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Measles can lead to hearing loss, brain swelling, and other issues. Getty Images

When many people hear the word “measles,” they often think of the initial flu-like symptoms followed by a rash three to five days later.

But there are also complications of measles that people need to be aware of.

“Measles can start out as a rash, but it can escalate very quickly to dangerous complications,” said Swapna Reddy, JD, MPH, a health law and policy professor at Arizona State University, in Phoenix.

Children younger than 5 years of age and adults older than 20 years of age are most at risk from measles complications, reports the Centers for Disease Control and Prevention (CDC).

But no one is entirely safe from complications.

“We get concerned about very young babies because we can’t vaccinate them. So of course we see the most complications in that age group,” said Dr. Sharon Nachman, chief of the division of pediatric infectious diseases at Stony Brook University Hospital, in Stony Brook, New York.

“Having said that, if you get measles at any age, you can have complications such as measles pneumonia or measles encephalitis.”

Here’s an overview of the most common and serious complications of measles.

Diarrhea is the most common measles complication, occurring in about 1 in 12 people with measles.

Ear infection is another common complication of measles. About 1 in 14 people with measles will get an ear infection. This occurs mainly in children.

Ear infections aren’t just uncomfortable, but they can also lead to permanent hearing loss.

About 1 in 16 people with measles will develop pneumonia, either viral or bacterial. Pneumonia is the most common cause of measles-related death in children.

Acute encephalitis, or swelling of the brain, occurs in about 1 in 1,000 people with measles.

Symptoms start on average six days after the appearance of the measles rash. These include fever, headache, stiff neck, drowsiness, vomiting, convulsions, and coma.

A 43-year-old El Al Airlines flight attendant recently developed encephalitis after contracting measles. She’s now in a coma and needs a respirator in order to breathe.

About 15 percent of people who develop measles encephalitis will die. Up to one-quarter will have ongoing brain damage afterward.

The World Health Organization reports that in 2017, there were 110,000 measles deaths around the world. The risk is higher in young children and adults.

The most common cause of measles-related death children is pneumonia. In adults, it’s encephalitis.

In the United States, about 1 in 500 people who had measles from 1985 through 1992 died.

Although this is small compared to the rest of the world, measles-related deaths are still a concern — especially with the increase in measles cases in the country in recent years.

“The vast majority of deaths due to measles are happening outside the U.S.,” said Reddy. “But that picture is changing. And it’s going in the opposite direction than we need to be headed.”

Women who develop measles while pregnant have a higher risk of premature labor, spontaneous abortion, or having a baby with a low birth weight.

One complication of measles can occur years after the initial illness. Known as subacute sclerosing panencephalitis (SSPE), this degenerative disease affects the central nervous system.

People develop symptoms on average seven years after having measles, although this ranges from one month to 27 years.

Symptoms include difficulty thinking, slurred speech, stumbling, falling, seizures, and eventually death.

The CDC estimates that 4 to 11 out of every 100,000 people who contracted measles in the United States from 1989 through 1991 were at risk of developing SSPE.

The risk may be higher for people who get measles before 2 years of age.

SSPE has been extremely rare in the United States since the early 1980s. But Nachman said that as measles cases in the country increase, we’re likely to see at least one case of SSPE in the near future.

The success of the measles vaccination program led to the CDC declaring that measles was eliminated from the United States in 2000.

New cases, though, are still being brought into the country by unvaccinated travelers, both Americans and foreign visitors.

Nachman said in order for vaccination programs to continue being successful, misconceptions about vaccines need to be addressed.

One of these is parents’ concerns over the preservative thimerosal.

After 2001, all childhood vaccines no longer included this preservative. In addition, the measles, mumps, and rubella (MMR) vaccine never contained thimerosal.

The CDC also reports that research doesn’t show any link between thimerosal in vaccines and autism.

Vaccination prevents children from getting the measles rash, but also the complications.

“Measles comes with consequences — some happen soon and others come later,” said Nachman. “All of those can be avoided with vaccination.”

In addition, as a result of “community immunity,” this protection can extend to the unvaccinated.

“There are children that are just not capable of being immunized for one reason or another. This may take the form of kids that are immunocompromised, for example,” said Matthew Speer, a faculty research associate at the College of Health Solutions at Arizona State University.