in otherwise healthy individuals. This immunosuppression is the main cause of death from measles, especially in areas with high rates of malnutrition (such as in humanitarian emergencies).24 In most countries, including the UK, measles is a notifiable disease.

Epidemiology

Measles vaccination is estimated to have prevented 57 million deaths worldwide between 2000 and 2020, but missed measles vaccinations and decreased surveillance during the covid-19 pandemic led to an 18% increase in measles cases and a 43% rise in measles related deaths globally in 2022 compared with 2021.5 Approximately 1.2 million children in Europe missed their measles vaccine during the pandemic, which, combined with the end of covid-19 public health measures, led to a 30-fold rise in measles cases in …

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