How to Spot Measles Symptoms in Adults as Outbreaks Spread in the US

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28-02-2025

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News of measles cropping up and circulating again can be unnerving for a bunch of reasons, not the least of which being that you may not be super familiar with it. The respiratory infection is easy to confuse with a cold or the flu, at least in its early stages—but because it's mega-contagious and can put you at risk for long-term complications, knowing how to identify measles symptoms in adults is important for determining whether you should get tested and self-isolate.
Recognizing key signs of the illness is especially pertinent right now: A measles outbreak spanning neighboring counties in Texas and New Mexico has sickened more than 120 people as of the time this story was published (up from around 20 cases earlier this month) and killed one child. And it's spreading so fast, the CDC is now updating this tracker page every Friday. (Alaska, California, Georgia, New Jersey, New York City, and Rhode Island have also reported cases in 2025.)
To be clear, this is a significant number; in all of 2024, there were 285 measles cases, and we've already surpassed 100 in February. It's especially bewildering when you consider that measles was declared 'eliminated' from the United States in 2000 thanks to widespread adoption of an effective vaccine as part of the CDC's childhood immunization schedule.
So what's going on? Well, measles is still prevalent elsewhere in the world, making it possible for people returning from travel or visiting the US to 'import' cases, Roy Gulick, MD, chief of the division of infectious diseases at Weill Medical College of Cornell University, in New York, tells SELF. And rates of vaccination in the US have also been decreasing since before the COVID pandemic, dropping to under 93% in the 2023–2024 school year—below the 95% necessary for herd immunity—and much lower in some states and counties, like the ones where the current outbreak is raging. In fact, 95% of this year's US cases are in people who are unvaccinated or whose vaccination status is unknown.
There's also the fact that, in the first few days of having measles, the symptoms can mimic any ol' respiratory infection—before the signature rash sets in, Theresa L. Lovins, MD, a family medicine physician in Columbus, Indiana, and member of the board of directors of the American Academy of Family Physicians, tells SELF. But you're already contagious then, so you might continue going about your usual routine, powering through what you think is a bad cold while inadvertently infecting others, she explains.
It doesn't help that measles can spread extremely easily. Like its respiratory cousins, it moves via droplets (the spray that happens when you talk or cough), but this particular virus can travel in the tiniest ones, staying in the air for up to two hours. So even if you just enter a space where someone with measles had recently been, you could breathe it in and get sick if you aren't immune, Dr. Lovins says. In fact, if you put a person with measles in a room with 10 people who are not immune to the virus, nine of them will catch it—which just underscores the importance of being fully vaccinated against it (more on this below).
Read on to learn about the symptoms of measles so you can spot it swiftly if it comes your way, as well as how it's diagnosed, what recovery typically looks like, and the potential complications that make it crucial to protect yourself and your loved ones.
As mentioned, the virus has pretty unassuming beginnings: You can expect the typical slate of upper respiratory symptoms that you might get with a cold or the flu, Dr. Lovins says. It's also worth noting that adults can be down bad with a measles-related fever, she adds, which can commonly climb to 104°F or higher. You'll probably be knocked out, or at least feel the need to be horizontal. (By comparison, children can often power through high fevers more easily and might not be quite so out-of-commission.) Within a couple days of feeling sick, 50% to 70% of people with measles will also develop something called Koplik spots, which are small, white blisters on the insides of the cheeks.
So to recap, for the first two to four days, common measles symptoms in adults include:
Runny nose
Red, watery eyes
Cough
High fever
Koplik spots (white spots in your mouth)
After this initial phase, you'll get the characteristic measles rash. It'll usually start at the top of your body, near your hairline and on your cheeks, and then move downward to your chest and trunk and finally outward to your limbs, Dr. Lovins says.
On paler skin tones, it shows up as tiny red spots, which then grow in size and overlap to form bigger blotches. It can also be a blanching rash, which means that when you press on the areas, the color goes away, and as you release, it comes back, Dr. Gulick says. On deeper skin tones, the small spots can be tougher to see but may show up as purple or darker than surrounding skin. Across the board, a measles rash also tends to give skin a pebbly or sandpapery texture as the spots multiply and get more consolidated, Dr. Lovins says. Unlike a rash associated with, say, chickenpox, it isn't typically painful or very itchy—though as it sets in you might see your fever spike even higher, Dr. Lovins adds, making you feel increasingly crappy, achy, and fatigued.
All to say, by day five and for up to a week, measles causes a rash that:
Starts on your face and spreads down and out
Shows up as tiny red spots (on light skin) or purply ones (on dark skin) that increasingly join together to form larger patches or splotches
Gives your skin a rough or pebbly texture
Is accompanied by a high fever
Considering both phases of the illness, symptoms typically last 8 to 12 days. And you're contagious throughout—from four days before to four days after the rash shows up.
A measles test is much like a COVID test: It typically involves a nasopharyngeal swab (or deep nose swab), though it could also be done with a throat swab, the way you'd get tested for strep throat. In either case, a PCR test on the sample can readily detect the virus's genetic material. (Less commonly, your provider might run a PCR on a urine sample—but the CDC prefers the other two options for accuracy.) Your doc may also order a blood test to check for antibodies to measles, Dr. Gulick says, which is generally positive in someone who's been recently exposed, so long as it's been at least three days since symptoms started.
