Skip to textbook content
Doctor’s PassportTextbook
TopicsAll topics

Loading topic navigation…

Textbook navigation
TopicsAll topics

Loading topic navigation…
Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.

Measles, mumps, rubella and varicella

Paediatrics and child health · UK scope · Sources checked 27 Aug 2026 · Clinical review pending

RapidFull
!
Respiratory, neurological or high-risk-host disease

Breathing difficulty, hypoxaemia, encephalopathy, seizure, severe dehydration, haemorrhagic lesions or rapidly painful inflamed chickenpox skin suggests a serious complication. Varicella or measles can be life threatening in neonates or immunocompromised children.

Action: Arrange emergency paediatric assessment and warn the receiving service before arrival so airborne or respiratory isolation is ready. Stabilise airway, breathing, circulation and glucose, investigate bacterial and neurological complications, and obtain infection-specialist advice on intravenous antiviral, antimicrobial, immunoglobulin and critical-care treatment.

Synopsis

Differentiate four vaccine-preventable viral infections, recognise severe and pregnancy-related risks, arrange testing and notification without exposing others, and use current MMRV and post-exposure pathways safely.

  • Measles classically causes high fever, cough, coryza and conjunctivitis followed by Koplik spots and a maculopapular rash spreading from face and hairline downwards.
  • Mumps usually causes painful unilateral or bilateral parotid swelling after fever, malaise and headache; orchitis, meningitis, pancreatitis and hearing loss are important complications.
  • Rubella is often mild or asymptomatic, with low-grade fever, post-auricular or suboccipital lymphadenopathy and a fine rash spreading from face to trunk; pregnancy exposure is the critical emergency.
  • Varicella produces intensely itchy crops of macules, papules, vesicles and crusts at different stages, usually concentrated on scalp and trunk, with possible mucosal lesions.
  • Call ahead before face-to-face assessment of suspected measles, rubella, mumps or varicella. Separate the child from vulnerable patients and apply the organism-specific respiratory or airborne precautions.
  • Measles, mumps and rubella are notifiable on clinical suspicion. Contact the health protection team promptly; do not wait for laboratory confirmation.
  • First-line diagnosis is clinical plus public-health-directed virology. Measles and rubella testing is coordinated with UKHSA; mumps commonly uses an oral-fluid sample; uncertain varicella can be tested by lesion PCR.
  • Management is usually supportive: fluids, rest and suitable paracetamol for discomfort. Never give aspirin under 16, and avoid ibuprofen or other NSAIDs in chickenpox.
  • Admit varicella in babies under 7 days, immunocompromised children, serious complications or continuing new lesions beyond day 5; babies aged 7 to 28 days need low-threshold review.
  • After significant varicella exposure, current UKHSA first-choice prophylaxis for susceptible immunosuppressed people is oral aciclovir or valaciclovir on days 7 to 14; neonatal exceptions may need immunoglobulin.
  • After measles exposure, health protection selects MMRV or MMR ideally within 72 hours for eligible susceptible contacts, or immunoglobulin within 6 days for defined vulnerable contacts.
  • From January 2026 the routine offer uses MMRV. The July 2026 schedule gives a dose at 1 year and an 18-month dose for children born on or after 1 July 2024, with cohort-specific preschool arrangements.

Key red flags

Suspected measles with respiratory distress, hypoxaemia, dehydration, altered consciousness or seizure requires urgent hospital assessment with advance infection-control warning.

Chickenpox with recurrent fever, fever beyond day 3 of rash, respiratory symptoms, neurological change, bleeding, petechiae, haemorrhagic rash or new lesions after day 5 needs urgent paediatric review.

Red, hot, exquisitely painful or rapidly spreading skin around varicella lesions may indicate invasive group-A streptococcal or staphylococcal infection, even when colour change is subtle.

A newborn with possible varicella, or any immunocompromised child exposed to or developing measles or varicella, needs same-day specialist and health-protection assessment.

Severe headache, neck stiffness, reduced consciousness, ataxia, orchitis pain, pancreatitis symptoms or hearing change after mumps requires complication assessment.

Any suspected rubella exposure or illness involving a pregnant person requires immediate health-protection and maternity advice because fetal risk is disproportionate to maternal illness.

Investigation priorities

01
First-line: clinical pattern and exposure historyFirst stepFirst line

Form a working diagnosis while arranging safe infection-control and notification.

Management branches

Suspected caseIsolate, assess and notify

Measles, mumps, rubella or varicella is clinically possible.

  1. Keep the child away from shared clinical areas and tell the receiving service before any face-to-face attendance.
  2. Assess physiological severity and high-risk host status, then apply respiratory or airborne isolation appropriate to the virus.
  3. Notify measles, mumps or rubella on suspicion and arrange UKHSA-directed testing; seek public-health advice for significant varicella exposures or clusters.
Uncomplicated illnessProvide supportive treatment

The child is stable, drinking and has no serious complication or vulnerable-host indication.

  1. Give fluids, rest, skin care and paracetamol for distress using the current age-and-weight dose.
  2. Avoid aspirin in every child and avoid ibuprofen or other NSAIDs during chickenpox.
  3. Give written isolation, deterioration and vulnerable-contact advice, including when and how to seek review without exposing a waiting room.

Key medicines

ParacetamolGive the current product-label or BNFC age-and-weight oral dose at the stated interval and maximum, only while fever, parotid pain or skin discomfort causes distress.Check age, weight, liver disease and all combination products. Do not use temperature response to judge severity, and never give aspirin to a child under 16.
Aciclovir or valaciclovir varicella prophylaxisFor a susceptible immunosuppressed child after significant exposure, give the current UKHSA age-and-weight oral prophylaxis regimen from day 7 through day 14 after the first exposure day.This off-label prophylaxis requires exposure, susceptibility and immune-risk assessment. Adjust for renal function and hydration; active rash requires therapeutic dosing and severe disease may require intravenous aciclovir.
Open full textbook →Answer 2 questions
Sources and review status5 sources · checked 27 Aug 2026 · clinical review pending+
Sources

Sources and review status

National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 27 Aug 2026; clinical approval remains outstanding.

  • UKHSA MMRV programme collectionCurrent 2026 programme material and linked Green Book chapters for all four components.
  • UKHSA national measles guidelinesCase management, notification, testing, infection control and post-exposure assessment.
  • UKHSA varicella prophylaxis guidanceExposure definition, susceptibility thresholds, antiviral timing and neonatal immunoglobulin exceptions.
  • NHSGGC paediatric varicella managementAge-specific admission, complication red flags, lesion PCR and therapeutic escalation.
  • UKHSA routine schedule July 2026Current MMRV timing and birth-cohort distinctions within the national childhood schedule.

Editorial contact: Doctor’s Passport editorial team. Source-check date is separate from clinical approval. Report a content problem ·

Content changes
Authoring stateRapid draftClinical stateAwaiting reviewJurisdictionUnited Kingdom