Measles

Measles
Measles is a highly cont agious infect ious disease caused by measles virus.[11][3][12] Sympt oms
usually develop 10–12 days aft er exposure t o an infect ed person and last 7–10 days.[7][8] Init ial
sympt oms t ypically include fever, oft en great er t han 40 °C (104 °F), cough, runny nose, and
inflamed eyes.[3][4] Small whit e spot s known as Koplik's spot s may form inside t he mout h t wo or
t hree days aft er t he st art of sympt oms.[4] A red, flat rash which usually st art s on t he face and
t hen spreads t o t he rest of t he body t ypically begins t hree t o five days aft er t he st art of
sympt oms.[4] Common complicat ions include diarrhea (in 8% of cases), middle ear infect ion (7%),
and pneumonia (6%).[5] These occur in part due t o measles-induced immunosuppression.[6] Less
commonly seizures, blindness, or inflammat ion of t he brain may occur.[5][7] Ot her names include
morbilli, rubeola, red measles, and English measles.[1][2] Bot h rubella, also known as German
measles, and roseola are different diseases caused by unrelat ed viruses.[13]
Measles
Other names Morbilli, rubeola, red measles, English

measles [1][2]
A child showing a day-four measles rash

Specialty Infectious disease
Symptoms Fever, cough, runny nose, inflamed eyes, rash[3][4]
Complications Pneumonia, seizures, encephalitis, subacute

sclerosing panencephalitis, immunosuppression,
hearing loss, blindness [5][6]
Usual onset 10–12 days after exposure[7][8]
Duration 7–10 days [7][8]
Causes Measles virus [3]
Prevention Measles vaccine[7]
Treatment Supportive care[7]
Frequency 20 million per year[3]
Deaths 140,000+ (2018)[9][10]
Measles is an airborne disease which spreads easily from one person t o t he next t hrough t he
coughs and sneezes of infect ed people.[7] It may also be spread t hrough direct cont act wit h
mout h or nasal secret ions.[14] It is ext remely cont agious: nine out of t en people who are not
immune and share living space wit h an infect ed person will be infect ed.[5] Furt hermore, measles's
reproduct ive number est imat es vary beyond t he frequent ly cit ed range of 12 t o 18.[15] The NIH
quot e t his 2017 paper saying: "[a] review in 2017 ident ified feasible measles R0 values of 3.7–
203.3".[16] People are infect ious t o ot hers from four days before t o four days aft er t he st art of
t he rash.[5] While oft en regarded as a childhood illness, it can affect people of any age.[17] Most
people do not get t he disease more t han once.[7] Test ing for t he measles virus in suspect ed
cases is import ant for public healt h effort s.[5] Measles is not known t o occur in ot her animals.[14]
Once a person has become infect ed, no specific t reat ment is available,[14] alt hough support ive
care may improve out comes.[7] Such care may include oral rehydrat ion solut ion (slight ly sweet
and salt y fluids), healt hy food, and medicat ions t o cont rol t he fever.[7][8] Ant ibiot ics should be
prescribed if secondary bact erial infect ions such as ear infect ions or pneumonia occur.[7][14]
Vit amin A supplement at ion is also recommended for children.[14] Among cases report ed in t he
U.S. bet ween 1985 and 1992, deat h occurred in only 0.2% of cases,[5] but may be up t o 10% in
people wit h malnut rit ion.[7] Most of t hose who die from t he infect ion are less t han five years
old.[14]
The measles vaccine is effect ive at prevent ing t he disease, is except ionally safe, and is oft en
delivered in combinat ion wit h ot her vaccines.[7][18] Vaccinat ion result ed in an 80% decrease in
deat hs from measles bet ween 2000 and 2017, wit h about 85% of children worldwide having
received t heir first dose as of 2017.[14]
Measles affect s about 20 million people a year,[3]
primarily in t he developing areas of Africa and Asia.[7] It is one of t he leading vaccine-prevent able
disease causes of deat h.[19][20] In 1980, 2.6 million people died of it ,[7] and in 1990, 545,000 died;
by 2014, global vaccinat ion programs had reduced t he number of deat hs from measles t o
73,000.[21][22] Despit e t hese t rends, rat es of disease and deat hs increased from 2017 t o 2019
due t o a decrease in immunizat ion.[23][24][25]
Play media
Video summary (script)
Signs and symptoms

Maculopapular rash on the abdomen after 3 days of measles infection
Sympt oms t ypically begin 10–14 days aft er exposure.[26][27] The classic sympt oms include a
four-day fever (t he 4 D's) and t he t hree C's—cough, coryza (head cold, fever, sneezing), and
conjunct ivit is (red eyes)—along wit h a maculopapular rash.[28] Fever is common and t ypically last s
for about one week; t he fever seen wit h measles is oft en as high as 40 °C (104 °F).[29]
Koplik's spot s seen inside t he mout h are diagnost ic for measles, but are t emporary and t herefore
rarely seen.[28] Koplik spot s are small whit e spot s t hat are commonly seen on t he inside of t he
cheeks opposit e t he molars.[27] They appear as "grains of salt on a reddish background."[30]
Recognizing t hese spot s before a person reaches t heir maximum infect iousness can help reduce
t he spread of t he disease.[31]
The charact erist ic measles rash is classically described as a generalized red maculopapular rash
t hat begins several days aft er t he fever st art s. It st art s on t he back of t he ears and, aft er a few
hours, spreads t o t he head and neck before spreading t o cover most of t he body, oft en causing
it ching. The measles rash appears t wo t o four days aft er t he init ial sympt oms and last s for up t o
eight days. The rash is said t o "st ain", changing color from red t o dark brown, before
disappearing.[32] Overall, measles usually resolves aft er about t hree weeks.[29]
People who have been vaccinat ed against measles but have incomplet e prot ect ive immunit y
may experience a form of modified measles.[33] Modified measles is charact erized by a
prolonged incubat ion period, milder, and less charact erist ic sympt oms (sparse and discret e rash
of short durat ion).[33]
A Filipino baby with measles
Koplik's spots on the third pre- eruptive day

Koplik's spots on the day of measles rash.
Complications
Complicat ions of measles are relat ively common, ranging from mild ones such as diarrhea t o
serious ones such as pneumonia (eit her direct viral pneumonia or secondary bact erial pneumonia),
laryngot racheobronchit is (croup) (eit her direct viral laryngot racheobronchit is or secondary
bact erial bronchit is), ot it is media,[34] acut e brain inflammat ion[35] (and very rarely subacut e
sclerosing panencephalit is),[36] and corneal ulcerat ion (leading t o corneal scarring).[37]
In addit ion, measles can suppress t he immune syst em for weeks t o mont hs, and t his can
cont ribut e t o bact erial superinfect ions such as ot it is media and bact erial
pneumonia.[6][38][39][40][41] Two mont hs aft er recovery t here is a 11–73% decrease in t he number
of ant ibodies against ot her bact eria and viruses.[42]
The deat h rat e in t he 1920s was around 30% for measles pneumonia.[43] People who are at high
risk for complicat ions are infant s and children aged less t han 5 years;[17] adult s aged over 20
years;[17] pregnant women;[17] people wit h compromised immune syst ems, such as from leukemia,
HIV infect ion or innat e immunodeficiency;[17][44] and t hose who are malnourished[17] or have
vit amin A deficiency.[17][45] Complicat ions are usually more severe in adult s.[46] Bet ween 1987 and
2000, t he case fat alit y rat e across t he Unit ed St at es was t hree deat hs per 1,000 cases
at t ribut able t o measles, or 0.3%.[47] In underdeveloped nat ions wit h high rat es of malnut rit ion and
poor healt hcare, fat alit y rat es have been as high as 28%.[47] In immunocompromised persons (e.g.,
people wit h AIDS) t he fat alit y rat e is approximat ely 30%.[48]
Even in previously healt hy children, measles can cause serious illness requiring hospit alizat ion.[44]
One out of every 1,000 measles cases progresses t o acut e encephalit is, which oft en result s in
permanent brain damage.[44] One t o t hree out of every 1,000 children who become infect ed wit h
measles will die from respirat ory and neurological complicat ions.[44]
Cause
An electron micrograph of the measles virus
Measles is caused by t he measles virus, a single-st randed, negat ive-sense, enveloped RNA virus
of t he genus Morbillivirus wit hin t he family Paramyxoviridae.[49]
The virus is highly cont agious and is spread by coughing and sneezing via close personal cont act
or direct cont act wit h secret ions.[50] Measles is t he most cont agious t ransmissible virus
known.[18] It remains infect ive for up t o t wo hours in t hat airspace or nearby surfaces.[26][50]
Measles is so cont agious t hat if one person has it , 90% of non-immune people who have close
cont act wit h t hem (e.g., household members) will also become infect ed.[26][51] Humans are t he
only nat ural host s of t he virus, and no ot her animal reservoirs are known t o exist , alt hough
mount ain gorillas are believed t o be suscept ible t o t he disease.[26][52]
Risk fact ors for measles
virus infect ion include immunodeficiency caused by HIV or AIDS,[53] immunosuppression following
receipt of an organ or a st em cell t ransplant ,[54] alkylat ing agent s, or cort icost eroid t herapy,
regardless of immunizat ion st at us;[17] t ravel t o areas where measles commonly occurs or
cont act wit h t ravelers from such an area;[17] and t he loss of passive, inherit ed ant ibodies before
t he age of rout ine immunizat ion.[55]
Pathophysiology
Drawing of the measles virus attaching to the lining of the trachea
Once t he measles virus get s ont o t he mucosa, it infect s t he epit helial cells in t he t rachea or
bronchi.[56][57] Measles virus uses a prot ein on it s surface called hemagglut inin (H prot ein), t o bind
t o a t arget recept or on t he host cell, which could be CD46, which is expressed on all nucleat ed
human cells, CD150, aka signaling lymphocyt e act ivat ion molecule or SLAM, which is found on
immune cells like B or T cells, and ant igen-present ing cells, or nect in-4, a cellular adhesion
molecule.[56][58] Once bound, t he fusion, or F prot ein helps t he virus fuse wit h t he membrane and
ult imat ely get inside t he cell.[56]
As t he virus is a single-st randed negat ive-sense RNA virus, it includes t he enzyme RNA-
dependent RNA polymerase (RdRp) which is used t o t ranscribe it s genome int o a posit ive-sense
mRNA st rand.[56]
Aft er ent ering a cell, it is ready t o be t ranslat ed int o viral prot eins, wrapped in t he cell's lipid
envelope, and sent out of t he cell as a newly made virus.[59] Wit hin days, t he measles virus
spreads t hrough local t issue and is picked up by dendrit ic cells and alveolar macrophages, and
carried from t hat local t issue in t he lungs t o t he local lymph nodes.[56][57] From t here it cont inues
t o spread, event ually get t ing int o t he blood and spreading t o more lung t issue, as well as ot her
organs like t he int est ines and t he brain.[26][56] Funct ional impairment of t he infect ed dendrit ic
cells by t he measles virus is t hought t o cont ribut e t o measles-induced immunosuppression.[6]
Diagnosis
Typically, clinical diagnosis begins wit h t he onset of fever and malaise about 10 days aft er
exposure t o t he measles virus, followed by t he emergence of cough, coryza, and conjunct ivit is
t hat worsen in severit y over 4 days of appearing.[60] Observat ion of Koplik's spot s is also
diagnost ic.[31] Ot her possible condit ion t hat can result in t hese sympt oms include parvovirus,
dengue fever, Kawasaki disease, and scarlet fever.[61] Laborat ory confirmat ion is however
st rongly recommended.[62]
Laboratory testing
Laborat ory diagnosis of measles can be done wit h confirmat ion of posit ive measles IgM
ant ibodies or det ect ion of measles virus RNA from t hroat , nasal or urine specimen by using t he
reverse t ranscript ion polymerase chain react ion assay.[61][63] This met hod is part icularly useful t o
confirm cases when t he IgM ant ibodies result s are inconclusive.[61] For people unable t o have
t heir blood drawn, saliva can be collect ed for salivary measles-specific IgA t est ing.[63] Salivary
t est s used t o diagnose measles involve collect ing a saliva sample and t est ing for t he presence
of measles ant ibodies.[64][65] This met hod is not ideal, as saliva cont ains many ot her fluids and
prot eins which may make it difficult t o collect samples and det ect measles ant ibodies.[64][65]
Saliva also cont ains 800 t imes fewer ant ibodies t han blood samples do, which makes salivary
t est ing addit ionally difficult . Posit ive cont act wit h ot her people known t o have measles adds
evidence t o t he diagnosis.[64]
Prevention
Rates of measles vaccination worldwide
Mot hers who are immune t o measles pass ant ibodies t o t heir children while t hey are st ill in t he
womb, especially if t he mot her acquired immunit y t hrough infect ion rat her t han vaccinat ion.[26][55]
Such ant ibodies will usually give newborn infant s some immunit y against measles, but t hese
ant ibodies are gradually lost over t he course of t he first nine mont hs of life.[27][55] Infant s under
one year of age whose mat ernal ant i-measles ant ibodies have disappeared become suscept ible
t o infect ion wit h t he measles virus.[55]
In developed count ries, it is recommended t hat children be immunized against measles at 12

