Measles complications span respiratory, gastrointestinal, neurological, and systemic domains, with severity varying by age and immune status.
Common Complications
Respiratory and Ear Infections:
Otitis media is the most frequent complication, affecting 1 in 10 children with measles.1 2 3 Bronchopneumonia occurs in 1 in 20 cases and is the leading cause of measles-related death globally.1 2 3 4 5 Laryngotracheobronchitis (croup) affects up to 20% of patients.2
Gastrointestinal:
Diarrhea occurs in approximately 1 in 10 cases and can lead to dehydration, particularly in young children.2 3
Serious Neurological Complications
Acute Encephalitis:
Occurs in approximately 1 in 1,000 measles cases, typically during the exanthem period.1 2 3 It can result in permanent neurologic sequelae including seizures, deafness, and intellectual disability.1 3
Acute Disseminated Encephalomyelitis (ADEM):
Develops in roughly 1 in 1,000 cases within 2 weeks of the viral rash.1 Symptoms range from headache and confusion to severe manifestations including quadriplegia, bladder and bowel incontinence, and altered mental status.1 Diagnosis involves CSF analysis showing lymphocytic pleocytosis and elevated protein, with MRI revealing bilateral asymmetric white matter lesions.1
Subacute Sclerosing Panencephalitis (SSPE):
A rare but devastating progressive degenerative disease caused by persistent infection with a mutated measles virus strain.1 6 7 Symptoms typically emerge 7–10 years after primary infection (3–5 years if infection occurred before age 2).6 7 Clinical features include personality or behavior changes, poor school performance, intellectual deterioration, progressive motor decline, autonomic dysfunction, and focal paralysis.1 SSPE occurs in approximately 1 in 10,000 measles cases overall, but rises to 1 in 600 cases among children infected before age 2 years.6 7
Measles Inclusion Body Encephalitis:
Occurs in immunocompromised patients, presenting within 1 year of infection with progressive neurologic dysfunction over weeks to months.3
High-Risk Populations
Complications occur more frequently in children younger than 5 years, adults older than 20 years, pregnant individuals, and immunocompromised persons.1 3 6 Among unvaccinated individuals in the United States, 1 in 5 with measles are hospitalized for complications.1 3
Pregnancy and Neonatal Outcomes:
Measles during pregnancy carries substantial risk. In a retrospective study of 55 pregnant individuals in Namibia (2009–2010), 29% had preterm deliveries, 19% of neonates required intensive care, and 50% of neonates died by age 28 days.1 Other risks include intrauterine fetal death, spontaneous abortion, and congenital measles infection in neonates born within 10 days of maternal rash onset.1
Additional Sequelae
Measles can cause prolonged immunosuppression lasting years, resulting in “immune amnesia”—loss of immune memory—that increases susceptibility to other infections and elevates all-cause childhood mortality in affected communities.2 8
Laboratory abnormalities commonly occur in hospitalized patients, including leukopenia (36%), hyponatremia (14%), thrombocytopenia (9%), pancytopenia (3%), and hypocalcemia (2%).2
Mortality varies globally depending on nutritional status and access to healthcare; in 2018, more than 140,000 children died of measles worldwide, predominantly those younger than 5 years, with pneumonia as the leading cause.4 5
The above is a quote from Healio
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