Measles is an infection with the measles virus, which occurs only in humans. It is one of the most contagious infectious diseases of all: even brief contact is enough, and almost all unprotected people who become infected also fall ill.¹
Its reputation as a “childhood illness” is misleading. Measles affects anyone without immunity, and babies and adults in particular often become seriously ill. On top of this comes a special feature that was underestimated for a long time: the virus attacks immune cells and weakens the body's defences for weeks. In addition, a considerable part of the immune memory already built up can be lost — known as immune amnesia. It is being discussed whether this effect can last for up to three years; during this time, those affected are more susceptible to other infections.¹
Something ordinary or measles? Children often have a fever with a rash, and usually a harmless viral infection or a reaction to a medicine is behind it. With measles, several signs typically come together: high fever, runny nose, cough, red eyes — and only a few days later the rash. A look at the vaccination record (Impfpass) helps to put things into perspective.
2. Course: the two phases of measles
On average, 10 to 14 days pass between infection and the first symptoms, and about 14 to 17 days until the rash appears.¹ The illness typically runs in two phases:¹,²
Early stage (catarrhal stage): fever, runny nose, cough and conjunctivitis with red, light-sensitive eyes. Typical are small whitish spots on the inside of the cheeks, called Koplik spots — they are regarded as a clear sign of measles, but cannot always be seen.
Rash (exanthem): after a few days, often on the second to fourth day after the first symptoms, the rash starts on the face and behind the ears and spreads over the body. The brownish-pink blotches merge together. The fever often rises a second time, and those affected are clearly ill.
Fading: the rash lasts around four to seven days and then fades, sometimes with fine peeling of the skin. The exhaustion and susceptibility to infections can last considerably longer.
In babies who still have some of their mother's antibodies, or after antibodies have been given, measles can sometimes be milder. With a severely weakened immune system, on the other hand, the typical rash may be missing while the illness is particularly severe.²
3. Complications: why measles is not a harmless childhood illness
Secondary bacterial infections — common because the immune defences are weakened: middle ear infection, bronchitis and pneumonia.¹ Pneumonia is one of the most dangerous consequences in young children.
Diarrhoea and inflammation of the larynx — the latter with a barking cough and difficulty breathing (measles croup).²
Acute inflammation of the brain (encephalitis) — according to the RKI, in about one in 1,000 cases, usually four to seven days after the rash begins, with headache, fever and impaired consciousness. It is fatal in around ten to 20 per cent of those affected, and 20 to 30 per cent are left with lasting damage.¹
SSPE (subacute sclerosing panencephalitis) — a rare, progressive brain disease that develops years after measles and is always fatal. The younger the child was when they had measles, the higher the risk; for illness in the first year of life, the RKI estimates it at around 170 per 100,000 cases.¹
Pregnancy — measles during pregnancy increases the risk of miscarriage and premature birth and can be severe for the pregnant woman herself.
Get medical help immediately — for breathing difficulties or impaired consciousness, call 112 (emergency number in Germany). Shortness of breath, a whistling sound when breathing in, severe headache with a stiff neck, increasing drowsiness or confusion, and seizures are emergencies. Babies who are barely drinking or are noticeably limp also need medical treatment straight away. See also shortness of breath and fever. Phone ahead if you suspect measles, so that you do not infect anyone in the waiting room.
4. Transmission, risk groups and medicines
Transmission through the air: via droplets and very fine particles when breathing, coughing and speaking. The virus can remain in the air of a room for a while after the sick person has left.¹
Contagious phase: from as early as four days before the rash begins until, as a rule, four days afterwards — in other words, before anyone is thinking of measles.¹
Vaccination gaps in adults: many people born after 1970 have not been vaccinated at all or only once. STIKO, the German Standing Committee on Vaccination, recommends vaccination for them.³
Babies: children under eleven months are usually not yet vaccinated and rely on the protection of the people around them.
Weakened immunity due to medicines: people receiving immunosuppressants, chemotherapy, biologics or high-dose cortisone usually must not be given the live vaccine and become particularly seriously ill. These people depend on as many others as possible being vaccinated.
Are you planning immunosuppressive treatment? Then have your measles protection checked beforehand. The MMR vaccination is a live vaccine and usually has to be given before treatment starts — afterwards it is often no longer possible. Immunoglobulins or blood products can also weaken the effect of the vaccination for several months. More in the guide Vaccines and medications.
5. Diagnosis and notification requirement
The clinical picture is often typical. Because measles has become rare and is easily confused with other illnesses, every suspected case is confirmed in the laboratory.¹
Call ahead: the practice can then give you an appointment in a way that means no one in the waiting room is infected.
Bring your vaccination record: the number and dates of measles vaccinations are crucial for the assessment.
Laboratory confirmation: detection of antibodies in the blood and of the virus's genetic material from a throat swab or urine.¹
Notification to the public health office: doctors must report even a suspected case without delay, as well as illness and death; laboratories report detection of the pathogen.¹ The local public health office (Gesundheitsamt) then traces contacts.
