Intended for healthcare professionals

Practice Easily Missed?

Measles in older children and adults

BMJ 2017; 356 doi: (Published 16 February 2017) Cite this as: BMJ 2017;356:j426
  1. Beatrice Clare Cockbain, foundation year 2 doctor,
  2. Tehmina Bharucha, specialist registrar in combined infection training,
  3. Dianne Irish, consultant virologist,
  4. Michael Jacobs, consultant in infectious diseases
  1. Royal Free Hospital, London
  1. Correspondence to beatricecockbain{at}
  • Accepted 12 December 2016

What you need to know

  • Consider measles in patients with fever, flu-like symptoms, and rash, and ask about immunisation and contact with unwell people

  • When a case is suspected, contact local public health authorities and test for measles using immunoglobulin M serology and, if available, reverse transcription polymerase chain reaction

  • Offer opportunistic immunisation for children older than 1 year and adults who are unvaccinated or have only received one dose of the measles, mumps, and rubella vaccine

A 23 year old woman has fever, flu-like symptoms, diarrhoea, and a rash that has spread from her face to her body. She cannot recall being in contact with anyone unwell and has not recently travelled or taken any drugs. She reports missing vaccinations as a child because her parents were concerned about safety. On examination she has a maculopapular blanching rash on her face and chest. Measles was suspected and confirmed with serology that was positive for immunoglobulin M antibodies to the measles virus. Reverse transcription polymerase chain reaction on a throat swab detected measles virus RNA.

What is measles?

Measles is widely perceived as a disease of early childhood, despite almost two thirds of recent cases in the United Kingdom being in those aged 15 and older.1 Patients typically present with fever, cough, coryza, and conjunctivitis, followed two to four days later by a characteristic erythematous maculopapular rash that spreads downwards from the face (figs 1 and 2).2 Patients are infectious from four days before to four days after the onset of rash. Koplik’s spots—whitish lesions …

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