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<\/p>\nHistorically, measles has been an illness doctors only learned about in textbooks. With increasing measles outbreaks in the U.S. and around the world, that\u2019s changing.<\/p>\n
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The measles rash (seen here) often starts on the face and neck before spreading downward. <\/p>\n
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Here are the numbers<\/a>: The Centers for Disease Control & Prevention reported 2,255 confirmed measles cases in the U.S. in 2025. There have been 416 more confirmed cases as of the first twenty-three days of January. An ongoing South Carolina outbreak hit 789 cases<\/a> as of January 27, 2026.<\/p>\n Here are five things families need to know about the measles, from the perspective of a practicing ER doctor.<\/p>\n 1. The Measles Is More Than \u201cJust A Rash\u201d<\/p>\n The measles, in fact, is a full-body viral infection. Here\u2019s how it typically goes. Following an exposure, symptoms usually appear 7-14 days later: a high fever, cough, runny nose, and red, watery eyes. A classic early clue is what are called \u201cKoplik\u201d spots (see image below), tiny white dots that form inside the mouth. <\/p>\n These are Koplik spots\u2014tiny white lesions in the mouth. They are a diagnostic hallmark of measles, often appearing several days before the classic rash and signaling high contagiousness.<\/p>\n https:\/\/www.cdc.gov\/measles\/signs-symptoms\/photos.html<\/p>\n Then comes the rash, commonly 3-5 days after the first symptoms. The measles rash often starts on the face and spreads downward, with concomitant fevers spiking dangerously to 104\u00b0F or higher.<\/p>\n Several issues contribute contagion in the measles. First, people are typically contagious from four days before the rash starts through four days after. This means people can spread measles before they know they have it. Furthermore, the virus can remain infectious in the air for up to 2 hours after an infected person leaves a room. The measles is one of the most contagious known viruses.<\/p>\n This combination is why measles can rip through schools, clinics and crowded spaces with terrifying speed.<\/p>\n 2. Measles Outbreaks Are Spiking Because Vaccinations Are Down<\/p>\n Because measles is so contagious, it requires ~95% community immunity to reliably stop its spread. As vaccine coverage ticks down, outbreaks ignite.<\/p>\n In the U.S., kindergarten measles-mumps-rubella (MMR) vaccination rates dropped<\/a> from 95.2% in 2019\u20132020 to 92.5% in 2024\u20132025, according to CDC. This left 280,000 kindergartners unprotected. A drop in vaccine coverage of just a few percentage points is important. In a classroom of 20 kids, just 1 or 2 unvaccinated children can fuel a local outbreak.<\/p>\n Vaccine coverage also varies significantly by state and community. In the 2024-2025 school year, exemptions<\/a> increased to 3.6% from 3.3% the year before. Seventeen states reported exemptions over 5%. Localized hotspots like this create the conditions for measles outbreaks. <\/p>\n