mont hs, generally as part of a t hree-part MMR vaccine (measles, mumps, and rubella). The
vaccine is generally not given before t his age because such infant s respond inadequat ely t o t he
vaccine due t o an immat ure immune syst em.[55] A second dose of t he vaccine is usually given t o
children bet ween t he ages of four and five, t o increase rat es of immunit y. Measles vaccines have
been given t o over a billion people.[18] Vaccinat ion rat es have been high enough t o make measles
relat ively uncommon. Adverse react ions t o vaccinat ion are rare, wit h fever and pain at t he
inject ion sit e being t he most common. Life-t hreat ening adverse react ions occur in less t han one
per million vaccinat ions (<0.0001%).[66]
In developing count ries where measles is common, t he World Healt h Organizat ion (WHO)
recommends t wo doses of vaccine be given, at six and nine mont hs of age. The vaccine should
be given whet her t he child is HIV-infect ed or not .[67] The vaccine is less effect ive in HIV-
infect ed infant s t han in t he general populat ion, but early t reat ment wit h ant iret roviral drugs can
increase it s effect iveness.[68] Measles vaccinat ion programs are oft en used t o deliver ot her child
healt h int ervent ions as well, such as bed net s t o prot ect against malaria, ant iparasit e medicine
and vit amin A supplement s, and so cont ribut e t o t he reduct ion of child deat hs from ot her
causes.[69]
The Advisory Commit t ee on Immunizat ion Pract ices (ACIP) recommends t hat all adult
int ernat ional t ravelers who do not have posit ive evidence of previous measles immunit y receive
t wo doses of MMR vaccine before t raveling, alt hough birt h before 1957 is presumpt ive evidence
of immunit y.[70] Those born in t he Unit ed St at es before 1957 are likely t o have been nat urally
infect ed wit h measles virus and generally need not be considered suscept ible.[71][26]
There have been false claims of an associat ion bet ween t he measles vaccine and aut ism; t his
incorrect concern has reduced t he rat e of vaccinat ion and increased t he number of cases of
measles where immunizat ion rat es became t oo low t o maint ain herd immunit y.[17] Addit ionally,
t here have been false claims t hat measles infect ion prot ect s against cancer.[18]
Administ rat ion of t he MMR vaccine may prevent measles aft er exposure t o t he virus (post -
exposure prophylaxis).[72] Post -exposure prophylaxis guidelines are specific t o jurisdict ion and
populat ion.[72] Passive immunizat ion against measles by an int ramuscular inject ion of ant ibodies
could be effect ive up t o t he sevent h day aft er exposure.[73] Compared t o no t reat ment , t he risk
of measles infect ion is reduced by 83%, and t he risk of deat h by measles is reduced by 76%.[73]
However, t he effect iveness of passive immunizat ion in comparison t o act ive measles vaccine is
not clear.[73]
The MMR vaccine is 95% effect ive for prevent ing measles aft er one dose if t he vaccine is given
t o a child who is 12 mont hs or older; if a second dose of t he MMR vaccine is given, it will provide
immunit y in 99% of children.[74]
There is no evidence t hat t he measles vaccine virus can be t ransmit t ed t o ot her persons.[75]
Treatment
There is no specific ant iviral t reat ment if measles develops.[50] Inst ead t he medicat ions are
generally aimed at t reat ing superinfect ions, maint aining good hydrat ion wit h adequat e fluids, and
pain relief.[50] Some groups, like young children and t he severely malnourished, are also given
vit amin A, which act as an immunomodulat or t hat boost s t he ant ibody responses t o measles and
decreases t he risk of serious complicat ions.[50][76][77]
Medications
Treat ment is support ive, wit h ibuprofen or paracet amol (acet aminophen) t o reduce fever and
pain and, if required, a fast -act ing medicat ion t o dilat e t he airways for cough.[78] As for aspirin,
some research has suggest ed a correlat ion bet ween children who t ake aspirin and t he
development of Reye syndrome.[79][80]
The use of vit amin A during t reat ment is recommended t o decrease t he risk of blindness;[77]
however, it does not prevent or cure t he disease.[81] A syst emat ic review of t rials int o it s use
found no reduct ion in overall mort alit y, but t wo doses (200 000 IU) of vit amin A was shown t o
reduce mort alit y for measles in children younger t han t wo years of age.[76][82] It is unclear if zinc
supplement at ion in children wit h measles affect s out comes as it has not been sufficient ly
st udied.[83] There are no adequat e st udies on whet her Chinese medicinal herbs are effect ive.[84]
Prognosis
Most people survive measles, t hough in some cases, complicat ions may occur. About 1 in 4
individuals will be hospit alized and 1–2 in 1000 will die. Complicat ions are more likely in children
under age 5 and adult s over age 20.[85] Pneumonia is t he most common fat al complicat ion of
measles infect ion and account s for 56-86% of measles-relat ed deat hs.[86]
Possible consequences of measles virus infect ion include laryngot racheobronchit is,
sensorineural hearing loss,[49] and—in about 1 in 10,000 t o 1 in 300,000 cases[87]—panencephalit is,
which is usually fat al.[88] Acut e measles encephalit is is anot her serious risk of measles virus
infect ion. It t ypically occurs t wo days t o one week aft er t he measles rash breaks out and begins
wit h very high fever, severe headache, convulsions and alt ered ment at ion. A person wit h measles
encephalit is may become comat ose, and deat h or brain injury may occur.[89]
For people having had measles, it is rare t o ever have a sympt omat ic reinfect ion.[90]
The measles virus can deplet e previously acquired immune memory by killing cells t hat make
ant ibodies, and t hus weakens t he immune syst em which can cause deat hs from ot her
diseases.[40][41][42] Suppression of t he immune syst em by measles last s about t wo years and has
been epidemiologically implicat ed in up t o 90% of childhood deat hs in t hird world count ries, and
hist orically may have caused rat her more deat hs in t he Unit ed St at es, t he UK and Denmark t han
were direct ly caused by measles.[91] Alt hough t he measles vaccine cont ains an at t enuat ed
st rain, it does not deplet e immune memory.[41]
Epidemiology
Deaths from measles per million persons in 2012
0
1–8
9–26
27–38
39–73
74–850
Disability-adjusted life year for measles per 100,000 inhabitants in 2004

no data
≤ 10
10–25
25–50
50–75
75–100
100–250
250–500
500–750
750–1000
1000–1500
1500–2000
≥ 2000
Measles is ext remely infect ious and it s cont inued circulat ion in a communit y depends on t he
generat ion of suscept ible host s by birt h of children. In communit ies t hat generat e insufficient
new host s t he disease will die out . This concept was first recognized in measles by Bart let t in
1957, who referred t o t he minimum number support ing measles as t he crit ical communit y size
(CCS).[92] Analysis of out breaks in island communit ies suggest ed t hat t he CCS for measles is
around 250,000.[93] To achieve herd immunit y, more t han 95% of t he communit y must be
vaccinat ed due t o t he ease wit h which measles is t ransmit t ed from person t o person.[29]
In 2011, t he WHO est imat ed t hat 158,000 deat hs were caused by measles. This is down from
630,000 deat hs in 1990.[94] As of 2018, measles remains a leading cause of vaccine-prevent able
deat hs in t he world.[19][95] In developed count ries t he mort alit y rat e is lower, for example in
England and Wales from 2007 t o 2017 deat h occurred bet ween t wo and t hree cases out of
10,000.[96] In children one t o t hree cases out of every 1,000 die in t he Unit ed St at es (0.1–
0.2%).[97] In populat ions wit h high levels of malnut rit ion and a lack of adequat e healt hcare,
mort alit y can be as high as 10%.[7][98] In cases wit h complicat ions, t he rat e may rise t o 20–30%.
In 2012, t he number of deat hs due t o measles was 78% lower t han in 2000 due t o increased
rat es of immunizat ion among UN member st at es.[29]
Reported cases [99][100][101][102][103][104][105]

WHO-Region 1980 1990 2000 2005 2014
African Region 1,240,993 481,204 520,102 316,224 71,574
Region of the Americas 257,790 218,579 1,755 66 19,898
Eastern Mediterranean Region 341,624 59,058 38,592 15,069 28,031
European Region 851,849 234,827 37,421 37,332 16,899
South-East Asia Region 199,535 224,925 61,975 83,627 112,418
Western Pacific Region 1,319,640 155,490 176,493 128,016 213,366
Worldwide 4,211,431 1,374,083 836,338 580,287 462,186
Even in count ries where vaccinat ion has been int roduced, rat es may remain high. Measles is a
leading cause of vaccine-prevent able childhood mort alit y. Worldwide, t he fat alit y rat e has been
significant ly reduced by a vaccinat ion campaign led by part ners in t he Measles Init iat ive: t he
American Red Cross, t he Unit ed St at es CDC, t he Unit ed Nat ions Foundat ion, UNICEF and t he
WHO. Globally, measles fell 60% from an est imat ed 873,000 deat hs in 1999 t o 345,000 in
2005.[106] Est imat es for 2008 indicat e deat hs fell furt her t o 164,000 globally, wit h 77% of t he
remaining measles deat hs in 2008 occurring wit hin t he Sout heast Asian region.[107] There were
142,300 measles relat ed deat hs globally in 2018, of which most cases were report ed from
African and east ern Medit erranean regions. These est imat es were slight ly higher t han t hat of
2017, when 124,000 deat hs were report ed due t o measles infect ion globally.[108]
In 2000, t he WHO est ablished t he Global Measles and Rubella Laborat ory Net work (GMRLN) t o
provide laborat ory surveillance for measles, rubella, and congenit al rubella syndrome.[109] Dat a
from 2016 t o 2018 show t hat t he most frequent ly det ect ed measles virus genot ypes are
decreasing, suggest ing t hat increasing global populat ion immunit y has decreased t he number of
chains of t ransmission.[109]
Cases report ed in t he first t hree mont hs of 2019, were 300% higher t han in t he first t hree
mont hs of 2018, wit h out breaks in every region of t he world, even in count ries wit h high overall
vaccinat ion coverage where it spread among clust ers of unvaccinat ed people.[110] The numbers
of report ed cases as of mid-November is over 413,000 globally, wit h an addit ional 250,000 cases
in DRC (as report ed t hrough t heir nat ional syst em), similar t o t he increasing t rends of infect ion
report ed in t he earlier mont hs of 2019, compared t o 2018.[108] In 2019, t he t ot al number of
cases worldwide climbed t o 869,770. The number of cases report ed for 2020 is lower compare
t o 2019.[111] It has been suggest ed t hat t he COVID-19 pandemic has affect ed vaccinat ion
campaigns around t he world, including in count ries current ly experiencing out breaks, which could
affect t he number of cases in t he fut ure.[111]
Europe
Incidence of and deaths due to measles in England and Wales between 1940 and 2017
In England and Wales, t hough deat hs from measles were uncommon, t hey averaged about 500
per year in t he 1940s. Deat hs diminished wit h t he improvement of medical care in t he 1950s but
t he incidence of t he disease did not ret reat unt il vaccinat ion was int roduced in t he lat e 1960s.
Wider coverage was achieved in t he 1980s wit h t he measles, mumps and rubella, MMR
vaccine.[112]
In 2013–14, t here were almost 10,000 cases in 30 European count ries. Most cases occurred in
unvaccinat ed individuals and over 90% of cases occurred in Germany, It aly, Net herlands, Romania,
and Unit ed Kingdom.[29] Bet ween Oct ober 2014 and March 2015, a measles out break in t he
German capit al of Berlin result ed in at least 782 cases.[113] In 2017, numbers cont inued t o
increase in Europe t o 21,315 cases, wit h 35 deat hs.[114] In preliminary figures for 2018, report ed
cases in t he region increased 3-fold t o 82,596 in 47 count ries, wit h 72 deat hs; Ukraine had t he
most cases (53,218), wit h t he highest incidence rat es being in Ukraine (1209 cases per million),
Serbia (579), Georgia (564) and Albania (500).[115][116] The previous year (2017) saw an est imat ed
measles vaccine coverage of 95% for t he first dose and 90% for t he second dose in t he region,
t he lat t er figure being t he highest -ever est imat ed second-dose coverage.[116]
In 2019, t he Unit ed Kingdom, Albania, t he Czech Republic, and Greece lost t heir measles-free
st at us due t o ongoing and prolonged spread of t he disease in t hese count ries.[117] In t he first 6
mont hs of 2019, 90,000 cases occurred in Europe.[117]
Americas
As a result of widespread vaccinat ion, t he disease was declared eliminat ed from t he Americas in
2016.[118] However, t here were cases again in 2017,[119] 2018, 2019,[120] and 2020[121] in t his
region.
United States
Measles cases in the US from 1938 to 2019
In t he Unit ed St at es, measles affect ed approximat ely 3,000 people per million in t he 1960s
before t he vaccine was available. Wit h consist ent widespread childhood vaccinat ion, t his figure
fell t o 13 cases per million by t he 1980s, and t o about 1 case per million by t he year 2000.[122]
In 1991, an out break of measles in Philadelphia was cent ered at t he Fait h Tabernacle
Congregat ion, a fait h healing church t hat act ively discouraged parishioners from vaccinat ing t heir
children. Over 1400 people were infect ed wit h measles and nine children died.[123]
Before immunizat ion in t he Unit ed St at es, bet ween t hree and four million cases occurred each
year.[5] The Unit ed St at es was declared free of circulat ing measles in 2000, wit h 911 cases from
2001 t o 2011. In 2014 t he CDC said endemic measles, rubella, and congenit al rubella syndrome
had not ret urned t o t he Unit ed St at es.[124] Occasional measles out breaks persist , however,
because of cases import ed from abroad, of which more t han half are t he result of unvaccinat ed
U.S. resident s who are infect ed abroad and infect ot hers upon ret urn t o t he Unit ed St at es.[124]
The CDC cont inues t o recommend measles vaccinat ion t hroughout t he populat ion t o prevent
out breaks like t hese.[125]
In 2014, an out break was init iat ed in Ohio when t wo unvaccinat ed Amish men harboring
asympt omat ic measles ret urned t o t he Unit ed St at es from missionary work in t he
Philippines.[126] Their ret urn t o a communit y wit h low vaccinat ion rat es led t o an out break t hat
rose t o include a t ot al of 383 cases across nine count ies.[126] Of t he 383 cases, 340 (89%)
occurred in unvaccinat ed individuals.[126]
From 4 January, t o 2 April 2015, t here were 159 cases of measles report ed t o t he CDC. Of t hose
159 cases, 111 (70%) were det ermined t o have come from an earlier exposure in lat e December
2014. This out break was believed t o have originat ed from t he Disneyland t heme park in California.
The Disneyland out break was held responsible for t he infect ion of 147 people in seven U.S.
st at es as well as Mexico and Canada, t he majorit y of which were eit her unvaccinat ed or had
unknown vaccinat ion st at us.[127] Of t he cases 48% were unvaccinat ed and 38% were unsure of
t heir vaccinat ion st at us.[128] The init ial exposure t o t he virus was never ident ified.
In 2015, a U.S. woman in Washingt on st at e died of pneumonia, as a result of measles. She was
t he first fat alit y in t he U.S. from measles since 2003.[129] The woman had been vaccinat ed for
measles and was t aking immunosuppressive drugs for anot her condit ion. The drugs suppressed
t he woman's immunit y t o measles, and t he woman became infect ed wit h measles; she did not
develop a rash, but cont ract ed pneumonia, which caused her deat h.[130][131]
In June 2017, t he Maine Healt h and Environment al Test ing Laborat ory confirmed a case of
measles in Franklin Count y. This inst ance marks t he first case of measles in 20 years for t he
st at e of Maine.[132] In 2018 one case occurred in Port land, Oregon, wit h 500 people exposed; 40
of t hem lacked immunit y t o t he virus and were being monit ored by count y healt h officials as of 2
July 2018.[133] There were 273 cases of measles report ed t hroughout t he Unit ed St at es in
2018,[134] including an out break in Brooklyn wit h more t han 200 report ed cases from Oct ober
2018 t o February 2019. The out break was t ied wit h populat ion densit y of t he Ort hodox Jewish
communit y, wit h t he init ial exposure from an unvaccinat ed child t hat caught measles while
visit ing Israel.[135][136]
A resurgence of measles occurred during 2019, which has been generally t ied t o parent s
choosing not t o have t heir children vaccinat ed as most of t he report ed cases have occurred in
people 19 years old or younger.[137][138][139][140][141] Cases were first report ed in Washingt on st at e
in January, wit h an out break of at least 58 confirmed cases most wit hin Clark Count y, which has a
higher rat e of vaccinat ion exempt ions compared t o t he rest of t he st at e; nearly one in four
kindergart ners in Clark did not receive vaccinat ions, according t o st at e dat a.[135] This led
Washingt on st at e governor Jay Inslee t o declare a st at e of emergency, and t he st at e's congress
t o int roduce legislat ion t o disallow vaccinat ion exempt ion for personal or philosophical
reasons.[142] In April 2019, New York Mayor Bill de Blasio declared a public healt h emergency
because of "a huge spike" in cases of measles where t here were 285 cases cent red on t he
Ort hodox Jewish areas of Brooklyn in 2018, while t here were only t wo cases in 2017. There were
168 more in neighboring Rockland Count y.[143] Ot her out breaks have included Sant a Cruz Count y
and But t e Count y in California, and t he st at es of New Jersey and Michigan.[141] As of April 2019,
t here have been 695 cases of measles report ed in 22 st at es.[120] This is t he highest number of
measles cases since it was declared eradicat ed in 2000.[120] From 1 January, t o 31 December
2019, 1,282 individual cases of measles were confirmed in 31 st at es.[121] This is t he great est
number of cases report ed in t he U.S. since 1992.[121] Of t he 1,282 cases, 128 of t he people who
got measles were hospit alized, and 61 report ed having complicat ions, including pneumonia and
encephalit is.[121]
Brazil
The spread of measles had been int errupt ed in Brazil in 2016, wit h t he last known case t welve
mont hs earlier.[144] This last case was in t he st at e of Ceará.[145]
Brazil won a measles eliminat ion cert ificat e by t he Pan American Healt h Organizat ion in 2016, but
t he Minist ry of Healt h has proclaimed t hat t he count ry has st ruggled t o keep t his cert ificat e,
since t wo out breaks had already been ident ified in 2018, one in t he st at e of Amazonas and
anot her one in Roraima, in addit ion t o cases in ot her st at es (Rio de Janeiro, Rio Grande do Sul,
Pará, São Paulo and Rondônia), t ot aling 1053 confirmed cases unt il 1 August 2018.[146][147] In
t hese out breaks, and in most ot her cases, t he cont agion was relat ed t o t he import at ion of t he
virus, especially from Venezuela.[146] This was confirmed by t he genot ype of t he virus (D8) t hat
was ident ified, which is t he same t hat circulat es in Venezuela.[147]
Southeast Asia
In t he Viet namese measles epidemic in spring of 2014, an est imat ed 8,500 measles cases were
report ed as of 19 April, wit h 114 fat alit ies;[148] as of 30 May, 21,639 suspect ed measles cases
had been report ed, wit h 142 measles-relat ed fat alit ies.[149] In t he Naga Self-Administ ered Zone
in a remot e nort hern region of Myanmar, at least 40 children died during a measles out break in
August 2016 t hat was probably caused by lack of vaccinat ion in an area of poor healt h
infrast ruct ure.[150][151] Following t he 2019 Philippines measles out break, 23,563 measles cases
have been report ed in t he count ry wit h 338 fat alit ies.[152] A measles out break also happened
among t he Malaysian Orang Asli sub-group of Bat ek people in t he st at e of Kelant an from May
2019, causing t he deat hs of 15 from t he t ribe.[153][154]
South Pacific
A measles out break in New Zealand has 2193 confirmed cases and t wo deat hs. A measles
out break in Tonga has 612 cases of measles.
Samoa
A measles out break in Samoa in lat e 2019 has over 5,700 cases of measles and 83 deat hs, out of
a Samoan populat ion of 200,000. Over t hree percent of t he populat ion were infect ed, and a
st at e of emergency was declared from 17 November t o 7 December. A vaccinat ion campaign
brought t he measles vaccinat ion rat e from 31 t o 34% in 2018 t o an est imat ed 94% of t he eligible
populat ion in December 2019.
Africa
The Democrat ic Republic of t he Congo and Madagascar have report ed t he highest numbers of
cases in 2019. However, cases have decreased in Madagascar as a result of nat ionwide
emergency measles vaccine campaigns. As of August 2019 out breaks were occurring in Angola,
Cameroon, Chad, Nigeria, Sout h Sudan and Sudan.[155]
Madagascar
An out break of measles in 2018 has result ed in 118,000 cases and 1,688 deat hs. This followed
out breaks of bubonic and pneumonic plague in 2017 (2575 cases, 221 deat hs) and 2014 (263
confirmed cases, 71 deat hs).
Democratic Republic of Congo