Telling it apart: rubella, fifth disease, roseola, scarlet fever — and a drug rash, for example a few days after starting an antibiotic — can look similar. That is why the question about new medicines is always part of the assessment; more under skin rash.
6. Treatment: what is possible
The sober truth: there is no specific antiviral treatment against the measles virus.¹ The symptoms and complications are treated — the rest is up to the immune system. Which treatment is needed in the individual case is decided by the treating practice.
BasicsRelieve symptoms
Bed rest, fluids, a darkened room
Drink plenty, especially with a high fever and diarrhoea. Dimmed light helps when the inflamed eyes are sensitive to light.
Fever and pain relief
Paracetamol or ibuprofen bring down fever and relieve pain — for children, dosed according to body weight.
ComplicationsTargeted treatment
Antibiotics for secondary bacterial infections
For a middle ear infection or pneumonia caused by bacteria. They do not work against the measles virus itself.
Hospital treatment
In case of shortness of breath, dehydration, encephalitis or severe illness with weakened immunity.
Doctor's decisionVitamin A
Vitamin A for severe illness
The WHO recommends vitamin A for all children under five with measles; in children with vitamin A deficiency, especially those under two, it lowers mortality.¹ Whether it is given in Germany is decided by the paediatrician. It does not replace vaccination.
What does not help: antibiotics “as a precaution” without a bacterial infection, homeopathic remedies or dietary supplements against the virus. And deliberately arranged infections at so-called measles parties needlessly expose children to the complications described in section 3.
7. Fever medicine, antibiotics, vitamin A
Using fever medicine correctly
Paracetamol and ibuprofen are the usual medicines. Important for children: dose according to body weight, keep to the intervals between doses and check that the active ingredient is not already contained in another product. Acetylsalicylic acid (aspirin) is off-limits for children and teenagers with feverish viral infections, because it can trigger a rare, life-threatening condition called Reye's syndrome — more under aspirin.
When an antibiotic becomes necessary
If a bacterial middle ear infection or pneumonia develops as well, the rule is: the antibiotic is taken as prescribed and for the whole duration, even if things get better sooner. If a new rash appears while you are taking the antibiotic, contact the practice — it may come from the illness or be a drug reaction. How to take antibiotics correctly is explained in the guide Taking antibiotics correctly.
Do not give high doses of vitamin A on your own initiative. High doses of vitamin A are toxic: they can damage the liver, bones and nervous system, and during pregnancy the unborn child. After calls to tackle measles with vitamin A instead of vaccination, cases of poisoning in children were reported in the USA. With measles, vitamin A belongs in a doctor's hands — as an add-on for certain severe cases, not as prevention.
Contact with measles while on immunosuppressants: call, do not stop. If you take medicines that suppress the immune system and have had contact with someone who is ill, contact your practice straight away. For people who must not be vaccinated, there is preventive treatment with antibodies, which only makes sense within a few days of the contact. Do not stop your medicines on your own in the meantime — with cortisone and many immunosuppressants, that is risky in itself. Background in the guide Stopping medications.
Immunosuppressants, fever medicine, antibiotic — all in one plan
brite reminds you of every dose and checks for interactions when new medicines are added.
Measles vaccination uses a live vaccine; in Germany it is always given as a combination against measles, mumps and rubella (MMR), and for children sometimes also against chickenpox (MMRV). Single vaccines against measles alone are not available in Germany. STIKO recommends:³
Children: first vaccination at 11 months, second at 15 months. If earlier protection is needed, for example when starting nursery (Kita), the first vaccination can be given from 9 months. There must be at least four weeks between the two vaccinations.¹,³
Adults: people born after 1970 who are unvaccinated, were vaccinated only once in childhood or do not know their vaccination status should be vaccinated once.³
Adults exposed through work: anyone born after 1970 who works, for example, in healthcare, in communal facilities or in accommodation for refugees needs two vaccinations.³
After contact: unprotected people born after 1970 should be vaccinated, ideally within three days of the contact — this can still prevent the illness.¹
More on all vaccinations in adulthood can be found in the guide Vaccinations for adults. If nobody knows any more whether you have been vaccinated, an extra vaccination is usually not a problem — a blood test beforehand is not strictly necessary.
How safe is the vaccination?
Redness and swelling at the injection site and a mild fever are common. In a small proportion of those vaccinated, so-called vaccine measles appears one to two weeks after the vaccination: fever and a faint rash, which are not contagious. Febrile seizures are rare. Vaccination must not be given during pregnancy or when the immune system is significantly weakened.¹,³
Myth: the MMR vaccination and autism. The claim goes back to a 1998 publication that was retracted because of falsified data; its author lost his licence to practise medicine. Numerous large studies with, in total, well over a million children have found no link.⁴
9. The Measles Protection Act: who has to prove what
The Measles Protection Act (Masernschutzgesetz) has been in force in Germany since 1 March 2020. It obliges certain groups to provide proof of adequate protection against measles.⁵ This is not forced vaccination — nobody is vaccinated against their will. But anyone who does not provide the proof must expect consequences.
