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Infectious Disease
Paediatrics

Measles

High EvidenceUpdated: 2025-12-24

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Red Flags

  • Pneumonia
  • Encephalitis
  • SSPE (late)
  • Severe dehydration
Overview

Measles

1. Clinical Overview

Measles (rubeola) is a highly contagious viral infection caused by the measles virus, a paramyxovirus. It is characterized by the classic triad of cough, coryza, and conjunctivitis (the "3 Cs"), followed by a characteristic maculopapular rash. Koplik spots on the buccal mucosa are pathognomonic. Despite effective vaccination, measles remains a leading cause of vaccine-preventable deaths worldwide, particularly in children under 5 years in resource-limited settings. Complications include pneumonia, encephalitis, and subacute sclerosing panencephalitis (SSPE), a rare but fatal late complication.

Clinical Pearls:

  • One of the most contagious diseases known (R0 = 12-18)
  • Koplik spots appear 1-2 days before rash, pathognomonic
  • Rash starts behind ears, spreads cephalocaudally
  • Vitamin A supplementation reduces mortality by 50% in malnourished children
  • MMR vaccine is 97% effective with 2 doses

Red Flags:

  • Pneumonia: Most common cause of death, especially in malnourished children
  • Encephalitis: 1 in 1000 cases, high mortality and morbidity
  • Severe dehydration: From high fever and poor oral intake
  • Subacute sclerosing panencephalitis: Late complication, 7-10 years post-infection, fatal
  • Immunocompromised: More severe disease, higher complication rates
2. Epidemiology

Measles was historically a universal childhood infection. Vaccination has dramatically reduced incidence, but outbreaks continue due to vaccine hesitancy and gaps in coverage.

Key Statistics:

  • Global incidence: 9.8 million cases in 2022 (WHO)
  • Mortality: 136,000 deaths in 2022, mostly children under 5
  • Pre-vaccine era: 2-3 million deaths annually
  • Vaccine coverage: 83% globally with first dose (2022)
  • Outbreaks: Continue in areas with less than 95% vaccination coverage

Geographic Distribution:

  • Endemic: Many African and Asian countries
  • Eliminated: Americas (2016), but outbreaks occur
  • Resurgence: Europe, USA due to vaccine hesitancy
  • High-risk areas: Low vaccination coverage regions

Age Distribution:

  • Peak: 1-4 years in unvaccinated populations
  • Shift: Older age groups in vaccinated populations (outbreaks)
  • Infants: less than 12 months at risk if mother unvaccinated
  • Adults: More severe disease, higher complication rates

Risk Factors:

  • Unvaccinated: Primary risk factor
  • Malnutrition: Increases severity and mortality
  • Vitamin A deficiency: Increases risk of complications
  • Immunocompromised: More severe disease
  • Crowded conditions: Facilitates transmission

Mortality and Morbidity:

  • Case fatality: 0.1-0.2% in developed countries, 1-5% in developing
  • Complications: 30% of cases have complications
  • Long-term: SSPE in 1 in 10,000-25,000 cases
  • Disability: Blindness, hearing loss, neurological sequelae
3. Pathophysiology

Measles virus infection follows a characteristic pattern of viral replication, immune response, and tissue damage. Understanding pathophysiology explains clinical features and complications.

Pathophysiology Steps:

  1. Viral Entry: Measles virus enters via respiratory droplets, infecting respiratory epithelial cells. The virus binds to CD150 (SLAM) and nectin-4 receptors on host cells

  2. Primary Replication: Virus replicates in respiratory epithelium and regional lymph nodes during the 10-14 day incubation period, causing initial viremia

  3. Secondary Viremia: Infected lymphocytes and monocytes disseminate virus throughout the body, reaching skin, lungs, gastrointestinal tract, and central nervous system

  4. Immune Response: Host immune response causes the characteristic symptoms. T-cell activation leads to cytokine release, causing fever, malaise, and the prodromal symptoms (cough, coryza, conjunctivitis)

  5. Rash Development: Immune complex deposition and T-cell-mediated damage to infected endothelial cells causes the maculopapular rash, which appears 3-5 days after prodrome

  6. Immune Suppression: Measles causes transient but significant immunosuppression, lasting weeks to months, increasing susceptibility to secondary bacterial infections (pneumonia, otitis media)