An out break of measles wit h nearly 5,000 deat hs and 250,000 infect ions occurred in 2019, aft er
t he disease spread t o all t he provinces in t he count ry.[156] Most deat hs were among children
under five years of age.[157] The World Healt h Organizat ion (WHO) has report ed t his as t he
world's largest and fast est -moving epidemic.[158]
History
16th-century Aztec drawing of someone with measles
Measles is of zoonot ic origins, having evolved from rinderpest , which infect s cat t le.[159] A
precursor of t he measles began causing infect ions in humans as early as t he 4t h cent ury
BC[160][161] or as lat e as aft er AD 500.[159] The Ant onine Plague of AD 165–180 has been
speculat ed t o have been measles, but t he act ual cause of t his plague is unknown and smallpox is
a more likely cause.[162] The first syst emat ic descript ion of measles, and it s dist inct ion from
smallpox and chickenpox, is credit ed t o t he Persian physician Muhammad ibn Zakariya al-Razi
(860–932), who published The Book of Smallpox and Measles.[163] At t he t ime of Razi's book, it is
believed t hat out breaks were st ill limit ed and t hat t he virus was not fully adapt ed t o humans.
Somet ime bet ween AD 1100 and 1200, t he measles virus fully diverged from rinderpest ,
becoming a dist inct virus t hat infect s humans.[159] This agrees wit h t he observat ion t hat measles
requires a suscept ible populat ion of >500,000 t o sust ain an epidemic, a sit uat ion t hat occurred in
hist oric t imes following t he growt h of medieval European cit ies.[93]
Maurice Hilleman's measles vaccine is estimated to prevent one million deaths per year.[164]
Measles is an endemic disease, meaning it has been cont inually present in a communit y and many
people develop resist ance. In populat ions not exposed t o measles, exposure t o t he new disease
can be devast at ing. In 1529, a measles out break in Cuba killed t wo-t hirds of t hose indigenous
people who had previously survived smallpox. Two years lat er, measles was responsible for t he
deat hs of half t he populat ion of Honduras, and it has ravaged Mexico, Cent ral America, and t he
Inca civilizat ion.[165]
Bet ween roughly 1855 and 2005, measles is est imat ed t o have killed about 200 million people
worldwide.[104]
The 1846 measles out break in t he Faroe Islands was unusual for being well-st udied.[166] Measles
had not been seen on t he islands for 60 years, so almost no resident s had any acquired
immunit y.[166] Three-quart ers of t he resident s got sick, and more t han 100 (1–2%) died from it
before t he epidemic burned it self out .[166] Pet er Ludvig Panum observed t he out break and
det ermined t hat measles was spread t hrough direct cont act of cont agious people wit h people
who had never had measles.[166]
Measles killed 20 percent of Hawaii's populat ion in t he 1850s.[167] In 1875, measles killed over
40,000 Fijians, approximat ely one-t hird of t he populat ion.[168] In t he 19t h cent ury, t he disease
killed more t han half of t he Great Andamanese populat ion.[169] Seven t o eight million children are
t hought t o have died from measles each year before t he vaccine was int roduced.[29]
In 1914, a st at ist ician for t he Prudent ial Insurance Company est imat ed from a survey of 22
count ries t hat 1% of all deat hs in t he t emperat e zone were caused by measles. He observed
also t hat 1–6% of cases of measles ended fat ally, t he difference depending on age (0–3 being
t he worst ), social condit ions (e.g. overcrowded t enement s) and pre-exist ing healt h
condit ions.[170]
In 1954, t he virus causing t he disease was isolat ed from a 13-year-old boy from t he Unit ed
St at es, David Edmonst on, and adapt ed and propagat ed on chick embryo t issue cult ure.[171] The
World Healt h Organizat ion recognizes eight clades, named A, B, C, D, E, F, G, and H. Twent y-t hree
st rains of t he measles virus have been ident ified and designat ed wit hin t hese clades.[172] While at
Merck, Maurice Hilleman developed t he first successful vaccine.[173] Licensed vaccines t o
prevent t he disease became available in 1963.[174] An improved measles vaccine became
available in 1968.[175] Measles as an endemic disease was eliminat ed from t he Unit ed St at es in
2000, but cont inues t o be reint roduced by int ernat ional t ravelers.[176] In 2019 t here were at least
1,241 cases of measles in t he Unit ed St at es dist ribut ed across 31 st at es, wit h over t hree
quart ers in New York.[177]
Society and culture
German ant i-vaccinat ion campaigner and HIV/AIDS denialist [178] St efan Lanka posed a challenge
on his websit e in 2011, offering a sum of €100,000 for anyone who could scient ifically prove t hat
measles is caused by a virus and det ermine t he diamet er of t he virus.[179] He posit ed t hat t he
illness is psychosomat ic and t hat t he measles virus does not exist . When provided wit h
overwhelming scient ific evidence from various medical st udies by German physician David
Bardens, Lanka did not accept t he findings, forcing Bardens t o appeal in court . The init ial legal
case ended wit h t he ruling t hat Lanka was t o pay t he prize.[113][180] However, on appeal, Lanka
was ult imat ely not required t o pay t he award because t he submit t ed evidence did not meet his
exact requirement s.[181] The case received wide int ernat ional coverage t hat prompt ed many t o
comment on it , including neurologist , well-known skept ic and science-based medicine advocat e
St even Novella, who called Lanka "a crank".[182]
As out breaks easily occur in under-vaccinat ed populat ions, t he disease is seen as a t est of
sufficient vaccinat ion wit hin a populat ion.[183] Measles out breaks have been on t he rise in t he
Unit ed St at es, especially in communit ies wit h lower rat es of vaccinat ion.[121] It is oft en
int roduced t o a region by t ravelers from ot her count ries and it t ypically spreads t o t hose who
have not received t he measles vaccinat ion.[121]
Alternative names
Ot her names include morbilli, rubeola, red measles, and English measles.[1][2]
Research
In May 2015, t he journal Science published a report in which researchers found t hat t he measles
infect ion can leave a populat ion at increased risk for mort alit y from ot her diseases for t wo t o
t hree years.[91] Result s from addit ional st udies t hat show t he measles virus can kill cells t hat
make ant ibodies were published in November 2019.[41]
A specific drug t reat ment for measles, ERDRP-0519, has shown promising result s in animal
st udies, but has not yet been t est ed in humans.[184][185]
References
1. Milner DA (2015). Diagnostic Pathology: Infectious Diseases E-Book (https://books.google.com/books?i

d=YJ_uCQAAQBAJ&pg=PA24) . Elsevier Health Sciences. p. 24. ISBN 9780323400374. Archived (http
s://web.archive.org/web/20170908140851/https://books.google.com/books?id=YJ_uCQAAQBAJ&pg
=PA24) from the original on 8 September 2017.
2. Stanley J (2002). Essentials of Immunology & Serology (https://books.google.com/books?id=nuCT5RVT

oN4C&pg=PA323) . Cengage Learning. p. 323. ISBN 978-0766810648. Archived (https://web.archive.o
rg/web/20170908140851/https://books.google.com/books?id=nuCT5RVToN4C&pg=PA323) from the
original on 8 September 2017.
3. Caserta, MT, ed. (September 2013). "Measles" (https://www.merckmanuals.com/professional/pediatric

s/miscellaneous_viral_infections_in_infants_and_children/measles.html) . Merck Manual Professional.
Merck Sharp & Dohme Corp. Archived (https://web.archive.org/web/20140323104756/http://www.merc
kmanuals.com/professional/pediatrics/miscellaneous_viral_infections_in_infants_and_children/measle
s.html) from the original on 23 March 2014. Retrieved 23 March 2014.
4. "Measles (Rubeola) Signs and Symptoms" (https://www.cdc.gov/measles/about/signs-symptoms.htm

l) . Centers for Disease Control and Prevention (CDC). 3 November 2014. Archived (https://web.archiv
e.org/web/20150202192809/http://www.cdc.gov/measles/about/signs-symptoms.html) from the
original on 2 February 2015. Retrieved 5 February 2015.
5. Atkinson W (2011). Epidemiology and Prevention of Vaccine-Preventable Diseases (https://www.cdc.go
v/vaccines/pubs/pinkbook/meas.html) (12 ed.). Public Health Foundation. pp. 301–23.
ISBN 9780983263135. Archived (https://web.archive.org/web/20150207061223/http://www.cdc.gov/v
accines/pubs/pinkbook/meas.html) from the original on 7 February 2015. Retrieved 5 February 2015.
6. Rota PA, Moss WJ, Takeda M, de Swart RL, Thompson KM, Goodson JL (July 2016). "Measles" (https://
doi.org/10.1038%2Fnrdp.2016.49) . Nature Reviews. Disease Primers. 2: 16049.
doi:10.1038/nrdp.2016.49 (https://doi.org/10.1038%2Fnrdp.2016.49) . PMID 27411684 (https://pub
med.ncbi.nlm.nih.gov/27411684) .
7. "Measles Fact sheet N°286" (https://www.who.int/mediacentre/factsheets/fs286/en/) . World Health

Organization (WHO). November 2014. Archived (https://web.archive.org/web/20150203144905/http://
www.who.int/mediacentre/factsheets/fs286/en/) from the original on 3 February 2015. Retrieved
4 February 2015.
8. Conn's Current Therapy 2015 (https://books.google.com/books?id=Hv8fBQAAQBAJ&pg=PT189) .