Who?
What has to be proven?
Consequences without proof
Children aged one and over at nursery (Kita) or with a childminder
From the age of one, one vaccination; from the age of two, two vaccinations
No care at the facility
Schoolchildren
Two vaccinations
No exclusion because school attendance is compulsory, but a fine of up to 2,500 euros is possible
People born after 1970 who work at nurseries, schools, hospitals, practices or care facilities
Two vaccinations
No new employment; for those already employed, the public health office decides, and a fine is possible
Residents of shared accommodation, for example for refugees
Age-appropriate protection against measles
The public health office decides on measures
Table scrolls to the right
Accepted as proof are the vaccination record, a medical certificate confirming existing immunity — for example after having had measles — or a medical certificate stating that vaccination is not possible for medical reasons.⁵ The obligation expressly applies even if only combination vaccines are available. In July 2022, the Federal Constitutional Court of Germany confirmed that the rules are constitutional.⁶
10. When measles occurs around you
Check the vaccination record — yours and your children's. Two documented vaccinations as a rule mean reliable protection.
People who are ill stay at home — according to medical assessment, at least until the fourth day after the rash began; a doctor decides on the return to nursery, school or work. For nurseries and schools, this is governed by § 34 of the German Infection Protection Act (IfSG).¹
Contacts without protection — the public health office can temporarily exclude them from attending communal facilities such as nurseries and schools. Prompt vaccination after contact can shorten this.
Protect babies, pregnant women and people with weakened immunity — they should have no contact with people who are ill.
Before travelling and before a pregnancy — clarify your measles protection in good time. Vaccination is no longer possible during pregnancy; advice in the guide Medications during pregnancy.
Care for children properly — fever medicine according to weight, plenty to drink, no aspirin. More in the guide Medications for children.
Weeks of recovery after measles
Keep a record of fever, cough and medicines over time — so your practice can see whether a complication is looming.
According to the Robert Koch Institute, Germany's national public health institute, contagiousness begins as early as four days before the rash and usually lasts until four days afterwards. Because people are already contagious before the typical rash appears, measles spreads so easily.
STIKO, the German Standing Committee on Vaccination, recommends an MMR vaccination for everyone born after 1970 who is unvaccinated, was vaccinated only once or does not know their vaccination status. Anyone born after 1970 who works, for example, in healthcare, at schools or at nurseries must provide proof of two vaccinations or of immunity under the Measles Protection Act.
No. Under the Measles Protection Act, children aged one and over may only be looked after if protection against measles has been proven: one vaccination from the age of one, two from the age of two. Exceptions apply only with proven immunity or a medical contraindication certified by a doctor.
Many cases heal without lasting effects, but complications such as middle ear infections and pneumonia are common. In about one in 1,000 cases, encephalitis develops, which can be fatal or leave lasting damage. Years later, the always fatal SSPE can occur, especially after measles in infancy and early childhood.
After two vaccinations, this is rare. Anyone who has been vaccinated only once has less reliable protection, which is why STIKO recommends two doses in childhood. Illness in vaccinated people is usually milder.
In children with severe illness, and especially with vitamin A deficiency, vitamin A prescribed by a doctor can lower mortality; the WHO recommends it for all children under five with measles. However, it does not protect against infection and does not replace vaccination. High-dose vitamin A taken on your own initiative is toxic and dangerous.
No. The claim comes from a 1998 publication that was retracted because of falsified data. Large studies involving very many children have found no link between the MMR vaccination and autism.
German Standing Committee on Vaccination (STIKO) at the Robert Koch Institute: STIKO recommendations, Epidemiological Bulletin, current version. Accessed 2026. rki.de
Robert Koch Institute and Paul Ehrlich Institute: answers to common objections to vaccination (MMR vaccination and autism). Accessed 2026 — German source. rki.de
German Federal Institute for Public Health, infektionsschutz.de: Measles Protection Act — questions and answers (as of October 2025) — German source. infektionsschutz.de
Federal Constitutional Court of Germany (Bundesverfassungsgericht): order of 21 July 2022, 1 BvR 469/20 and others (Measles Protection Act) — German source. bundesverfassungsgericht.de
Medicines safely through the infection — with brite
Medical disclaimer: This article is for general information and does not replace medical advice, diagnosis or treatment. If you suspect measles, phone the practice before you go; if there is shortness of breath, seizures, marked drowsiness or a stiff neck, call 112 straight away. People on immunosuppressive treatment should contact their practice promptly after contact alone and must not stop their medicines on their own. The choice of medicine and its dose are always set individually by the treating practice. Last updated: September 2026.