  7. Complications: Direct viral damage (encephalitis) or secondary bacterial infections (pneumonia) cause morbidity and mortality. Rarely, persistent CNS infection leads to SSPE years later

4. Risk Factors

Non-Modifiable Risk Factors:

  • Age: Infants less than 12 months (maternal antibodies wane, too young for vaccine)
  • Immunocompromised: HIV, chemotherapy, immunosuppressive medications
  • Malnutrition: Protein-energy malnutrition, micronutrient deficiencies
  • Pregnancy: Increased severity, risk to fetus

Modifiable Risk Factors:

  • Unvaccinated: Primary preventable risk factor
  • Vitamin A deficiency: Increases complication risk
  • Malnutrition: Worsens outcomes
  • Crowded living: Facilitates transmission
  • Travel: To endemic areas without immunity

High-Risk Groups:

  • Unvaccinated children: Highest risk
  • Infants: Too young for vaccination, rely on herd immunity
  • Immunocompromised: More severe disease, may not mount adequate immune response to vaccine
  • Healthcare workers: Occupational exposure risk
  • Travelers: To endemic areas

Protective Factors:

  • Vaccination: 97% effective with 2 doses of MMR
  • Prior infection: Lifelong immunity (rare reinfection)
  • Maternal antibodies: Protect infants less than 6 months
  • Herd immunity: 95% vaccination coverage prevents outbreaks
5. Clinical Presentation

Measles follows a characteristic clinical course: incubation, prodrome, rash, and recovery. Recognition of the classic features enables early diagnosis and isolation.

Incubation Period:

Prodromal Phase (2-4 days):

Exanthem Phase:

Koplik Spots:

Recovery Phase:

Atypical Presentations:

Duration
10-14 days (range 7-21 days)
Asymptomatic
No symptoms during this period
Contagious
Not yet contagious
6. Examination

Clinical diagnosis is usually straightforward based on characteristic features. Examination focuses on identifying diagnostic signs and assessing for complications.

General Examination:

  • Vital signs: High fever (39-40°C), tachycardia
  • Appearance: Ill-appearing, miserable child
  • Dehydration: Assess for signs (dry mucosa, reduced urine output)

Head and Neck:

  • Koplik spots: Buccal mucosa, opposite molars (pathognomonic)
  • Conjunctivitis: Bilateral, red, watery, photophobia
  • Coryza: Profuse nasal discharge
  • Pharyngitis: Red throat, may be present

Respiratory:

  • Cough: Dry, persistent, may be severe
  • Respiratory distress: Tachypnea, retractions (pneumonia)
  • Auscultation: Wheeze, crepitations (pneumonia)
  • Oxygen saturation: Check if respiratory symptoms

Dermatological:

  • Rash: Maculopapular, starts behind ears
  • Distribution: Cephalocaudal spread
  • Character: Discrete → confluent
  • Desquamation: Fine scaling as rash fades

Neurological:

  • Mental status: Alert, may be irritable
  • Meningeal signs: If encephalitis suspected
  • Focal deficits: Rare, suggests encephalitis
  • Seizures: May occur with encephalitis

Complications Assessment:

  • Pneumonia: Respiratory distress, crepitations
  • Otitis media: Ear pain, bulging tympanic membrane
  • Encephalitis: Altered mental status, seizures
  • Dehydration: Clinical signs, assess severity
7. Investigations

Diagnosis is usually clinical. Laboratory confirmation is important for public health surveillance and in atypical cases.

Clinical Diagnosis:

  • Usually sufficient: Classic prodrome + rash + Koplik spots
  • Public health: Notifiable disease, report immediately
  • Isolation: Required until 4 days after rash onset

Laboratory Confirmation:

Serology:

  • IgM antibodies: Appear 3-4 days after rash, peak at 7-10 days, detectable for 1-2 months
  • IgG antibodies: Appear 7-10 days after rash, indicate immunity
  • Paired sera: 4-fold rise in IgG confirms diagnosis
  • Timing: IgM most useful in first week of rash

Viral Detection:

  • RT-PCR: Detects viral RNA in throat swab, urine, or blood
  • Most sensitive: In prodrome and early rash phase
  • Useful: For confirmation, especially in vaccinated individuals
  • Specimens: Throat swab, urine, blood

Viral Culture:

  • Less commonly used: Requires specialized facilities
  • Slow: Takes days to weeks
  • Useful: For strain typing in outbreaks

Other Investigations:

  • Complete blood count: Leukopenia common, lymphopenia
  • CXR: If pneumonia suspected
  • Lumbar puncture: If encephalitis suspected
  • Vitamin A: Check levels in malnourished children

Differential Diagnosis Considerations:

ConditionDistinguishing Features
RubellaMilder, no Koplik spots, postauricular lymphadenopathy
RoseolaRash after fever resolves, no prodrome
Scarlet feverSandpaper rash, strawberry tongue, no Koplik spots
Kawasaki diseaseProlonged fever, conjunctivitis, no Koplik spots
Drug eruptionHistory of medication, no prodrome
Enteroviral exanthemNo Koplik spots, milder prodrome
8. Management

Management is primarily supportive. Vitamin A supplementation reduces mortality, especially in malnourished children. Complications require specific treatment.

MEASLES MANAGEMENT ALGORITHM
============================

Patient presents with suspected measles
                |
                v
        Clinical Diagnosis (Prodrome + Rash + Koplik spots)
                |
                +-------------------+-------------------+
                |                   |                   |
        Notify Public Health    Supportive Care      Complication Assessment
        - Immediate reporting  - Fluids              - Respiratory
        - Isolation           - Antipyretics        - Neurological
        - Contact tracing      - Rest               - Dehydration
                              - Nutrition
                              |
                        Vitamin A Supplement
                        - Age 6-11 months: 100,000 IU
                        - Age ≥12 months: 200,000 IU
                        - Repeat next day and 4 weeks later
                        - All children in developing countries
                        - Malnourished children

                    COMPLICATION MANAGEMENT
                        |
                        +-------------------+-------------------+
                        |                   |                   |
                Pneumonia              Encephalitis         Other Complications
                        |                   |                   |
            - Antibiotics          - Supportive care      - Otitis media:
              (bacterial)          - Seizure control        Antibiotics
            - Oxygen if needed     - ICP management       - Dehydration:
            - Supportive care      - Consider acyclovir     IV fluids
            - Monitor closely        (if HSV possible)     - Malnutrition:
                                                             Nutritional support

                    PREVENTION
                        |
                        v
            - MMR vaccination (2 doses)
            - Post-exposure prophylaxis:
              * MMR within 72 hours
              * Immunoglobulin within 6 days
            - Isolation: 4 days after rash onset
            - Contact management

Supportive Care:

General Measures:

  • Isolation: Until 4 days after rash onset (airborne precautions)
  • Rest: Encourage rest during acute phase
  • Fluids: Maintain hydration, oral rehydration if needed
  • Nutrition: Encourage intake, may need nutritional support
  • Antipyretics: Paracetamol/acetaminophen for fever and discomfort

Vitamin A Supplementation:

  • Indication: All children with measles in developing countries, malnourished children
  • Dosing:
    • Age 6-11 months: 100,000 IU orally
    • Age ≥12 months: 200,000 IU orally
    • Repeat: Next day and 4 weeks later if malnourished
  • Benefit: Reduces mortality by 50%, reduces complication rates
  • Mechanism: Supports immune function, epithelial integrity

Complication Management:

Pneumonia:

  • Antibiotics: For bacterial superinfection (amoxicillin, ceftriaxone)
  • Oxygen: If hypoxemic (SpO2 less than 92%)
  • Supportive: Respiratory support as needed
  • Monitoring: Close observation for deterioration

Encephalitis:

  • Supportive care: Maintain airway, breathing, circulation
  • Seizures: Anticonvulsants if needed
  • ICP management: If elevated intracranial pressure
  • Consider: Acyclovir if HSV encephalitis possible (rare)
  • Prognosis: Variable, may have sequelae

Otitis Media:

  • Antibiotics: Amoxicillin or amoxicillin-clavulanate
  • Analgesia: For pain relief
  • Follow-up: Ensure resolution

Dehydration:

  • Oral rehydration: If mild-moderate
  • IV fluids: If severe or unable to take orally
  • Monitor: Fluid balance, electrolytes

Prevention:

Vaccination:

  • MMR vaccine: 2 doses (12-15 months, 4-6 years)
  • Efficacy: 97% with 2 doses
  • Herd immunity: Requires 95% coverage
  • Catch-up: Unvaccinated should receive MMR

Post-Exposure Prophylaxis:

  • MMR vaccine: Within 72 hours of exposure (if unvaccinated)
  • Immunoglobulin: Within 6 days for high-risk (infants, immunocompromised, pregnant)
  • Isolation: Exposed unvaccinated should be isolated
9. Complications

Measles causes significant complications, particularly in malnourished children and immunocompromised individuals. Complications are the main cause of mortality.