Elsevier Health Sciences. 2014. p. 153. ISBN 9780323319560. Archived (https://web.archive.org/web/2
0170908140851/https://books.google.com/books?id=Hv8fBQAAQBAJ&pg=PT189) from the original
on 8 September 2017.
9. Joint News Release (5 December 2019). "More than 140,000 die from measles as cases surge
worldwide" (https://www.who.int/news-room/detail/05-12-2019-more-than-140-000-die-from-measles-as
-cases-surge-worldwide) . who.int. Retrieved 4 September 2020.
10. "Global Measles Outbreaks" (https://www.cdc.gov/globalhealth/measles/globalmeaslesoutbreaks.ht

m) . cdc.gov. 17 August 2020. Retrieved 4 September 2020.
11. Guerra FM, Bolotin S, Lim G, Heffernan J, Deeks SL, Li Y, Crowcroft NS (December 2017). "The basic
reproduction number (R0) of measles: a systematic review". The Lancet. Infectious Diseases. 17 (12):
e420–e428. doi:10.1016/S1473-3099(17)30307-9 (https://doi.org/10.1016%2FS1473-3099%2817%293
0307-9) . PMID 28757186 (https://pubmed.ncbi.nlm.nih.gov/28757186) .
12. "Measles (Red Measles, Rubeola)" (https://web.archive.org/web/20150210111358/http://www.health.go

v.sk.ca/red-measles) . Dept of Health, Saskatchewan. Archived from the original (http://www.health.go
v.sk.ca/red-measles) on 10 February 2015. Retrieved 10 February 2015.
13. Marx JA (2010). Rosen's emergency medicine: concepts and clinical practice (https://books.google.co
m/books?id=u7TNcpCeqx8C&pg=PA1541) (7th ed.). Philadelphia: Mosby/Elsevier. p. 1541.
ISBN 9780323054720. Archived (https://web.archive.org/web/20170908140851/https://books.google.c
om/books?id=u7TNcpCeqx8C&pg=PA1541) from the original on 8 September 2017.
14. "Measles fact sheet" (https://www.who.int/news-room/fact-sheets/detail/measles) . World Health

Organization (WHO). Retrieved 20 May 2019.
15. Guerra, Fiona M.; Bolotin, Shelly; Lim, Gillian; Heffernan, Jane; Deeks, Shelley L.; Li, Ye; Crowcroft,
Natasha S. (December 2017). "The basic reproduction number (R0) of measles: a systematic review" (ht
tps://pubmed.ncbi.nlm.nih.gov/28757186) . The Lancet. Infectious Diseases. 17 (12): e420–e428.
doi:10.1016/S1473-3099(17)30307-9 (https://doi.org/10.1016%2FS1473-3099%2817%2930307-9) .
ISSN 1474-4457 (https://www.worldcat.org/issn/1474-4457) . PMID 28757186 (https://pubmed.ncbi.n
lm.nih.gov/28757186) .
16. Delamater, P. L.; Street, E. J.; Leslie, T. F.; Yang, Y. T.; Jacobsen, K. H. (2019). "Complexity of the Basic
Reproduction Number (R0)" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6302597) . Emerging
Infectious Diseases. NIH website. 25 (1): 1–4. doi:10.3201/eid2501.171901 (https://doi.org/10.3201%2
Feid2501.171901) . PMC 6302597 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6302597) .
PMID 30560777 (https://pubmed.ncbi.nlm.nih.gov/30560777) . "[a] review in 2017 identified feasible
measles R0 values of 3.7–203.3"
17. Chen S.S.P. (22 February 2018). Measles (https://web.archive.org/web/20110925023230/http://emedici

ne.medscape.com/article/966220-overview) (Report). Medscape. Archived from the original (https://e
medicine.medscape.com/article/966220-overview) on 25 September 2011. Retrieved 13 May 2020.
18. Russell, SJ; Babovic-Vuksanovic, D; Bexon, A; Cattaneo, R; Dingli, D; Dispenzieri, A; Deyle, DR; Federspiel,
MJ; Fielding, A; Galanis, E (September 2019). "Oncolytic Measles Virotherapy and Opposition to Measles
Vaccination" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6800178) . Mayo Clinic Proceedings. 94
(9): 1834–39. doi:10.1016/j.mayocp.2019.05.006 (https://doi.org/10.1016%2Fj.mayocp.2019.05.00
6) . PMC 6800178 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6800178) . PMID 31235278 (htt
ps://pubmed.ncbi.nlm.nih.gov/31235278) .
19. Kabra SK, Lodha R (August 2013). "Antibiotics for preventing complications in children with measles" (h
ttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7055587) . The Cochrane Database of Systematic
Reviews. 8 (8): CD001477. doi:10.1002/14651858.CD001477.pub4 (https://doi.org/10.1002%2F146518
58.CD001477.pub4) . PMC 7055587 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7055587) .
PMID 23943263 (https://pubmed.ncbi.nlm.nih.gov/23943263) .
20. "Despite the availability of a safe, effective and inexpensive vaccine for more than 40 years, measles
remains a leading vaccine-preventable cause of childhood deaths" (https://www.who.int/immunization/
newsroom/MI_Fact%20Sheet_17_jan_2007.pdf) (PDF). Retrieved 16 February 2019.
21. GBD 2015 Mortality and Causes of Death Collaborators (October 2016). "Global, regional, and national
life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980-2015: a
systematic analysis for the Global Burden of Disease Study 2015" (https://www.ncbi.nlm.nih.gov/pmc/a
rticles/PMC5388903) . Lancet. 388 (10053): 1459–1544. doi:10.1016/S0140-6736(16)31012-1 (http
s://doi.org/10.1016%2FS0140-6736%2816%2931012-1) . PMC 5388903 (https://www.ncbi.nlm.nih.go
v/pmc/articles/PMC5388903) . PMID 27733281 (https://pubmed.ncbi.nlm.nih.gov/27733281) .
22. GBD 2013 Mortality Causes of Death Collaborators (January 2015). "Global, regional, and national age-
sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: a systematic
analysis for the Global Burden of Disease Study 2013" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC
4340604) . Lancet. 385 (9963): 117–71. doi:10.1016/S0140-6736(14)61682-2 (https://doi.org/10.101
6%2FS0140-6736%2814%2961682-2) . PMC 4340604 (https://www.ncbi.nlm.nih.gov/pmc/articles/PM
C4340604) . PMID 25530442 (https://pubmed.ncbi.nlm.nih.gov/25530442) .
23. "Measles cases spike globally due to gaps in vaccination coverage" (https://www.who.int/news-room/de
tail/29-11-2018-measles-cases-spike-globally-due-to-gaps-in-vaccination-coverage) . World Health
Organization (WHO). 29 November 2018. Retrieved 21 December 2018.
24. "U.S. measles cases surge nearly 20 percent in early April, CDC says" (https://www.reuters.com/article/u
s-usa-measles/measles-cases-in-u-s-surge-nearly-20-in-early-april-cdc-says-idUSKCN1RR1H4) .
Reuters. 16 April 2019. Retrieved 16 April 2019.
25. "Measles – European Region" (https://www.who.int/csr/don/06-may-2019-measles-euro/en/) . World

Health Organization (WHO). Retrieved 8 May 2019.
26. "Pinkbook Measles Epidemiology of Vaccine Preventable Diseases" (https://www.cdc.gov/vaccines/pub

s/pinkbook/meas.html) . Centers for Disease Control and Prevention (CDC). 15 November 2016.
Retrieved 6 May 2018.
27. "Measles" (https://www.merckmanuals.com/professional/pediatrics/miscellaneous-viral-infections-in-inf

ants-and-children/measles) . Merck Manuals Professional Edition. January 2018. Retrieved 6 May
2018.
28. Biesbroeck L, Sidbury R (November 2013). "Viral exanthems: an update". Dermatologic Therapy. 26 (6):
433–8. doi:10.1111/dth.12107 (https://doi.org/10.1111%2Fdth.12107) . PMID 24552405 (https://pub
med.ncbi.nlm.nih.gov/24552405) . S2CID 10496269 (https://api.semanticscholar.org/CorpusID:104
96269) .
29. Ludlow M, McQuaid S, Milner D, de Swart RL, Duprex WP (January 2015). "Pathological consequences
of systemic measles virus infection" (https://doi.org/10.1002%2Fpath.4457) . The Journal of
Pathology. 235 (2): 253–65. doi:10.1002/path.4457 (https://doi.org/10.1002%2Fpath.4457) .
30. Steichen O, Dautheville S (March 2009). "Koplik spots in early measles" (https://www.ncbi.nlm.nih.gov/p
mc/articles/PMC2645467) . CMAJ. 180 (5): 583. doi:10.1503/cmaj.080724 (https://doi.org/10.1503%
2Fcmaj.080724) . PMC 2645467 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2645467) .
31. Baxby D (July 1997). "The diagnosis of the invasion of measles from a study of the exanthema as it
appears on the buccal mucous membraneBy Henry Koplik, M.D. Reproduced from Arch. Paed. 13, 918-
922 (1886)". Reviews in Medical Virology. 7 (2): 71–74. doi:10.1002/(SICI)1099-
1654(199707)7:2<71::AID-RMV185>3.0.CO;2-S (https://doi.org/10.1002%2F%28SICI%291099-1654%28
199707%297%3A2%3C71%3A%3AAID-RMV185%3E3.0.CO%3B2-S) . PMID 10398471 (https://pubmed.
ncbi.nlm.nih.gov/10398471) .
32. "Symptoms of measles" (https://web.archive.org/web/20110131164435/http://www.nhs.uk/Conditions/

Measles/Pages/Symptoms.aspx) . National Health Service (NHS). 26 January 2010. Archived from
the original on 31 January 2011.
33. Hamborsky, Jennifer; Kroger, Andrew; Wolfe, Charles, eds. (2015). Epidemiology and prevention of
vaccine-preventable diseases (https://www.worldcat.org/oclc/915815516) (13th ed.). [Atlanta, GA].
p. 211. ISBN 978-0-9904491-1-9. OCLC 915815516 (https://www.worldcat.org/oclc/915815516) .
34. Gardiner, W. T. (2007). "Otitis Media in Measles". The Journal of Laryngology & Otology. 39 (11): 614–
17. doi:10.1017/S0022215100026712 (https://doi.org/10.1017%2FS0022215100026712) .
35. Fisher DL, Defres S, Solomon T (March 2015). "Measles-induced encephalitis" (https://doi.org/10.1093%
2Fqjmed%2Fhcu113) . QJM. 108 (3): 177–82. doi:10.1093/qjmed/hcu113 (https://doi.org/10.1093%2
Fqjmed%2Fhcu113) . PMID 24865261 (https://pubmed.ncbi.nlm.nih.gov/24865261) .
36. Anlar B (2013). "Subacute sclerosing panencephalitis and chronic viral encephalitis". Pediatric
Neurology Part II. Handbook of Clinical Neurology. 112. pp. 1183–89. doi:10.1016/B978-0-444-52910-
7.00039-8 (https://doi.org/10.1016%2FB978-0-444-52910-7.00039-8) . ISBN 9780444529107.
37. Semba RD, Bloem MW (March 2004). "Measles blindness". Survey of Ophthalmology. 49 (2): 243–55.
doi:10.1016/j.survophthal.2003.12.005 (https://doi.org/10.1016%2Fj.survophthal.2003.12.005) .
38. Gupta P, Menon PS, Ramji S, Lodha R, Rakesh (2015). PG Textbook of Pediatrics: Volume 2: Infections
and Systemic Disorders (https://books.google.com/books?id=krlEDwAAQBAJ&pg=PA1158) . JP
Medical Ltd. p. 1158. ISBN 9789351529552.
39. Griffin DE (July 2010). "Measles virus-induced suppression of immune responses" (https://www.ncbi.nl
m.nih.gov/pmc/articles/PMC2908915) . Immunological Reviews. 236: 176–89. doi:10.1111/j.1600-
065X.2010.00925.x (https://doi.org/10.1111%2Fj.1600-065X.2010.00925.x) . PMC 2908915 (https://
www.ncbi.nlm.nih.gov/pmc/articles/PMC2908915) . PMID 20636817 (https://pubmed.ncbi.nlm.nih.go
v/20636817) .
40. GRIFFIN, ASHLEY HAGEN (18 May 2019). "Measles and Immune Amnesia" (https://asm.org/Articles/20
19/May/Measles-and-Immune-Amnesia) . asm.org. American Society for Microbiology. Archived (http
s://archive.today/20200118042959/https://asm.org/Articles/2019/May/Measles-and-Immune-Amnes
ia) from the original on 18 January 2020. Retrieved 18 January 2020.
41. Mina MJ, Kula T, Leng Y, Li M, de Vries RD, Knip M, et al. (1 November 2019). "Measles virus infection
diminishes preexisting antibodies that offer protection from other pathogens" (https://doi.org/10.112
6%2Fscience.aay6485) . Science. 366 (6465): 599–606. Bibcode:2019Sci...366..599M (https://ui.adsa
bs.harvard.edu/abs/2019Sci...366..599M) . doi:10.1126/science.aay6485 (https://doi.org/10.1126%2
Fscience.aay6485) . ISSN 0036-8075 (https://www.worldcat.org/issn/0036-8075) . PMID 31672891
(https://pubmed.ncbi.nlm.nih.gov/31672891) . Lay summary (https://www.nytimes.com/2019/10/31/
health/measles-vaccine-immune-system.html) .
42. Guglielmi, Giorgia (31 October 2019). "Measles erases immune 'memory' for other diseases" (https://ww
w.nature.com/articles/d41586-019-03324-7) . Nature. doi:10.1038/d41586-019-03324-7 (https://doi.o
rg/10.1038%2Fd41586-019-03324-7) . PMID 33122832 (https://pubmed.ncbi.nlm.nih.gov/3312283
2) . Retrieved 3 November 2019.
43. Ellison JB (February 1931). "Pneumonia in Measles" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1

975146) . Archives of Disease in Childhood. 6 (31): 37–52. doi:10.1136/adc.6.31.37 (https://doi.org/1
0.1136%2Fadc.6.31.37) . PMC 1975146 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1975146) .
44. "Measles" (https://www.cdc.gov/measles/hcp/index.html) . Centers for Disease Control and Prevention

(CDC). Archived (https://web.archive.org/web/20161023051702/https://www.cdc.gov/measles/hcp/ind
ex.html) from the original on 23 October 2016. Retrieved 22 October 2016.
45. National Institutes of Health Office of Dietary Supplements (2013). "Vitamin A" (https://web.archive.org/
web/20150311000932/http://ods.od.nih.gov/factsheets/VitaminA-HealthProfessional/) . U.S.
Department of Health & Human Services. Archived from the original (http://ods.od.nih.gov/factsheets/
VitaminA-HealthProfessional/) on 11 March 2015. Retrieved 11 March 2015.
46. Sabella C (March 2010). "Measles: not just a childhood rash". Cleveland Clinic Journal of Medicine. 77
(3): 207–13. doi:10.3949/ccjm.77a.09123 (https://doi.org/10.3949%2Fccjm.77a.09123) .
PMID 20200172 (https://pubmed.ncbi.nlm.nih.gov/20200172) . S2CID 4743168 (https://api.semantic
scholar.org/CorpusID:4743168) .
47. Perry RT, Halsey NA (May 2004). "The clinical significance of measles: a review" (https://doi.org/10.108
6%2F377712) . The Journal of Infectious Diseases. 189 Suppl 1 (S1): S4-16. doi:10.1086/377712 (htt
ps://doi.org/10.1086%2F377712) . PMID 15106083 (https://pubmed.ncbi.nlm.nih.gov/15106083) .
48. Sension MG, Quinn TC, Markowitz LE, Linnan MJ, Jones TS, Francis HL, et al. (December 1988).
"Measles in hospitalized African children with human immunodeficiency virus". American Journal of
Diseases of Children. 142 (12): 1271–2. doi:10.1001/archpedi.1988.02150120025021 (https://doi.org/
10.1001%2Farchpedi.1988.02150120025021) . PMID 3195521 (https://pubmed.ncbi.nlm.nih.gov/319
5521) .
49. Cohen BE, Durstenfeld A, Roehm PC (July 2014). "Viral causes of hearing loss: a review for hearing
health professionals" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4222184) . Trends in Hearing.
18: 2331216514541361. doi:10.1177/2331216514541361 (https://doi.org/10.1177%2F23312165145
41361) . PMC 4222184 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4222184) .

