Measles is a highly contagious infection caused by the measles virus. Initial signs and symptoms typically include fever, often greater than 40 °C (104.0 °F), cough, runny nose, and inflamed eyes. Two or three days after the start of symptoms, small white spots may form inside the mouth, known as Koplik's spots. A red, flat rash which usually starts on the face and then spreads to the rest of the body typically begins three to five days after the start of symptoms. Symptoms usually develop 10–12 days after exposure to an infected person and last 7–10 days. Complications occur in about 30% and may include diarrhea, blindness, inflammation of the brain, and pneumonia among others. Rubella (German measles) and roseola are different diseases. Measles is an airborne disease which spreads easily through the coughs and sneezes of those infected. It may also be spread through contact with saliva or nasal secretions. Nine out of ten people who are not immune and share living space with an infected person will catch it. People are infectious to others from four days before to four days after the start of the rash. People usually do not get the disease more than once. Testing for the virus in suspected cases is important for public health efforts. The measles vaccine is effective at preventing the disease. Vaccination has resulted in a 75% decrease in deaths from measles between 2000 and 2013 with about 85% of children globally being currently vaccinated. No specific treatment is available. Supportive care may improve outcomes. This may include giving oral rehydration solution (slightly sweet and salty fluids), healthy food, and medications to control the fever. Antibiotics may be used if a secondary bacterial infection such as pneumonia occurs. Vitamin A supplementation is also recommended in the developing world. Measles affects about 20 million people a year, primarily in the developing areas of Africa and Asia. It causes the most vaccine-preventable deaths of any disease. It resulted in about 96,000 deaths in 2013, down from 545,000 deaths in 1990. In 1980, the disease was estimated to have caused 2.6 million deaths per year. Most of those who are infected and who die are less than five years old. The risk of death among those infected is usually 0.2%, but may be up to 10% in those who have malnutrition. It is not believed to affect other animals. Before immunization in the United States, between three and four million cases occurred each year. As a result of widespread vaccination, the disease was eliminated from the Americas in 2016.