Respiratory Complications:

Pneumonia:

  • Incidence: Most common complication (5-10% of cases)
  • Causes: Primary viral or secondary bacterial
  • Mortality: Leading cause of death
  • Risk factors: Malnutrition, young age, immunocompromised
  • Management: Antibiotics for bacterial, supportive care

Laryngotracheobronchitis:

  • Croup-like symptoms: Stridor, barking cough
  • Management: Supportive, may need airway support

Neurological Complications:

Acute Encephalitis:

  • Incidence: 1 in 1000 cases
  • Onset: 2-6 days after rash
  • Presentation: Fever, altered mental status, seizures
  • Mortality: 15-25%
  • Sequelae: 25-35% have permanent neurological damage
  • Management: Supportive, anticonvulsants

Subacute Sclerosing Panencephalitis (SSPE):

  • Incidence: 1 in 10,000-25,000 cases
  • Onset: 7-10 years after measles (mean 7 years)
  • Presentation: Progressive neurological deterioration, myoclonus, dementia
  • Course: Invariably fatal, 1-3 years from onset
  • Risk: Higher if measles less than 2 years of age
  • No effective treatment

Other Neurological:

  • Seizures: Febrile or from encephalitis
  • Transverse myelitis: Rare
  • Guillain-Barré syndrome: Rare association

Other Complications:

Otitis Media:

  • Incidence: 5-15% of cases
  • Management: Antibiotics
  • Sequelae: Rare hearing loss

Diarrhea:

  • Common: Especially in malnourished
  • Management: Oral rehydration, nutritional support

Keratitis:

  • Corneal ulceration: Can cause blindness
  • Risk: Vitamin A deficiency increases risk
  • Management: Vitamin A, ophthalmology referral

Malnutrition:

  • Worsening: Measles causes catabolic state
  • Management: Nutritional support, vitamin A

Immunosuppression:

  • Transient: Lasts weeks to months
  • Risk: Increased susceptibility to other infections
  • Management: Supportive, monitor for secondary infections
10. Prognosis

Prognosis is generally excellent in well-nourished, immunocompetent children with access to care. Complications significantly worsen outcomes.

Uncomplicated Measles:

  • Recovery: Complete in 1-2 weeks
  • Mortality: less than 0.1% in developed countries
  • Sequelae: Rare, usually none
  • Immunity: Lifelong after natural infection

With Complications:

  • Pneumonia: Mortality 5-10% if severe
  • Encephalitis: Mortality 15-25%, 25-35% have sequelae
  • Overall: Case fatality 0.1-0.2% in developed countries

In Resource-Limited Settings:

  • Mortality: 1-5% overall
  • Higher: In malnourished children (up to 10%)
  • Blindness: From keratitis, vitamin A deficiency
  • Long-term: Neurological sequelae from encephalitis

Factors Affecting Prognosis:

  • Nutritional status: Malnutrition worsens outcomes
  • Age: Infants and adults have higher mortality
  • Immunocompetence: Immunocompromised have worse outcomes
  • Access to care: Early treatment improves outcomes
  • Vitamin A: Supplementation reduces mortality
Key Evidence & Guidelines

Major Guidelines:

  • WHO Guidelines (2013): Measles vaccines: WHO position paper
  • CDC Guidelines (2018): Prevention of measles, rubella, congenital rubella syndrome, and mumps
  • NICE Clinical Knowledge Summary: Measles
  • AAP Red Book: Measles prevention and control

Landmark Clinical Trials:

  1. Vitamin A Trials (1987-1992): Vitamin A supplementation in measles

    • Reduces mortality by 50% in developing countries
    • Reduces complication rates
    • Recommended for all children with measles in developing countries
    • PMID: 12292169

  2. MMR Vaccine Efficacy Studies (1970s-1980s): Vaccine development

    • 97% efficacy with 2 doses
    • Long-lasting immunity
    • Safe and effective
    • PMID: Various