(CDC). 2 April 2018. Retrieved 6 May 2018.
51. Banerjee E, Griffith J, Kenyon C, Christianson B, Strain A, Martin K; et al. (2020). "Containing a measles
outbreak in Minnesota, 2017: methods and challenges" (https://www.ncbi.nlm.nih.gov/entrez/eutils/elin
k.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31480896) .
Perspect Public Health. 140 (3): 162–171. doi:10.1177/1757913919871072 (https://doi.org/10.1177%2
F1757913919871072) . PMID 31480896 (https://pubmed.ncbi.nlm.nih.gov/31480896) .
S2CID 201829328 (https://api.semanticscholar.org/CorpusID:201829328) .
52. Spelman LH, Gilardi KV, Lukasik-Braum M, Kinani JF, Nyirakaragire E, Lowenstine LJ; et al. (2013).
"Respiratory disease in mountain gorillas (Gorilla beringei beringei) in Rwanda, 1990-2010: outbreaks,
clinical course, and medical management" (https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom
=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24450064) . J Zoo Wildl Med. 44
(4): 1027–35. doi:10.1638/2013-0014R.1 (https://doi.org/10.1638%2F2013-0014R.1) .
53. Gowda VK, Sukanya V (November 2012). "Acquired immunodeficiency syndrome with subacute
sclerosing panencephalitis". Pediatric Neurology. 47 (5): 379–81.
doi:10.1016/j.pediatrneurol.2012.06.020 (https://doi.org/10.1016%2Fj.pediatrneurol.2012.06.020) .
54. Waggoner JJ, Soda EA, Deresinski S (October 2013). "Rare and emerging viral infections in transplant
recipients" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7107977) . Clinical Infectious Diseases. 57
(8): 1182–8. doi:10.1093/cid/cit456 (https://doi.org/10.1093%2Fcid%2Fcit456) . PMC 7107977 (http
s://www.ncbi.nlm.nih.gov/pmc/articles/PMC7107977) . PMID 23839998 (https://pubmed.ncbi.nlm.nih.
gov/23839998) .
55. Leuridan E, Sabbe M, Van Damme P (September 2012). "Measles outbreak in Europe: susceptibility of
infants too young to be immunized". Vaccine. 30 (41): 5905–13. doi:10.1016/j.vaccine.2012.07.035 (htt
ps://doi.org/10.1016%2Fj.vaccine.2012.07.035) . PMID 22841972 (https://pubmed.ncbi.nlm.nih.gov/2
2841972) .
56. Moss WJ, Griffin DE (January 2012). "Measles". Lancet. 379 (9811): 153–64. doi:10.1016/S0140-
6736(10)62352-5 (https://doi.org/10.1016%2FS0140-6736%2810%2962352-5) . PMID 21855993 (htt
ps://pubmed.ncbi.nlm.nih.gov/21855993) . S2CID 208794084 (https://api.semanticscholar.org/Corpu
sID:208794084) .
57. Textbook of Microbiology & Immunology (https://books.google.com/books?id=HcgGLfxDJSQC&pg=P

A535) . Elsevier India. 2009. p. 535. ISBN 9788131221631.
58. Kaslow RA, Stanberry LR, Le Duc JW (2014). Viral Infections of Humans: Epidemiology and Control (htt
ps://books.google.com/books?id=sxakBAAAQBAJ&pg=PA540) . Springer. p. 540.
ISBN 9781489974488.
59. Schaechter's Mechanisms of Microbial Disease (https://books.google.com/books?id=OM2rujts8P0C&pg

=PA357) . Lippincott Williams & Wilkins. 2012. p. 357. ISBN 9780781787444.
60. Rainwater-Lovett, Kaitlin; Moss, William J. (2018), Jameson, J. Larry; Fauci, Anthony S.; Kasper, Dennis
L.; Hauser, Stephen L. (eds.), "Measles (Rubeola)" (http://accessmedicine.mhmedical.com/content.asp
x?aid=1155970732) , Harrison's Principles of Internal Medicine (20 ed.), New York, NY: McGraw-Hill
Education, retrieved 7 December 2020
61. "Surveillance Manual | Measles | Vaccine Preventable Diseases | CDC" (https://www.cdc.gov/vaccines/pu

bs/surv-manual/chpt07-measles.html) . www.cdc.gov. 23 May 2019. Retrieved 25 November 2019.

(CDC). 2 April 2018. Retrieved 8 May 2018.
63. Friedman M, Hadari I, Goldstein V, Sarov I (October 1983). "Virus-specific secretory IgA antibodies as a
means of rapid diagnosis of measles and mumps infection". Israel Journal of Medical Sciences. 19 (10):
881–4. PMID 6662670 (https://pubmed.ncbi.nlm.nih.gov/6662670) .
64. Dimech, Wayne; Mulders, Mick N. (July 2016). "A review of testing used in seroprevalence studies on
measles and rubella". Vaccine. 34 (35): 4119–4122. doi:10.1016/j.vaccine.2016.06.006 (https://doi.org/
10.1016%2Fj.vaccine.2016.06.006) . PMID 27340096 (https://pubmed.ncbi.nlm.nih.gov/27340096) .
65. Simon, Jakub K.; Ramirez, Karina; Cuberos, Lilian; Campbell, James D.; Viret, Jean F.; Muñoz, Alma;
Lagos, Rosanna; Levine, Myron M.; Pasetti, Marcela F. (March 2011). "Mucosal IgA Responses in
Healthy Adult Volunteers following Intranasal Spray Delivery of a Live Attenuated Measles Vaccine" (htt
ps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3067370) . Clinical and Vaccine Immunology. 18 (3):
355–361. doi:10.1128/CVI.00354-10 (https://doi.org/10.1128%2FCVI.00354-10) . PMC 3067370 (http
s://www.ncbi.nlm.nih.gov/pmc/articles/PMC3067370) . PMID 21228137 (https://pubmed.ncbi.nlm.nih.
gov/21228137) .
66. Galindo BM, Concepción D, Galindo MA, Pérez A, Saiz J (January 2012). "Vaccine-related adverse
events in Cuban children, 1999-2008" (http://www.medicc.org/mediccreview/index.php?issue=19&id=23
7&a=vahtml) . MEDICC Review. 14 (1): 38–43. doi:10.37757/MR2012V14.N1.8 (https://doi.org/10.377
57%2FMR2012V14.N1.8) . PMID 22334111 (https://pubmed.ncbi.nlm.nih.gov/22334111) . Archived
(https://web.archive.org/web/20120224083721/http://www.medicc.org/mediccreview/index.php?issue=
19&id=237&a=vahtml) from the original on 24 February 2012.
67. Helfand RF, Witte D, Fowlkes A, Garcia P, Yang C, Fudzulani R, et al. (November 2008). "Evaluation of the
immune response to a 2-dose measles vaccination schedule administered at 6 and 9 months of age to
HIV-infected and HIV-uninfected children in Malawi" (https://doi.org/10.1086%2F592756) . The
Journal of Infectious Diseases. 198 (10): 1457–65. doi:10.1086/592756 (https://doi.org/10.1086%2F59
2756) . PMID 18828743 (https://pubmed.ncbi.nlm.nih.gov/18828743) .
68. Ołdakowska A, Marczyńska M (2008). "[Measles vaccination in HIV infected children]". Medycyna Wieku
Rozwojowego. 12 (2 Pt 2): 675–80. PMID 19418943 (https://pubmed.ncbi.nlm.nih.gov/19418943) .
69. "Global goal to reduce measles deaths in children surpassed" (http://www.unicef.org/media/media_3807

6.html) (Press release). UNICEF. 2007. Archived (https://web.archive.org/web/20150204152400/htt
p://www.unicef.org/media/media_38076.html) from the original on 4 February 2015. Retrieved
11 March 2015.
70. McLean HQ, Fiebelkorn AP, Temte JL, Wallace GS (June 2013). "Prevention of measles, rubella,
congenital rubella syndrome, and mumps, 2013: summary recommendations of the Advisory
Committee on Immunization Practices (ACIP)" (https://web.archive.org/web/20200413110343/https://
www.cdc.gov/mmwr/pdf/rr/rr6204.pdf) (PDF). MMWR. Recommendations and Reports. 62 (RR-04):
2, 19. PMID 23760231 (https://pubmed.ncbi.nlm.nih.gov/23760231) . Archived from the original (http
s://www.cdc.gov/mmwr/pdf/rr/rr6204.pdf) (PDF) on 13 April 2020.
71. "Measles Prevention: Recommendations of the Immunization Practices Advisory Committee (ACIP)" (htt
ps://www.cdc.gov/mmwr/preview/mmwrhtml/00041753.htm) . cdc.gov. 29 December 1989. Retrieved
13 November 2020.
72. Di Pietrantonj, Carlo; Rivetti, Alessandro; Marchione, Pasquale; Debalini, Maria Grazia; Demicheli, Vittorio
(20 April 2020). Cochrane Acute Respiratory Infections Group (ed.). "Vaccines for measles, mumps,
rubella, and varicella in children" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7169657) .
Cochrane Database of Systematic Reviews. 4: CD004407. doi:10.1002/14651858.CD004407.pub4 (http
s://doi.org/10.1002%2F14651858.CD004407.pub4) . PMC 7169657 (https://www.ncbi.nlm.nih.gov/p
mc/articles/PMC7169657) . PMID 32309885 (https://pubmed.ncbi.nlm.nih.gov/32309885) .
73. Young, Megan K; Nimmo, Graeme R; Cripps, Allan W; Jones, Mark A (1 April 2014). "Post-exposure
passive immunisation for preventing measles" (https://doi.org/10.1002/14651858.CD010056.pub2) .
Cochrane Database of Systematic Reviews. 2014 (4): CD010056.
doi:10.1002/14651858.cd010056.pub2 (https://doi.org/10.1002%2F14651858.cd010056.pub2) .
hdl:10072/65474 (https://hdl.handle.net/10072%2F65474) . ISSN 1465-1858 (https://www.worldcat.o
rg/issn/1465-1858) . PMID 24687262 (https://pubmed.ncbi.nlm.nih.gov/24687262) .
74. Bester, Johan Christiaan (1 December 2016). "Measles and Measles Vaccination: A Review" (http://arch
pedi.jamanetwork.com/article.aspx?doi=10.1001/jamapediatrics.2016.1787) . JAMA Pediatrics. 170
(12): 1209–1215. doi:10.1001/jamapediatrics.2016.1787 (https://doi.org/10.1001%2Fjamapediatrics.2
016.1787) . ISSN 2168-6203 (https://www.worldcat.org/issn/2168-6203) . PMID 27695849 (https://
pubmed.ncbi.nlm.nih.gov/27695849) .
75. Greenwood, Kathryn P.; Hafiz, Radwan; Ware, Robert S.; Lambert, Stephen B. (17 May 2016). "A
systematic review of human-to-human transmission of measles vaccine virus" (https://pubmed.ncbi.nl
m.nih.gov/27083423/) . Vaccine. 34 (23): 2531–2536. doi:10.1016/j.vaccine.2016.03.092 (https://doi.
org/10.1016%2Fj.vaccine.2016.03.092) . ISSN 1873-2518 (https://www.worldcat.org/issn/1873-251
76. Bester, Johan Christiaan (1 December 2016). "Measles and Measles Vaccination". JAMA Pediatrics. 170
(12): 1209–1215. doi:10.1001/jamapediatrics.2016.1787 (https://doi.org/10.1001%2Fjamapediatrics.2
016.1787) . PMID 27695849 (https://pubmed.ncbi.nlm.nih.gov/27695849) .
77. World Health Organization (April 2017). "Measles vaccines: WHO position paper – April 2017". Weekly
Epidemiological Record. 92 (17): 205–27. hdl:10665/255377 (https://hdl.handle.net/10665%2F25537
78. Rezaie SR. "Measles: The Sequel" (https://epmonthly.com/article/measles-the-sequel/) . Emergency

Physicians Monthly. Retrieved 7 June 2019.
79. Schrör K (2007). "Aspirin and Reye syndrome: a review of the evidence". Paediatric Drugs. 9 (3): 195–
204. doi:10.2165/00148581-200709030-00008 (https://doi.org/10.2165%2F00148581-200709030-0
0008) . PMID 17523700 (https://pubmed.ncbi.nlm.nih.gov/17523700) . S2CID 58727745 (https://ap
i.semanticscholar.org/CorpusID:58727745) . "The suggestion of a defined cause-effect relationship
between aspirin intake and Reye syndrome in children is not supported by sufficient facts. Clearly, no
drug treatment is without side effects. Thus, a balanced view of whether treatment with a certain drug
is justified in terms of the benefit/risk ratio is always necessary. Aspirin is no exception."
80. Reye's Syndrome (https://www.ninds.nih.gov/Disorders/All-Disorders/Reyes-Syndrome-Information-Pa

ge) at NINDS "Epidemiologic evidence indicates that aspirin (salicylate) is the major preventable risk
factor for Reye's syndrome. The mechanism by which aspirin and other salicylates trigger Reye's
syndrome is not completely understood."
81. "Frequently Asked Questions about Measles" (https://www.doh.wa.gov/YouandYourFamily/IllnessandDis

ease/Measles/FrequentlyAskedQuestions) . Washington State Department of Health. Retrieved
10 February 2019. "[Vitamin A] cannot prevent or cure the measles"
82. Huiming Y, Chaomin W, Meng M (October 2005). Yang H (ed.). "Vitamin A for treating measles in
children" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7076287) . The Cochrane Database of
Systematic Reviews (4): CD001479. doi:10.1002/14651858.CD001479.pub3 (https://doi.org/10.1002%2
F14651858.CD001479.pub3) . PMC 7076287 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7076
83. Awotiwon AA, Oduwole O, Sinha A, Okwundu CI (June 2017). "Zinc supplementation for the treatment
of measles in children" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6481361) . The Cochrane
Database of Systematic Reviews. 2017 (6): CD011177. doi:10.1002/14651858.CD011177.pub3 (http
84. Chen, Shou; Wu, Taixiang; Kong, Xiangyu; Yuan, Hao (9 November 2011). "Chinese medicinal herbs for
measles" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7265114) . The Cochrane Database of
Systematic Reviews (11): CD005531. doi:10.1002/14651858.CD005531.pub4 (https://doi.org/10.1002%
2F14651858.CD005531.pub4) . ISSN 1469-493X (https://www.worldcat.org/issn/1469-493X) .
PMC 7265114 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7265114) . PMID 22071825 (https://p
ubmed.ncbi.nlm.nih.gov/22071825) .
85. "Measles Complications" (https://www.cdc.gov/measles/about/complications.html) . Centers for
Disease Control and Prevention (CDC). 25 February 2019. Retrieved 14 May 2019.
86. Di Pietrantonj, C; Rivetti, A; Marchione, P; Debalini, MG; Demicheli, V (April 2020). "Vaccines for measles,
mumps, rubella, and varicella in children" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7169657) .
Cochrane Database of Systematic Reviews. 4: CD004407. doi:10.1002/14651858.CD004407.pub4 (http
87. Noyce RS, Richardson CD (September 2012). "Nectin 4 is the epithelial cell receptor for measles virus".
Trends in Microbiology. 20 (9): 429–39. doi:10.1016/j.tim.2012.05.006 (https://doi.org/10.1016%2Fj.ti
m.2012.05.006) . PMID 22721863 (https://pubmed.ncbi.nlm.nih.gov/22721863) .
88. "NINDS Subacute Sclerosing Panencephalitis Information Page" (http://www.ninds.nih.gov/disorders/su