It's worth noting that because the initial symptoms of measles closely resemble a cold or the flu—and catching either of the latter is far more common—your doctor probably won't test you for it if you're just feeling snotty, feverish, or generally lousy. But that can change in the setting of exposure, Dr. Gulick explains. So if you live in an area with an outbreak, you've recently traveled somewhere that hasn't fully contained measles (like many parts of Africa and Asia), or you've shared airspace with someone who just got back from one of these places and you have those cold symptoms, then your doctor may suggest testing, he says. And certainly if you've developed Koplik spots or the signature rash, they could move right to a diagnosis based on your symptoms alone and will also test you to confirm.
The bad news is, there's no treatment for measles itself—as in, nothing to kill the virus that causes it. So you just have to let it run its course.
In the meantime, you can certainly take fever-reducers like acetaminophen (Tylenol) to feel a little more comfortable. And you'll want to get plenty of rest, drink ample fluids, and stay well-nourished to help your immune system fight the virus. Most people will start to feel better within a couple days of developing the rash and recover completely in a week's time, Dr. Gulick says.
While, again, the majority of people do recover fully from measles without issue, as many as 30% of infected folks will go on to develop a complication of the virus, Dr. Gulick says, which can be pretty serious. And he emphasizes that along with children under five years old, adults over 20 are among the groups at highest risk for such problems.
What happens is, the virus can multiply and hitch a ride to other organs in your body if your immune system doesn't tame it in due time. Most commonly, it can head to your GI tract, where it triggers diarrhea, putting you at risk for dehydration, Dr. Gulick says. Like other respiratory viruses, it can also weasel its way into your ears and spark an infection there (though that's most common in kids) or seep into your lungs and cause pneumonia, an infection where the air sacs therein fill with fluid or pus. The latter can get serious very quickly: When your lungs are compromised, you're less able to clear out common bacteria, which can then set up shop and cause a secondary infection, Dr. Gulick explains. (At that point, you may need medical care and antibiotics to treat that.)
The most severe complications from measles, however, are of the neurological variety, occurring when the virus enters your brain. Though it's rare (happening in an estimated 1 in 1000 cases), the virus can cause encephalitis, or brain inflammation, resulting in fevers, headaches, and neck stiffness along with cognitive issues like confusion, seizures, and memory loss—as well as coma and death, if left untreated. (In some cases, about a week after your symptoms start, you can also get a type of autoimmune encephalitis, which occurs when your immune system misfires in response to the virus, Dr. Gulick adds.) And if that wasn't bad enough, in extremely rare circumstances, neurologic fallout from measles is delayed, showing up 7 to 10 years post-infection as subacute sclerosing panencephalitis, a degenerative disease that is ultimately fatal, Dr. Lovins says.
You're at greater risk for any of these scenarios if you're immunocompromised—for instance, you're chronically ill or on steroid therapy, undergoing chemotherapy, or taking other meds that suppress your immune system—or you're pregnant. In the latter case, your baby could be negatively affected too. Research shows measles during pregnancy is linked with a higher risk of premature birth, low birth weight, and even spontaneous abortion, as well as maternal death.
All to say, it's important to be proactive about prevention, and if you do catch measles, you'll want to be vigilant. If it feels like you're getting better, but your symptoms don't completely resolve or new ones crop up, be sure to see your doctor STAT, Dr. Lovins says.
As Dr. Gulick puts it, answers one, two, and three to this question are being fully vaccinated against the virus. That means having had both the recommended shots of the MMR (measles, mumps, rubella) vaccine. While one shot is 93% effective at warding off the virus, two offer up to 97% protection. And even if you're one of the 3 in 100 people who may still get infected while immunized, you'll have a milder case that puts you less at risk of complications than you would if you didn't get vaccinated.
If you are not fully vaccinated or are unsure of your status, your doctor may recommend a measles booster. Ultimately, there's no harm in getting another dose of the vaccine even if you're already protected—and it's better to be safe than sorry if you're traveling to an area with an outbreak or a country where measles is endemic. In that case, aim to get the vaccine at least two weeks pre-trip, Dr. Lovins says, to ensure your body has time to respond and develop immunity beforehand.
The only exception here is for certain heavily immunocompromised folks, who may not be eligible to get the MMR shot because it contains live parts of the virus (which can cause infection in those people), Dr. Gulick says. As he points out, that's all the more reason for everyone else to do their part in getting vaccinated: When we achieve the 95% vaccination rate necessary for herd immunity, we can keep the spread of measles at bay—and prevent it from reaching those people who don't share the same privilege of vaccination.
If you do wind up getting exposed to measles and you haven't been vaccinated (or don't know for sure), you may still be able to take some steps to avoid getting sick—if you act fast. According to the CDC, getting an MMR shot within three days of your run-in with measles can provide some protection. And if you can't receive the vaccine because you're immunocompromised or pregnant, you may also be able to receive a medication called IVIG (intravenous immunoglobulin) or IMIG (intramuscular immunoglobulin), both of which contain antibodies from healthy blood donors, Dr. Gulick says. It's basically like sending in supplemental fighters to bolster your body's defense against the virus. You'll get the surest protection if you receive it within three days of exposure to measles, but it can be given up to six days afterward.
Again, know that if you've received both shots of the MMR vaccine at any point in time, you're highly unlikely to get sick from measles (even during an outbreak). And in the rare case that you do, taking care of yourself as you recover and keeping your doc in the loop on how you feel and any additional symptoms that arise will help you get back to 100% as quickly as possible.
Related:
4 Doctors on the Frustration, Anxiety, and Fear of Treating Patients with Vaccine-Preventable Illnesses
This Is What It's Like When Your 4-Month-Old Catches Measles
My Child Can't Get Vaccinated. Here's What Life Is Like for Us.
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Originally Appeared on Self