  3. Herd Immunity Studies: Population-level protection

    • 95% coverage prevents outbreaks
    • Protects unvaccinated individuals
    • Critical for disease elimination
    • PMID: Various

  4. Post-Exposure Prophylaxis Studies: MMR and immunoglobulin

    • MMR within 72 hours: 90% effective
    • Immunoglobulin within 6 days: Prevents or modifies disease
    • Important for outbreak control
    • PMID: Various

  5. SSPE Studies: Long-term complications

    • Risk: 1 in 10,000-25,000 cases
    • Higher risk if measles less than 2 years
    • No effective treatment
    • PMID: Various

Meta-Analyses:

  • Vitamin A: Systematic review confirms mortality reduction (Huiming, 2005)
  • Vaccine efficacy: High effectiveness confirmed across studies (Demicheli, 2012)
  • Complications: Review of complication rates and risk factors (Perry, 2004)

Systematic Reviews:

  • Measles complications: Comprehensive review (Moss, 2017)
  • Vaccine safety: MMR vaccine safety confirmed (Demicheli, 2012)
  • Treatment: Supportive care and vitamin A (Kabra, 2013)
12. Patient

"What is measles?" Measles is a very contagious viral infection that causes a distinctive rash, high fever, cough, runny nose, and red eyes. It's spread through the air when an infected person coughs or sneezes. While most people recover, it can cause serious complications, especially in young children and those who are malnourished or have weak immune systems.

"How did my child get it?" Measles spreads very easily through the air. If your child was near someone with measles who coughed or sneezed, they could catch it. The virus can stay in the air for up to 2 hours. It's most contagious 4 days before the rash appears until 4 days after. If your child isn't vaccinated, they're at high risk if exposed.

"What symptoms will my child have?" Your child will likely have:

  • High fever (can be very high)
  • Cough, runny nose, and red, watery eyes (the "3 Cs")
  • Small white spots in the mouth (Koplik spots) - these appear before the rash
  • A red, bumpy rash that starts behind the ears and spreads down the body
  • Feeling very unwell and tired

The rash usually appears about 3-5 days after the fever and other symptoms start.

"How is it treated?" There's no specific medicine to cure measles, but treatment helps your child feel better and prevents complications:

  • Rest and plenty of fluids
  • Medicine to reduce fever (like paracetamol)
  • Vitamin A supplements (especially important in some countries)
  • Treatment for any complications that develop

"What about vitamin A?" Vitamin A is very important for children with measles, especially if they're malnourished. It can:

  • Reduce the risk of death by about half
  • Help prevent complications like pneumonia and eye problems
  • Support the immune system

Your doctor will give your child vitamin A supplements if needed.

"What complications should I watch for?" Call your doctor immediately if your child has:

  • Trouble breathing or fast breathing (pneumonia)
  • Severe cough or chest pain
  • Seizures or becomes very sleepy/confused (encephalitis)
  • Severe dehydration (not drinking, no urine)
  • Ear pain (ear infection)
  • Eye problems or vision changes

"How long will it last?" The fever and other symptoms usually last about a week. The rash appears around day 3-5 and lasts about 5-7 days, then fades. Your child should start feeling better as the rash fades. Full recovery usually takes 1-2 weeks.

"Is it dangerous?" In healthy, well-nourished children with good medical care, measles is usually not dangerous and most recover completely. However, it can be serious, especially if:

  • Your child is very young
  • Your child is malnourished
  • Your child has a weak immune system
  • Complications develop

That's why prevention with vaccination is so important.

"Can my other children catch it?" Yes, if they're not vaccinated or haven't had measles before, they're at high risk. Measles is one of the most contagious diseases. If one child has it, others in the household who aren't immune will likely get it too. Make sure all your children are vaccinated.

"How can I prevent it?" The best prevention is vaccination with the MMR (measles, mumps, rubella) vaccine:

  • Two doses are recommended (usually at 12-15 months and 4-6 years)
  • The vaccine is 97% effective with 2 doses
  • It's very safe
  • If your child was exposed and isn't vaccinated, they can get the vaccine within 72 hours to prevent or reduce the illness

"When can my child go back to school?" Your child should stay home and isolated until at least 4 days after the rash appeared. This helps prevent spreading it to others. Make sure they're feeling better and the fever is gone before returning.

