PUBLIC HEALTH
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MEASLES SYMPTOMS INCLUDE:
• Fever, usually 101°F up to 105°F
• Malaise
• Cough, coryza and conjunctivitis—the three “C”s
• Koplik spots - pathognomonic enanthema of clustered, white le-
sions on an erythematous background, the buccal mucosa opposite
the upper 1st and 2nd molars
• Maculopapular rash usually appears about 14 days after a person
is exposed.
» » Typically lasts three or more days
» » Spreads from the head to the trunk to the lower extrem-
ities
» » May not develop rash if immune compromised
THOSE AT RISK FOR INFECTION:
• Most outbreaks in the US occur in unvaccinated individuals.
• Recent international travelers, or travelers to US locations where
a measles case has been identified, may be at risk. Recent outbreaks
in the US have been related to travel to Israel and Ukraine.
THOSE AT HIGH RISK FOR SEVERE ILLNESS AND
COMPLICATIONS:
• Infants and children aged < five years
• Adults aged >20 years
• Pregnant women
• People with compromised immune systems, such as from leukemia
and HIV infection
CONTAGION PERIOD:
Individuals are often contagious for several days prior to recogniz-
ing symptoms and seeking health care, or before being diagnosed
with measles.
• The incubation period is 11-12 days
• Measles RNA by real-time polymerase chain reaction (RT-PCR)
or viral culture. This can be done on throat, nasopharyngeal swabs
and urine. Virus isolation is most likely successful when collected
within three days of rash onset but may be detected up to 10 days
after rash develops. Vaccinated persons may not have an IgM re-
sponse, so RT-PCR testing may be the best method to confirm such
cases when IgM is negative.
• Staff at the CDC Measles Laboratory are available for consulta-
tion and can assist with confirmatory testing as needed for measles.
For details on all types of specimens (serum, respiratory, urine)
collection and transport, see the CDC Measles Laboratory website
at http://www.cdc.gov/measles/lab- tools/index.html.
• Molecular analysis can also be conducted to determine the gen-
otype of the measles virus. This helps health departments map the
transmission pathways of measles viruses and identify potential
links for cases. It also can distinguish between wild-type measles
virus infection and a rash caused by recent measles vaccination.
REPORTING - WHAT INFORMATION SHOULD I RE-
PORT TO THE HEALTH DEPARTMENT?
Complete the demographic and laboratory information found
on the Epid 200 form at https://louisvilleky.gov/sites/default/files/
health_and_wellness/communicable_disease/epid_200_kentucky_
reportable_disease_form.pdf. For measles cases, the additional
clinical information is needed for all case investigations, and can
be sent to the local health department, if known:
1. Clinical symptoms: Date of onset of symptoms, date of rash
onset, prodromal symptoms, and any complications
2. Outcome of the illness (if known): Was hospitalization required?
Were there any complications of the illness?
3. Patient’s Vaccination status: Number of doses of measles vaccine
received, dates of measles vaccination, & reason if not vaccinated
4. If applicable, postexposure prophylaxis type (vaccine, IGIV,
IGIM) and date of administration of postexposure prophylaxis
5. Additional Epidemiological Information:
• Most people develop rash at day 14, but this can range between
seven and 21 days » » What setting was the disease transmitted, if known? (e.g.,
household, school, health care, event)
• Most people are infectious from four days before until four days
after the onset of rash » » Is the source of infection known? (e.g., age, vaccination
status, relationship to case, contact with probable or con-
firmed case, or contact with immigrants or travelers, or
international travel)
» » Travel history internationally, out-of-state, or locally, in
the three weeks prior to symptom onset
• People with measles should be quarantined (isolated) until infec-
tious period is over, typically four days after rash onset
TESTING FOR MEASLES:
Laboratory confirmation is essential for all measles cases. Efforts
should be made to obtain a serum sample and throat swab (or
nasopharyngeal swab) from suspected cases at first contact. The
following are recommended options for laboratory testing:
• Measles serum IgM antibody testing. IgM antibodies usually
appear within one to four days of rash onset, peak within a week
after rash onset, and are undetectable by six to eight weeks after the
rash resolves. IgG can be useful in cases where IgM is negative and
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convalescent serum testing is needed.
LOUISVILLE MEDICINE
PREVENTING MEASLES:
• Make every effort to vaccinate non-immune individuals prior
to exposure
• Children aged six to 11 months who are in outbreak situations or
travel internationally to endemic areas should receive one dose of
MMR vaccine at least two weeks prior to travel. Children vaccinated
before age 12 months should receive two additional doses of MMR
or MMRV vaccine on or after the first birthday according to the