Last Updated: 2023-07-07

Author(s): Anzengruber F., Navarini A.

ICD11: 1F03

Morbilli, 1. infectious disease.

  • Highly contagious infectious disease caused by measles viruses
  • The measles virus is an RNA virus approximately 140 nm in size, which belongs to the group of paramyxoviruses

  • Mostly occurring in winter and spring
  • In 1964, the introduction of live measles vaccination led to a significant decrease in incidence
  • Most affected are children, adolescents and young adults
  • Worldwide 158000 deaths per year
  • Europe-wide there is 1 death per 3000 reported cases
  • The measles virus has been eliminated in Scandinavia, Australia and in North and South America

  • Transmission: droplet infection (speaking, coughing, sneezing)
  • The risk of infection is mostly in the catarrhal stage or the early exanthema stage
  • Incubation period: 10-14 days
  • In the keratinocytes and in the upper dermis, there is the formation of giant cells, the Warthin-Finkeldey cells
  • as a result of virus replication

  • 4 days after incubation period appearance of exanthema

  • Catarrhal prodromal stage:
    • Reduced general condition, fever (up to 40°C), pharyngitis, tracheitis, dry cough, rhinitis, conjunctivitis and photophobia
    • After 2-3 days, punctate white mucosal lesions (Koplik's spots) appear enorally in the region of the molars for 48 hours, which cannot be scraped off

  • Enanthema: From the 3rd day, there are red spots in the area of the oral mucosa with a simultaneous drop in fever

  • Exanthematic stage:
    • Starting retroauricularly, spreading over neck and trunk, morbilliform, erythematous, partly confluent patches finally pass to extremities
    • Simultaneously, the fever begins to rise again, after 3-4 days the body temperature is regressive
    • Foudroyant, sometimes lethal cases occur, especially in adults who have not been vaccinated. These are characterised by somnolence, bloody stools, hyperpyrexia, convulsions and circulatory disorders

  • clinic
  • BB (leukopenia)
  • PCR from body fluids
  • When neurological symptoms are present, a neurological consult is essential
  • Liquor puncture in case of neurological abnormalities. Note: In acute sclerosing panencephlitis with poor prognosis, very high IgG titres are found in the CSF
  • To perform a chest X-ray in case of pulmonary symptoms (streaky drawing)
  • IgM antibodies can be detected by ELISA from day 3 of the exanthema stage. If there is a 4-fold increase (2 levels) in the titer after 2 weeks, measles infection can be assumed

  • Bronchopneumonia (approx. 4-5%)
  • Otitis media (approx. 4-5%)
  • Measles croup
  • Lupus vulgaris (cutaneous spread of tubercle bacilli)
  • Masencephalitis (1:100,000)
  • Subacute sclerosing panencephalitis (SSPE)

After a measles infection has already been passed, there is lifelong immunity.

  1. Cutts FT, Henao-Restrepo AM, Olivé JM. Measles elimination: progress and challenges. Vaccine 1999;17:S47-S52.
  2. Davidkin I, Valle M, Peltola H, et al. Etiology of Measles‐ and Rubella‐like Illnesses in Measles, Mumps, and Rubella–Vaccinated Children. The Journal of Infectious Diseases 1998;178:1567-70.
  3. Velangi, Tidman. Gianotti-Crosti syndrome after measles, mumps and rubella vaccination. British Journal of Dermatology 1998;139:1122-3.
  4. Bundesamt für Gesundheit - Masern. (2016). Retrieved 10 May 2016, from