"Will my child be immune after this?" Yes, after having measles, your child will have lifelong immunity and won't get it again. However, it's much safer to get immunity through vaccination rather than getting the disease, which can cause serious complications.

13. References

  1. Moss WJ. Measles. Lancet. 2017;390(10111):2490-2502. PMID: 28673424

  2. World Health Organization. Measles vaccines: WHO position paper. Wkly Epidemiol Rec. 2017;92(17):205-227. PMID: 28459148

  3. Kabra SK, Lodha R. Antibiotics for preventing complications in children with measles. Cochrane Database Syst Rev. 2013;(8):CD001477. PMID: 23943263

  4. Hussey G. Preventing measles deaths. Child Health Dialogue. 1996;(3-4):8-9. PMID: 12292169

  5. Perry RT, Halsey NA. The clinical significance of measles: a review. J Infect Dis. 2004;189 Suppl 1:S4-S16. PMID: 15106083

  6. Demicheli V, Rivetti A, Debalini MG, Di Pietrantonj C. Vaccines for measles, mumps and rubella in children. Cochrane Database Syst Rev. 2012;(2):CD004407. PMID: 22336803

  7. Huiming Y, Chaomin W, Meng M. Vitamin A for treating measles in children. Cochrane Database Syst Rev. 2005;(4):CD001479. PMID: 16235283

  8. Strebel PM, Papania MJ, Gastanaduy PA, Goodson JL. Measles vaccines. In: Plotkin SA, Orenstein WA, Offit PA, eds. Vaccines. 7th ed. Philadelphia: Elsevier; 2018:579-618.

  9. Gastañaduy PA, Budd J, Fisher N, et al. A measles outbreak in an underimmunized Amish community in Ohio. N Engl J Med. 2016;375(14):1343-1354. PMID: 27705270

  10. Patel MK, Gacic-Dobo M, Strebel PM, et al. Progress toward regional measles elimination - worldwide, 2000-2016. MMWR Morb Mortal Wkly Rep. 2017;66(42):1148-1153. PMID: 29073125

  11. Durrheim DN, Crowcroft NS, Strebel PM. Measles - The epidemiology of elimination. Vaccine. 2014;32(49):6880-6883. PMID: 25444814

  12. Griffin DE. Measles virus and the nervous system. Handb Clin Neurol. 2014;123:577-590. PMID: 25015500

  13. Bellini WJ, Rota JS, Rota PA. Virology of measles virus. J Infect Dis. 1994;170 Suppl 1:S15-S23. PMID: 7930747

  14. Gershon AA. Measles virus (rubeola). In: Mandell GL, Bennett JE, Dolin R, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 8th ed. Philadelphia: Elsevier; 2015:1967-1973.

  15. American Academy of Pediatrics. Measles. In: Kimberlin DW, Brady MT, Jackson MA, Long SS, eds. Red Book: 2018 Report of the Committee on Infectious Diseases. 31st ed. Elk Grove Village, IL: American Academy of Pediatrics; 2018:537-550.

  16. McLean HQ, Fiebelkorn AP, Temte JL, Wallace GS. Prevention of measles, rubella, congenital rubella syndrome, and mumps, 2013: summary recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2013;62(RR-04):1-34. PMID: 23760231

  17. Gindler J, Tinker S, Markowitz L, et al. Acute measles mortality in the United States, 1987-2002. J Infect Dis. 2004;189 Suppl 1:S69-S77. PMID: 15106091

  18. Orenstein WA, Papania MJ, Wharton ME. Measles elimination in the United States. J Infect Dis. 2004;189 Suppl 1:S1-S3. PMID: 15106082

  19. Strebel PM, Cochi SL, Hoekstra E, et al. A world without measles. J Infect Dis. 2011;204 Suppl 1:S1-S3. PMID: 21666185

  20. World Health Organization. Global measles and rubella strategic plan: 2012-2020. Geneva: WHO; 2012. Available at: https://www.who.int/immunization/documents/control/ISBN_978_92_4_150339_6/en/

Last updated: 2025-12-24

At a Glance

EvidenceHigh
Last Updated2025-12-24

Red Flags

  • Pneumonia
  • Encephalitis
  • SSPE (late)
  • Severe dehydration

Guidelines

  • NICE Guidelines
  • BTS Guidelines
  • RCUK Guidelines