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School Nurse Guide to Measles – Rubeola


“Nurse Kevin, we don’t believe in immunizations; we feel that we should allow our child’s own immune system to get strong.” There are many, many different objections parents give me about immunizations, but this one was…well…I had never heard one like this before. Truth be known, why don’t we just ask our children to lick the inside rim of a gas station men’s room urinal? Will you have a strong immune system? Maybe…if you don’t catch something you can’t get rid of.

There are those “bugs” and “cooties” out there that a healthy immune system will be the best, first-line defense from. And, there are those “bugs” and “cooties” out there that will surely strengthen your immune system…provided you survive the infection. And, my fellow medical practitioners, there are some “bugs” and “cooties” out there that fall under the category of “once you got it…you got it!”

Note: This article is about measles,not about vaccinations. There’s no one who will have a reasonable argument against the measles vaccine in preventing measles. The argument comes from the assumptions of the undesired side effects of the vaccine. Nonetheless, we will talk about vaccines only in the relationship of measles prevention.

What is measles (rubeola)?

Measles is the result of being infected by the measles virus. Measles affect only humans. No animal can get measles or be a carrier of measles (as of yet). Measles, or rubeola, is a respiratory infection. Yes, after a few days, a rash appears, leading many to think that measles is a skin infection. The rash is secondary to the effects of the body’s own immune system kicking into gear in response to the measles virus.

The virus is not localized within the respiratory system; it is found in the bloodstream and presents with respiratory symptoms (we’ll chat about that later). When our body’s immune system finds this virus “doing its thing,” the immune system “attacks” the virus by releasing chemicals to kill the measles virus. These natural, biological chemicals affect the skin, and the resulting rash appears. It’s not like chicken pox; it’s more like an allergic rash (but not exactly).

What are the signs and symptoms of measles?

The incubation period is about 8-12 days. You will likely see no signs or symptoms of illness during this week or so. However, these little children will be contagious starting about 2 days BEFORE symptoms appear.

The initial findings will be cold-like or flu-like symptoms. There’ll be hacking coughing, a runny nose, and red, watery eyes. There’ll be an elevated temperature, and you may see that number get at or around 104°F to 105.8°F (40°C to 41 C).

About 2-5 days after the onset of initial symptoms is when the telltale findings began to present. Koplik’s spots may form inside the mouth (but not always) about 2-3 days before the measles rash itself. Koplik’s spots (also known as Koplik’s sign) look like “grains of salt on a wet background.” Koplik’s spots are a prodrome to measles.

Prodrome. Whenever we school nurses see a sign or symptom that causes us to step back and say, “They ain’t sick, but they are getting sick,” that’s a prodrome. It’s kinda like a sign that says, “Stop Ahead” before you get to the actual intersection or stop sign.

While Koplik’s spots show up 2-3 days after symptoms start, the rash appears 1-3 days after that. This reddish-brown, flat rash will start on the forehead, hairline, and face, then work its way over the rest of the body (3-5 days after the first symptoms appear).

If you have a child with cold-like or flu-like symptoms, and you see on their oral mucous membrane these little “grains of salt on a wet background,” you should suspect measles. No, you will not see these spots in every case, but then again…up and to now…seeing even one case in the United States for most of us school nurses would be a rare event. (I’ve been at this nursing gig for about 21 years.)

Measles timeline

Measles Timeline
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