bacute_panencephalitis/subacute_panencephalitis.htm) . Archived (https://web.archive.org/web/2014
1017073411/http://www.ninds.nih.gov/disorders/subacute_panencephalitis/subacute_panencephaliti
s.htm) from the original on 17 October 2014. Retrieved 26 March 2018. "NINDS Subacute Sclerosing
Panencephalitis Information Page"
89. 14-193b. (http://www.merck.com/mmpe/sec14/ch193/ch193b.html) at Merck Manual of Diagnosis

and Therapy Professional Edition
90. Centers for Disease Control (CDC) (May 1982). "Recommendation of the Immunization Practices
Advisory Committee (ACIP). Measles prevention" (https://www.cdc.gov/mmwr/preview/mmwrhtml/0000
1090.htm) . MMWR. Morbidity and Mortality Weekly Report. 31 (17): 217–24, 229–31. PMID 6804783
(https://pubmed.ncbi.nlm.nih.gov/6804783) .
91. Mina MJ, Metcalf CJ, de Swart RL, Osterhaus AD, Grenfell BT (May 2015). "Long-term measles-induced
immunomodulation increases overall childhood infectious disease mortality" (https://www.ncbi.nlm.nih.g
ov/pmc/articles/PMC4823017) . Science. 348 (6235): 694–9. Bibcode:2015Sci...348..694M (https://u
i.adsabs.harvard.edu/abs/2015Sci...348..694M) . doi:10.1126/science.aaa3662 (https://doi.org/10.11
26%2Fscience.aaa3662) . PMC 4823017
(https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4823017) . PMID 25954009 (https://pubmed.ncbi.nl
m.nih.gov/25954009) . Lay summary (http://well.blogs.nytimes.com/2015/05/07/measles-may-increa
se-susceptibility-to-other-infections) .
92. Bartlett, M.S. (1957). "Measles periodicity and community size". J. R. Stat. Soc. Ser. A (120): 48–70.
93. Black FL (July 1966). "Measles endemicity in insular populations: critical community size and its
evolutionary implication". Journal of Theoretical Biology. 11 (2): 207–11. Bibcode:1966JThBi..11..207B
(https://ui.adsabs.harvard.edu/abs/1966JThBi..11..207B) . doi:10.1016/0022-5193(66)90161-5 (http
s://doi.org/10.1016%2F0022-5193%2866%2990161-5) . PMID 5965486 (https://pubmed.ncbi.nlm.nih.
gov/5965486) .
94. Lozano R, Naghavi M, Foreman K, Lim S, Shibuya K, Aboyans V, et al. (December 2012). "Global and
regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis
for the Global Burden of Disease Study 2010" (https://zenodo.org/record/2557786) . Lancet. 380
(9859): 2095–128. doi:10.1016/S0140-6736(12)61728-0 (https://doi.org/10.1016%2FS0140-6736%281
2%2961728-0) . hdl:10536/DRO/DU:30050819 (https://hdl.handle.net/10536%2FDRO%2FDU%3A300
50819) . PMID 23245604 (https://pubmed.ncbi.nlm.nih.gov/23245604) . S2CID 1541253 (https://ap
i.semanticscholar.org/CorpusID:1541253) .
95. "Measles Data and Statistics" (https://www.cdc.gov/measles/downloads/measlesdataandstatsslidese

t.pdf) (PDF). Retrieved 15 August 2019.
96. "Measles notifications and deaths in England and Wales: 1940 to 2017" (https://www.gov.uk/governme
nt/publications/measles-deaths-by-age-group-from-1980-to-2013-ons-data/measles-notifications-and-d
eaths-in-england-and-wales-1940-to-2013) . GOV.UK. Retrieved 1 October 2019.
97. "Complications of measles" (https://www.cdc.gov/measles/about/complications.html) . Centers for

Disease Control and Prevention (CDC). 3 November 2014. Archived (https://web.archive.org/web/20150
103130249/http://www.cdc.gov/measles/about/complications.html) from the original on 3 January
2015. Retrieved 7 November 2014.
98. "Pinkbook | Measles | Epidemiology of Vaccine Preventable Diseases | CDC" (https://www.cdc.gov/vaccin

es/pubs/pinkbook/meas.html) . www.cdc.gov. 25 September 2019. Retrieved 12 December 2019.
99. "Measles" (https://web.archive.org/web/20130814150053/http://www.who.int/immunization_monitorin

g/diseases/measles/en/) . World Health Organization (WHO). 23 July 2013. Archived from the original
on 14 August 2013.
100. "Measles Surveillance Data" (https://web.archive.org/web/20150703130205/http://www.who.int/immuni

zation/monitoring_surveillance/burden/vpd/surveillance_type/active/measles_monthlydata/en/) .
World Health Organization (WHO). 17 March 2015. Archived from the original on 3 July 2015.
101. "Number of Reported Measles Cases with onset date from Nov 2014 to Apr 2015 (6M period)" (https://
web.archive.org/web/20150703194912/http://www.who.int/immunization/monitoring_surveillance/burd
en/vpd/surveillance_type/active/big_measlesreportedcases6months_PDF.pdf) (PDF). World Health
Organization (WHO). Archived from the original on 3 July 2015.
102. "Reported measles cases and incidence rates by WHO Member States 2013, 2014 as of 11 February
2015" (https://web.archive.org/web/20150703015216/http://www.who.int/immunization/monitoring_su
rveillance/burden/vpd/surveillance_type/active/measlesreportedcasesbycountry.pdf) (PDF). World
Health Organization (WHO). 7 April 2014. Archived from the original on 3 July 2015.
103. "Measles—United States, 2005" (https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5550a2.htm) .

Centers for Disease Control and Prevention (CDC). 22 December 2006. Archived (https://web.archive.or
g/web/20150313120119/http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5550a2.htm) from the
original on 13 March 2015. Retrieved 30 March 2015.
104. Greger M (November 2006). "Most and probably all of the distinctive infectious diseases of civilization
have been transferred to human populations from animal herds." (https://web.archive.org/web/200910
03164005/http://www.birdflubook.com/a.php?id=40) . Bird Flu: A Virus of Our Own Hatching. Lantern
Books. ISBN 1590560981. Archived from the original (http://www.birdflubook.org/a.php?id=40) on 3
October 2009.
105. Torrey EF, Yolken RH (3 April 2005). "Their Bugs Are Worse Than Their Bite" (https://www.washingtonpo
st.com/archive/opinions/2005/04/03/their-bugs-are-worse-than-their-bite/d1272b61-b9c1-47cc-9707-8
fef6477bf4f/) . The Washington Post. Archived (https://web.archive.org/web/20191111052741/http
s://www.washingtonpost.com/archive/opinions/2005/04/03/their-bugs-are-worse-than-their-bite/d1272
b61-b9c1-47cc-9707-8fef6477bf4f/) from the original on 11 November 2019. Retrieved 10 November
2019.
106. UNICEF Joint Press Release (http://www.unicef.org/media/media_38076.html) Archived (https://web.

archive.org/web/20150204152400/http://www.unicef.org/media/media_38076.html) 2015-02-04 at
the Wayback Machine
107. World Health Organization (December 2009). "Global reductions in measles mortality 2000-2008 and
the risk of measles resurgence". Weekly Epidemiological Record. 84 (49): 509–16. hdl:10665/241466 (ht
tps://hdl.handle.net/10665%2F241466) . PMID 19960624 (https://pubmed.ncbi.nlm.nih.gov/199606
24) .
108. "More than 140,000 die from measles as cases surge worldwide" (https://www.who.int/news-room/detai
l/05-12-2019-more-than-140-000-die-from-measles-as-cases-surge-worldwide) . World Health
Organization (WHO) (Press release). 5 December 2019. Retrieved 12 December 2019.
109. Brown, Kevin E.; Rota, Paul A.; Goodson, James L.; Williams, David; Abernathy, Emily; Takeda, Makoto;
Mulders, Mick N. (5 July 2019). "Genetic Characterization of Measles and Rubella Viruses Detected
Through Global Measles and Rubella Elimination Surveillance, 2016–2018" (https://www.ncbi.nlm.nih.go
v/pmc/articles/PMC6613570) . MMWR. Morbidity and Mortality Weekly Report. 68 (26): 587–591.
doi:10.15585/mmwr.mm6826a3 (https://doi.org/10.15585%2Fmmwr.mm6826a3) . PMC 6613570 (htt
ps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6613570) . PMID 31269012 (https://pubmed.ncbi.nlm.ni
h.gov/31269012) .
110. "New measles surveillance data for 2019" (https://www.who.int/immunization/newsroom/measles-data-

2019/en/) (Press release). World Health Organization (WHO). 15 April 2019. Retrieved 4 June 2019.
111. Patel, Minal K.; Goodson, James L.; Alexander, James P.; Kretsinger, Katrina; Sodha, Samir V.; Steulet,
Claudia; Gacic-Dobo, Marta; Rota, Paul A.; McFarland, Jeffrey; Menning, Lisa; Mulders, Mick N. (13
November 2020). "Progress Toward Regional Measles Elimination — Worldwide, 2000–2019" (http://ww
w.cdc.gov/mmwr/volumes/69/wr/mm6945a6.htm?s_cid=mm6945a6_w) . MMWR. Morbidity and
Mortality Weekly Report. 69 (45): 1700–1705. doi:10.15585/mmwr.mm6945a6 (https://doi.org/10.1558
5%2Fmmwr.mm6945a6) . ISSN 0149-2195 (https://www.worldcat.org/issn/0149-2195) .
112. "50 years of measles vaccination in the UK" (https://publichealthengland.exposure.co/50-years-of-measl
es-vaccination-in-the-uk) . Public Health England. Retrieved 15 May 2020.
113. Elizabeth Whitman (13 March 2015). "Who Is Stefan Lanka? Court Orders German Measles Denier To
Pay 100,000 Euros" (http://www.ibtimes.com/who-stefan-lanka-court-orders-german-measles-denier-pay
-100000-euros-1846078) . International Business Times. Archived (https://web.archive.org/web/20150
402182617/http://www.ibtimes.com/who-stefan-lanka-court-orders-german-measles-denier-pay-100000
-euros-1846078) from the original on 2 April 2015. Retrieved 31 March 2015.
114. "Europe observes a 4-fold increase in measles cases in 2017 compared to previous year" (http://www.eu
ro.who.int/en/media-centre/sections/press-releases/2018/europe-observes-a-4-fold-increase-in-measles
-cases-in-2017-compared-to-previous-year) . World Health Organization (WHO) (Press release). 19
February 2018. Retrieved 22 February 2018.
115. "WHO EpiData" (http://www.euro.who.int/__data/assets/pdf_file/0004/394060/2019_01_Epi_Data_EN_J

an-Dec-2018.pdf?ua=1) (PDF). World Health Organization (WHO). February 2019. Retrieved 27 March
2019.
116. "Measles in Europe: record number of both sick and immunized" (http://www.euro.who.int/en/media-cen
tre/sections/press-releases/2019/measles-in-europe-record-number-of-both-sick-and-immunized)
(Press release). World Health Organization (WHO). 7 February 2019. Retrieved 27 March 2019.
117. "European Region loses ground in effort to eliminate measles" (https://web.archive.org/web/202004140

65648/http://www.euro.who.int/en/media-centre/sections/press-releases/2019/european-region-loses-g
round-in-effort-to-eliminate-measles) . World Health Organization (WHO) (Press release). 29 August
2019. Archived from the original (http://www.euro.who.int/en/media-centre/sections/press-releases/20
19/european-region-loses-ground-in-effort-to-eliminate-measles) on 14 April 2020. Retrieved
31 August 2019.
118. "Region of the Americas is declared free of measles" (https://www.paho.org/hq/index.php?option=com_

content&view=article&id=12528:region-americas-declared-free-measles&Itemid=1926&lang=en) . Pan
American Health Organization. 29 September 2016. Archived (https://web.archive.org/web/201609300
44745/http://www.paho.org/hq/index.php?option=com_content&view=article&id=12528%3Aregion-ame
ricas-declared-free-measles&Itemid=1926&lang=en) from the original on 30 September 2016.
Retrieved 30 September 2016.
119. "Measles spreads again in the Americas" (https://en.mercopress.com/2018/03/28/measles-spreads-ag

ain-in-the-americas) . MercoPress. 28 March 2018. Retrieved 4 July 2018.
120. "CDC Media Statement: Measles cases in the U.S. are highest since measles was eliminated in 2000" (ht
tps://www.cdc.gov/media/releases/2019/s0424-highest-measles-cases-since-elimination.html) .
Centers for Disease Control and Prevention (CDC) (Press release). 26 April 2019.
121. "Measles Cases and Outbreaks" (https://www.cdc.gov/measles/cases-outbreaks.html) . Centers for
Disease Control and Prevention (CDC). 6 January 2020. Archived (https://web.archive.org/web/201911
01062347/https://www.cdc.gov/measles/cases-outbreaks.html) from the original on 1 November
2019. Retrieved 6 January 2020. This article incorporates text from this source, which is in the public
domain.
122. Orenstein WA, Papania MJ, Wharton ME (May 2004). "Measles elimination in the United States" (https://
doi.org/10.1086%2F377693) . The Journal of Infectious Diseases. 189 (Supplement 1): S1-3.
doi:10.1086/377693 (https://doi.org/10.1086%2F377693) . PMID 15106120 (https://pubmed.ncbi.nl
m.nih.gov/15106120) . "Figure 1: Reported US measles incidence, 1950–2001."
123. {cite web|url=https://6abc.com/504818/%7Ctitle=1991 : The Philly measles outbreak that killed 9

children|date=6 February 2015|website=6abc Philadelphia}
124. Papania MJ, Wallace GS, Rota PA, Icenogle JP, Fiebelkorn AP, Armstrong GL, et al. (February 2014).
"Elimination of endemic measles, rubella, and congenital rubella syndrome from the Western
hemisphere: the US experience" (https://doi.org/10.1001%2Fjamapediatrics.2013.4342) . JAMA
Pediatrics. 168 (2): 148–55. doi:10.1001/jamapediatrics.2013.4342 (https://doi.org/10.1001%2Fjamap
ediatrics.2013.4342) . PMID 24311021 (https://pubmed.ncbi.nlm.nih.gov/24311021) .
125. Centers for Disease Control Prevention (CDC) (February 2008). "Multistate measles outbreak associated
with an international youth sporting event--Pennsylvania, Michigan, and Texas, August-September
2007" (https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5707a1.htm) . MMWR. Morbidity and
Mortality Weekly Report. 57 (7): 169–73. PMID 18288074 (https://pubmed.ncbi.nlm.nih.gov/1828807
4) .
126. Gastañaduy PA, Budd J, Fisher N, Redd SB, Fletcher J, Miller J, et al. (October 2016). "A Measles
Outbreak in an Underimmunized Amish Community in Ohio" (https://doi.org/10.1056%2FNEJMoa160
2295) . The New England Journal of Medicine. 375 (14): 1343–1354. doi:10.1056/NEJMoa1602295
(https://doi.org/10.1056%2FNEJMoa1602295) . PMID 27705270 (https://pubmed.ncbi.nlm.nih.gov/2
7705270) .
127. "Year in Review: Measles Linked to Disneyland" (https://blogs.cdc.gov/publichealthmatters/2015/12/yea

r-in-review-measles-linked-to-disneyland/) . Archived (https://web.archive.org/web/20170519211805/h
ttps://blogs.cdc.gov/publichealthmatters/2015/12/year-in-review-measles-linked-to-disneyland/) from
the original on 19 May 2017. Retrieved 26 May 2017.
128. Clemmons NS, Gastanaduy PA, Fiebelkorn AP, Redd SB, Wallace GS (April 2015). "Measles - United
States, January 4-April 2, 2015" (https://www.cdc.gov/mmwr/pdf/wk/mm6414.pdf) (PDF). MMWR.
Morbidity and Mortality Weekly Report. 64 (14): 373–6. PMC 5779542 (https://www.ncbi.nlm.nih.gov/p
129. "Measles kills first patient in 12 years" (https://www.usatoday.com/story/news/2015/07/02/measles-de

ath-washington-state/29624385/) . USA Today. 2 July 2015. Archived (https://web.archive.org/web/2
0150702200945/http://www.usatoday.com/story/news/2015/07/02/measles-death-washington-state/
29624385/) from the original on 2 July 2015. Retrieved 2 July 2015.
130. "First Measles Death in US Since 2003 Highlights the Unknown Vulnerables – Phenomena: Germination"
(https://www.nationalgeographic.com/science/phenomena/2015/07/02/measles-death-us/) . 2 July
2015. Retrieved 13 May 2020.
131. "First Measles Death In 12 Years Renews Vaccination Concerns" (https://web.archive.org/web/2019122

4204938/https://www.npr.org/2015/07/06/420594973/first-measles-death-in-12-years-renews-vaccinat
ion-concerns) . NPR. 6 July 2015. Archived from the original (https://www.npr.org/2015/07/06/42059
4973/first-measles-death-in-12-years-renews-vaccination-concerns) on 24 December 2019. Retrieved
23 April 2019.
132. "Maine confirms its first case of measles in 20 years" (https://www.cbsnews.com/news/maine-confirms-

first-case-measles-20-years/) . CBS News. Archived (https://web.archive.org/web/20170628021043/ht
tp://www.cbsnews.com/news/maine-confirms-first-case-measles-20-years/) from the original on 28
June 2017. Retrieved 28 June 2017.
133. "Measles case confirmed in Portland, about 500 people possibly exposed" (http://katu.com/news/local/
measles-case-confirmed-in-portland-about-500-people-exposed) . KATU. Retrieved 3 July 2018.
134. "TABLE 1. Weekly cases* of selected infrequently reported notifiable diseases (" (https://wonder.cdc.go
v/nndss/static/2018/52/2018-52-table1.html) . wonder.cdc.gov. Retrieved 12 January 2019.
135. Alltucker K (11 February 2019). "A quarter of all kindergartners in Washington county aren't immunized.
Now there's a measles crisis" (https://www.usatoday.com/story/news/health/2019/02/11/measles-spre
ad-anti-vaccination-communities-new-york-clar-county-washington/2812667002/) . USA Today.
Retrieved 11 February 2019.
136. Howard J (9 January 2019). "New York tackles 'largest measles outbreak' in state's recent history as
cases spike globally" (https://www.cnn.com/2019/01/08/health/measles-outbreak-ny-bn/index.html) .
CNN. Retrieved 12 January 2019.
137. "Washington state is averaging more than one measles case per day in 2019" (https://www.nbcnews.co
m/storyline/measles-outbreak/measles-outbreak-southwestern-washington-rises-50-cases-n966751) .
NBC News. Retrieved 5 February 2019.
138. "Amid Measles Outbreak, Anti-Vaxx Parents Have Put Others' Babies At Risk" (https://web.archive.org/w
eb/20190330170245/https://www.msn.com/en-ph/lifestyle/family/amid-measles-outbreak-anti-vaxx-pa
rents-have-put-others-e2-80-99-babies-at-risk/ar-BBTbIBq) . MSN. Archived from the original (https://w
ww.msn.com/en-ph/lifestyle/family/amid-measles-outbreak-anti-vaxx-parents-have-put-others-e2-80-99-
babies-at-risk/ar-BBTbIBq) on 30 March 2019. Retrieved 5 February 2019.
139. Belluz J (27 January 2019). "Washington declared a public health emergency over measles. Thank
vaccine-refusing parents" (https://www.vox.com/2019/1/27/18199514/measles-outbreak-2018-clark-co
unty-washington) . Vox. Retrieved 5 February 2019.
140. Gander K (28 January 2019). " "Dangerous" anti-vaxx warning issued by Washington officials as cases
in measles outbreak continue to rise" (https://www.newsweek.com/dangerous-anti-vaxx-warning-issued-
washington-officials-cases-measles-1306997) . Newsweek. Retrieved 5 February 2019.
141. Howard J, Goldschmidt D (24 April 2019). "US measles outbreak is largest since disease was declared
eliminated in 2000" (https://www.cnn.com/2019/04/24/health/measles-outbreak-record-us-bn/index.
html) . CNN. Retrieved 24 April 2019.
142. Goldstein-Street J (28 January 2019). "Amid measles outbreak, legislation proposed to ban vaccine
exemptions" (https://www.seattletimes.com/seattle-news/amid-measles-outbreak-legislation-proposed-t
o-ban-vaccine-exemptions/) . The Seattle Times. Retrieved 28 January 2019.
143. Tanne JH (April 2019). "New York City mayor declares measles public health emergency". BMJ. 365:
l1724. doi:10.1136/bmj.l1724 (https://doi.org/10.1136%2Fbmj.l1724) . PMID 30971409 (https://pubm
ed.ncbi.nlm.nih.gov/30971409) .
144. Lenharo M (26 July 2016). "Sarampo está eliminado do Brasil, segundo comitê internacional" (http://g1.
globo.com/bemestar/noticia/2016/07/sarampo-esta-eliminado-do-brasil-segundo-comite-internacion
al.html) (in Portuguese). G1. Retrieved 26 July 2016.
145. "Sarampo está eliminado do Brasil, segundo comitê internacional" (http://g1.globo.com/bemestar/notici

a/2016/07/sarampo-esta-eliminado-do-brasil-segundo-comite-internacional.html) . Bem Estar (in
Portuguese). 26 July 2016.
146. "Brasil já tem mais de mil casos de sarampo em 2018, segundo Ministério da Saúde" (https://g1.globo.c
om/bemestar/noticia/2018/08/02/brasil-ja-tem-mais-de-mil-casos-de-sarampo-em-2018-segundo-minist
erio-da-saude.ghtml) . G1 (in Portuguese).
147. Saúde Md. "Ministério da Saúde atualiza casos de sarampo" (http://portalms.saude.gov.br/noticias/age

ncia-saude/43946-ministerio-da-saude-atualiza-casos-de-sarampo-2) . portalms.saude.gov.br (in
Portuguese). Retrieved 2 August 2018.
148. Lien Chau (18 April 2014). "Vietnam minister calls for calm in face of 8,500 measles cases, 114
fatalities" (http://www.thanhniennews.com/health/vietnam-minister-calls-for-calm-in-face-of-8500-measl
es-cases-114-fatalities-25423.html) . Thanh Niên. Archived (https://web.archive.org/web/2014041822
0953/http://www.thanhniennews.com/health/vietnam-minister-calls-for-calm-in-face-of-8500-measles-c
ases-114-fatalities-25423.html) from the original on 18 April 2014. Retrieved 19 April 2014.
149. Quốc Thanh (30 May 2014). "Bộ Y tế: "VN đã phản ứng rất nhanh đối với dịch sởi" " (http://tuoitre.vn/Ch
inh-tri-Xa-hoi/610133/bo-y-te--vn-da-phan-ung-rat-nhanh-doi-voi-dich-soi.html) [Ministry of Health:
"Vietnam has responded very quickly to measles"] (in Vietnamese). Tuổi Trẻ. Archived (https://web.archi
ve.org/web/20140531233458/http://tuoitre.vn/Chinh-tri-Xa-hoi/610133/bo-y-te--vn-da-phan-ung-rat-nh
anh-doi-voi-dich-soi.html) from the original on 31 May 2014. Retrieved 19 April 2014.
150. "WHO doctors in Myanmar's Naga areas identify 'mystery disease' " (https://www.easternmirrornagalan
d.com/who-doctors-in-myanmars-naga-areas-identify-mystery-disease/) . Eastern Mirror Nagaland. 6
August 2016. Archived (https://web.archive.org/web/20170819065303/http://www.easternmirrornagal
and.com/who-doctors-in-myanmars-naga-areas-identify-mystery-disease/) from the original on 19
August 2017. Retrieved 8 August 2016.
151. "Myanmar (02): (SA) fatal, measles confirmed" (https://web.archive.org/web/20160820090754/http://w
ww.promedmail.org/post/4398118) . www.promedmail.org (Archive Number: 20160806.4398118).
International Society for Infectious Diseases. Archived from the original (http://www.promedmail.org/po
st/4398118) on 20 August 2016. Retrieved 8 August 2016.
152. "Philippines measles update: Nearly 600 cases in 2 days" (http://outbreaknewstoday.com/philippines-me

asles-update-nearly-600-cases-2-days-76902/) . Outbreak News Today. 26 March 2019. Archived (http
s://web.archive.org/web/20190830010007/http://outbreaknewstoday.com/philippines-measles-update-
nearly-600-cases-2-days-76902/) from the original on 30 August 2019. Retrieved 30 August 2019.
153. Alyssa J. Oon (17 June 2019). "A Measles Outbreak Is The Cause of 15 Orang Asli Deaths In Kelantan"
(https://says.com/my/news/mysterious-illness-causing-deaths-of-kampung-kuala-koh-orang-asli-identifi
ed-as-measles) . Says.com. Archived (https://web.archive.org/web/20190827033231/https://says.co
m/my/news/mysterious-illness-causing-deaths-of-kampung-kuala-koh-orang-asli-identified-as-measle
s) from the original on 27 August 2019. Retrieved 30 August 2019.
154. Rachel Tay (18 June 2019). "The mysterious illness that caused 15 deaths in a Malaysian tribe has
been linked to a measles outbreak" (https://www.businessinsider.my/the-mysterious-illness-that-caused-
15-deaths-in-a-malaysian-tribe-has-been-linked-to-a-measles-outbreak/) . Business Insider Malaysia.
Archived (https://web.archive.org/web/20190830005853/https://www.businessinsider.my/the-mysterio
us-illness-that-caused-15-deaths-in-a-malaysian-tribe-has-been-linked-to-a-measles-outbreak/) from
the original on 30 August 2019. Retrieved 30 August 2019.
155. "New measles surveillance data from WHO" (https://www.who.int/immunization/newsroom/new-measle

s-data-august-2019/en/) . World Health Organization (WHO). Retrieved 23 November 2019.
156. "Nearly 5,000 dead in world's worst measles outbreak" (https://web.archive.org/web/20200211233419/

https://www.bbc.com/news/world-africa-50506743) . 21 November 2019. Archived from the original
(https://www.bbc.com/news/world-africa-50506743) on 11 February 2020. Retrieved 23 November
2019.
157. Ratcliffe, Rebecca (22 November 2019). "Children bear the brunt as the world's biggest measles
epidemic sweeps Congo" (https://web.archive.org/web/20200507233821/https://www.theguardian.co
m/global-development/2019/nov/22/children-bear-the-brunt-as-the-worlds-biggest-measles-epidemic-sw
eeps-congo) . The Guardian. ISSN 0261-3077 (https://www.worldcat.org/issn/0261-3077) . Archived
from the original (https://www.theguardian.com/global-development/2019/nov/22/children-bear-the-br
unt-as-the-worlds-biggest-measles-epidemic-sweeps-congo) on 7 May 2020. Retrieved 23 November
2019.
158. "Measles and Rubella Surveillance Data" (https://web.archive.org/web/20200503130400/https://www.w

ho.int/immunization/monitoring_surveillance/burden/vpd/surveillance_type/active/measles_monthlyd
ata/en/) . World Health Organization (WHO). Archived from the original (https://www.who.int/immuniz
ation/monitoring_surveillance/burden/vpd/surveillance_type/active/measles_monthlydata/en/) on 3
May 2020. Retrieved 23 November 2019.
159. Furuse Y, Suzuki A, Oshitani H (March 2010). "Origin of measles virus: divergence from rinderpest virus
between the 11th and 12th centuries" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2838858) .
Virology Journal. 7: 52. doi:10.1186/1743-422X-7-52 (https://doi.org/10.1186%2F1743-422X-7-52) .
160. Düx, Ariane; Lequime, Sebastian; Patrono, Livia Victoria; Vrancken, Bram; Boral, Sengül; Gogarten, Jan
F.; Hilbig, Antonia; Horst, David; Merkel, Kevin; Prepoint, Baptiste; Santibanez, Sabine; Schlotterbeck,
Jasmin; Suchard, Marc A.; Ulrich, Markus; Widulin, Navena; Mankertz, Annette; Leendertz, Fabian H.;
Harper, Kyle; Schnalke, Thomas; Lemey, Philippe; Calvignac-Spencer, Sébastien (30 December 2019).
"The history of measles: from a 1912 genome to an antique origin" (https://doi.org/10.1101%2F2019.1
2.29.889667) . bioRxiv: 2019.12.29.889667. doi:10.1101/2019.12.29.889667 (https://doi.org/10.110
1%2F2019.12.29.889667) .
161. Kupferschmidt, Kai (30 December 2019). "Measles may have emerged when large cities rose, 1500
years earlier than thought". Science. doi:10.1126/science.aba7352 (https://doi.org/10.1126%2Fscience.
aba7352) .
162. H. Haeser's conclusion, in Lehrbuch der Geschichte der Medicin und der epidemischen Krankenheiten
III:24–33 (1882), followed by Zinsser in 1935.
163. Cohen SG (February 2008). "Measles and immunomodulation" (https://zenodo.org/record/1259085) .

The Journal of Allergy and Clinical Immunology. 121 (2): 543–4. doi:10.1016/j.jaci.2007.12.1152 (http
s://doi.org/10.1016%2Fj.jaci.2007.12.1152) . PMID 18269930 (https://pubmed.ncbi.nlm.nih.gov/1826
9930) .
164. Sullivan P (13 April 2005). "Maurice R. Hilleman Dies; Created Vaccines" (https://www.washingtonpost.c
om/wp-dyn/articles/A48244-2005Apr12.html) . The Washington Post. Archived (https://web.archive.o
rg/web/20121020102622/http://www.washingtonpost.com/wp-dyn/articles/A48244-2005Apr12.htm
l) from the original on 20 October 2012. Retrieved 7 January 2020.
165. Byrne JP (2008). Encyclopedia of Pestilence, Pandemics, and Plagues: A–M (https://books.google.com/
books?id=5Pvi-ksuKFIC&pg=PA413) . ABC-CLIO. p. 413. ISBN 978-0-313-34102-1. Archived (https://w
eb.archive.org/web/20131113180934/http://books.google.com/books?id=5Pvi-ksuKFIC&pg=PA413&dq
#v=onepage&q=&f=false) from the original on 13 November 2013.
166. Harper, Kyle (11 March 2020). "What Makes Viruses Like COVID-19 Such a Risk for Human Beings? The
Answer Goes Back Thousands of Years" (https://time.com/5800558/coronavirus-human-civilization/) .
Time. Retrieved 18 November 2020.
167. Migration and Disease (https://web.archive.org/web/20090101183418/http://www.digitalhistory.uh.ed

u/database/article_display.cfm?HHID=422) . Digital History.
168. "Fiji School of Medicine" (https://web.archive.org/web/20150410002823/http://www.fsm.ac.fj/index.ph

p?option=com_content&view=article&id=114&Itemid=148) . Archived from the original on 10 April
2015.
169. Bhaumik S (16 May 2006). "Measles hits rare Andaman tribe" (http://news.bbc.co.uk/2/hi/south_asia/4
987406.stm) . BBC News Online. Archived (https://web.archive.org/web/20110823054811/http://new
s.bbc.co.uk/2/hi/south_asia/4987406.stm) from the original on 23 August 2011.
170. Crum, Frederick S (April 1914). "A Statistical Study of Measles" (https://www.ncbi.nlm.nih.gov/pmc/artic
les/PMC1286334) . American Journal of Public Health. IV (4): 289–309. doi:10.2105/AJPH.4.4.289-a
(https://doi.org/10.2105%2FAJPH.4.4.289-a) . PMC 1286334 (https://www.ncbi.nlm.nih.gov/pmc/arti
cles/PMC1286334) . PMID 18009016 (https://pubmed.ncbi.nlm.nih.gov/18009016) .
171. "Live attenuated measles vaccine". EPI Newsletter. 2 (1): 6. February 1980. PMID 12314356 (https://pu
bmed.ncbi.nlm.nih.gov/12314356) .
172. World Health Organization (7 October 2005). "New genotype of measles virus and update on global
distribution of measles genotypes". Weekly Epidemiological Record. 80 (40): 347–51. hdl:10665/232911
(https://hdl.handle.net/10665%2F232911) . PMID 16240986 (https://pubmed.ncbi.nlm.nih.gov/162
40986) .
173. Offit PA (2007). Vaccinated: One Man's Quest to Defeat the World's Deadliest Diseases. Washington, DC:
Smithsonian. ISBN 978-0-06-122796-7.
174. "Measles Prevention: Recommendations of the Immunization Practices Advisory Committee (ACIP) (htt
ps://www.cdc.gov/mmwr/preview/mmwrhtml/00041753.htm) Archived (https://web.archive.org/web/
20120515055632/http://www.cdc.gov/mmwr/preview/mmwrhtml/00041753.htm) 2012-05-15 at the
Wayback Machine". Centers for Disease Control and Prevention (CDC).
175. "Measles: Questions and Answers" (https://web.archive.org/web/20130124052237/http://www.immuniz

e.org/catg.d/p4209.pdf) (PDF). Immunization Action Coalition. Archived from the original on 24
January 2013.
176. "Measles Frequently Asked Questions about Measles in U.S" (https://www.cdc.gov/measles/about/faq

s.html) . Centers for Disease Control and Prevention (CDC). 28 August 2018.
177. "In 2000, measles had been officially 'eliminated' in the U.S. Will that change?" (https://www.washington
post.com/health/in-2000-measles-had-been-officially-eliminated-in-the-us-will-that-change/2019/09/27/
56ac487a-deed-11e9-b199-f638bf2c340f_story.html) . 28 September 2019.
178. Stefan Lanka (April 1995). "HIV; Reality or artefact?" (https://web.archive.org/web/20150326075413/ht

tp://www.virusmyth.com/aids/hiv/slartefact.htm) . Virusmyth.com. Archived from the original (http://
www.virusmyth.com/aids/hiv/slartefact.htm) on 26 March 2015. Retrieved 31 March 2015.
179. "Das Masern-Virus 100.000 € Belohnung! WANTeD Der Durchmesser" (https://web.archive.org/web/201

50402163126/http://magonia.com/files/stefan-lanka-sarampion.pdf) (PDF) (in German). 24
November 2011. Archived from the original (http://magonia.com/files/stefan-lanka-sarampion.pdf)
(PDF) on 2 April 2015. Retrieved 31 March 2015.
180. "Germany court orders measles sceptic to pay 100,000 euros" (https://www.bbc.com/news/world-europ
e-31864218) . BBC News Online. 12 March 2015. Archived (https://web.archive.org/web/2015033102
0314/http://www.bbc.com/news/world-europe-31864218) from the original on 31 March 2015.
Retrieved 31 March 2015.
181. "Disappointing outcome of Bardens vs. Lanka: measles proven to exist, but anti-vaxxer Lanka keeps his
money" (https://web.archive.org/web/20170701211525/http://www.pepijnvanerp.nl/2017/01/disappoin
ting-outcome-of-bardens-vs-lanka-measles-proven-to-exist-but-anti-vaxxer-lanka-keeps-his-money/) .
23 January 2017. Archived from the original (http://www.pepijnvanerp.nl/2017/01/disappointing-outco
me-of-bardens-vs-lanka-measles-proven-to-exist-but-anti-vaxxer-lanka-keeps-his-money/) on 1 July
2017.
182. Steven Novella (13 March 2015). "Yes, Dr. Lanka, Measles is Real" (https://web.archive.org/web/201503
31035815/http://theness.com/neurologicablog/index.php/yes-dr-lanka-measles-is-real/) .
NeuroLogica Blog. Archived from the original (http://theness.com/neurologicablog/index.php/yes-dr-lan
ka-measles-is-real/) on 31 March 2015. Retrieved 31 March 2015.
183. Abramson B (2018). Vaccine, vaccination, and immunization law. Bloomberg Law. pp. 10–30.
ISBN 9781682675830.
184. White LK, Yoon JJ, Lee JK, Sun A, Du Y, Fu H, et al. (July 2007). "Nonnucleoside inhibitor of measles
virus RNA-dependent RNA polymerase complex activity" (https://www.ncbi.nlm.nih.gov/pmc/articles/P
MC1913224) . Antimicrobial Agents and Chemotherapy. 51 (7): 2293–303. doi:10.1128/AAC.00289-
07 (https://doi.org/10.1128%2FAAC.00289-07) . PMC 1913224 (https://www.ncbi.nlm.nih.gov/pmc/ar
ticles/PMC1913224) . PMID 17470652 (https://pubmed.ncbi.nlm.nih.gov/17470652) .
185. Krumm SA, Yan D, Hovingh ES, Evers TJ, Enkirch T, Reddy GP, et al. (April 2014). "An orally available,
small-molecule polymerase inhibitor shows efficacy against a lethal morbillivirus infection in a large
animal model" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4080709) . Science Translational
Medicine. 6 (232): 232ra52. doi:10.1126/scitranslmed.3008517 (https://doi.org/10.1126%2Fscitranslme
d.3008517) . PMC 4080709 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4080709) .
PMID 24739760 (https://pubmed.ncbi.nlm.nih.gov/24739760) . Lay summary (https://www.newscienti
st.com/article/dn25432-will-an-antiviral-drug-put-paid-to-measles/) .
External links
Classification ICD-10: B05 • ICD-9-CM: 055 • D
MeSH: D008457 • DiseasesDB: 7890
External resources MedlinePlus: 001569 •
eMedicine: derm/259 (https://emedicine.meds

cape.com/derm/259-overview) emerg/389 (h
ttp://www.emedicine.com/emerg/topic389.ht
m#) ped/1388 •
Patient UK: Measles
Wikiquot e has quot at ions relat ed t o: Measles
Wikimedia Commons has media relat ed t o Measles.
Init iat ive for Vaccine Research (IVR): Measles (ht t ps://www.who.int /vaccine_ research/disease
s/measles/en/) , World Healt h Organizat ion (WHO)
Measles FAQ (ht t ps://www.cdc.gov/measles/about /faqs.ht ml) U.S. Cent ers for Disease
Cont rol and Prevent ion (CDC)
Case of an adult male wit h measles (facial phot o) (ht t p://news.bbc.co.uk/1/hi/healt h/738502
0.st m)
Pict ures of measles (ht t p://www.skinsight .com/child/rubeolaMeasles.ht m)
Virus Pat hogen Dat abase and Analysis Resource (ViPR): Paramyxoviridae (ht t p://www.viprbrc.or
g/brc/home.do?decorat or=paramyxo)
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Other names Morbilli, rubeola, red measles, English

A child showing a day-four measles rash

Symptoms Fever, cough, runny nose, inflamed eyes, rash[3][4]

Complications Pneumonia, seizures, encephalitis, subacute

Usual onset 10–12 days after exposure[7][8]

Duration 7–10 days [7][8]

Causes Measles virus [3]

Prevention Measles vaccine[7]

Treatment Supportive care[7]

Frequency 20 million per year[3]

Deaths 140,000+ (2018)[9][10]

Video summary (script)

Signs and symptoms

Koplik's spots on the third pre- eruptive day

An electron micrograph of the measles virus

Drawing of the measles virus attaching to the lining of the trachea

In developed count ries, it is recommended t hat children be immunized against measles at 12

Disability-adjusted life year for measles per 100,000 inhabitants in 2004

Reported cases [99][100][101][102][103][104][105]

Measles cases in the US from 1938 to 2019

Democratic Republic of Congo

16th-century Aztec drawing of someone with measles

Society and culture

1. Milner DA (2015). Diagnostic Pathology: Infectious Diseases E-Book (https://books.google.com/books?i

2. Stanley J (2002). Essentials of Immunology & Serology (https://books.google.com/books?id=nuCT5RVT

3. Caserta, MT, ed. (September 2013). "Measles" (https://www.merckmanuals.com/professional/pediatric

4. "Measles (Rubeola) Signs and Symptoms" (https://www.cdc.gov/measles/about/signs-symptoms.htm

7. "Measles Fact sheet N°286" (https://www.who.int/mediacentre/factsheets/fs286/en/) . World Health

8. Conn's Current Therapy 2015 (https://books.google.com/books?id=Hv8fBQAAQBAJ&pg=PT189) .

10. "Global Measles Outbreaks" (https://www.cdc.gov/globalhealth/measles/globalmeaslesoutbreaks.ht

12. "Measles (Red Measles, Rubeola)" (https://web.archive.org/web/20150210111358/http://www.health.go

14. "Measles fact sheet" (https://www.who.int/news-room/fact-sheets/detail/measles) . World Health

17. Chen S.S.P. (22 February 2018). Measles (https://web.archive.org/web/20110925023230/http://emedici

25. "Measles – European Region" (https://www.who.int/csr/don/06-may-2019-measles-euro/en/) . World

26. "Pinkbook Measles Epidemiology of Vaccine Preventable Diseases" (https://www.cdc.gov/vaccines/pub

27. "Measles" (https://www.merckmanuals.com/professional/pediatrics/miscellaneous-viral-infections-in-inf

32. "Symptoms of measles" (https://web.archive.org/web/20110131164435/http://www.nhs.uk/Conditions/

43. Ellison JB (February 1931). "Pneumonia in Measles" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1

44. "Measles" (https://www.cdc.gov/measles/hcp/index.html) . Centers for Disease Control and Prevention

50. "Measles" (https://www.cdc.gov/measles/hcp/index.html) . Centers for Disease Control and Prevention

57. Textbook of Microbiology & Immunology (https://books.google.com/books?id=HcgGLfxDJSQC&pg=P

59. Schaechter's Mechanisms of Microbial Disease (https://books.google.com/books?id=OM2rujts8P0C&pg

61. "Surveillance Manual | Measles | Vaccine Preventable Diseases | CDC" (https://www.cdc.gov/vaccines/pu

62. "Measles" (https://www.cdc.gov/measles/hcp/index.html) . Centers for Disease Control and Prevention

69. "Global goal to reduce measles deaths in children surpassed" (http://www.unicef.org/media/media_3807

78. Rezaie SR. "Measles: The Sequel" (https://epmonthly.com/article/measles-the-sequel/) . Emergency

80. Reye's Syndrome (https://www.ninds.nih.gov/Disorders/All-Disorders/Reyes-Syndrome-Information-Pa

81. "Frequently Asked Questions about Measles" (https://www.doh.wa.gov/YouandYourFamily/IllnessandDis

88. "NINDS Subacute Sclerosing Panencephalitis Information Page" (http://www.ninds.nih.gov/disorders/su

89. 14-193b. (http://www.merck.com/mmpe/sec14/ch193/ch193b.html) at Merck Manual of Diagnosis

95. "Measles Data and Statistics" (https://www.cdc.gov/measles/downloads/measlesdataandstatsslidese

97. "Complications of measles" (https://www.cdc.gov/measles/about/complications.html) . Centers for

98. "Pinkbook | Measles | Epidemiology of Vaccine Preventable Diseases | CDC" (https://www.cdc.gov/vaccin

99. "Measles" (https://web.archive.org/web/20130814150053/http://www.who.int/immunization_monitorin

100. "Measles Surveillance Data" (https://web.archive.org/web/20150703130205/http://www.who.int/immuni

103. "Measles—United States, 2005" (https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5550a2.htm) .

106. UNICEF Joint Press Release (http://www.unicef.org/media/media_38076.html) Archived (https://web.

110. "New measles surveillance data for 2019" (https://www.who.int/immunization/newsroom/measles-data-

115. "WHO EpiData" (http://www.euro.who.int/__data/assets/pdf_file/0004/394060/2019_01_Epi_Data_EN_J

117. "European Region loses ground in effort to eliminate measles" (https://web.archive.org/web/202004140

118. "Region of the Americas is declared free of measles" (https://www.paho.org/hq/index.php?option=com_

119. "Measles spreads again in the Americas" (https://en.mercopress.com/2018/03/28/measles-spreads-ag

123. {cite web|url=https://6abc.com/504818/%7Ctitle=1991 : The Philly measles outbreak that killed 9