Measles Information for Providers

Definitions

Clinical definition: Measles is characterized by a prodrome of fever, malaise, cough, coryza, conjunctivitis, and Koplik spots (clustered white lesions on the buccal mucosa), followed by onset of a maculopapular rash.

Incubation period: The incubation period is typically 11–12 days from exposure to measles virus until the first symptoms appear (prodromal symptoms). A rash follows the prodromal symptoms 2–4 days later and usually lasts 5–6 days. Measles is infectious 4 days before and 4 days after rash onset. 

Actions Requested: Prepare for a Measles Case

Verify Immunity for Healthcare Personnel

• Review guidance for immunization of health care workers with MMR vaccine and ensure healthcare personnel have documented evidence of measles immunity (before an exposure).
• People are considered immune to measles if: 
  • They were born before January 1, 1957 (except healthcare workers who should consider receiving at least one dose of measles-containing vaccine) OR 
  • Have documentation of healthcare provider-diagnosed measles, OR 
  • Have laboratory evidence of immunity to measles, OR 
  • Have written documentation to 2 doses of MMR vaccine. 
    • GCHD recommends checking titers if unable to prove immunity to measles 
    • Two doses of MMR vaccine should be given at the appropriate interval for non-immune healthcare personnel regardless of age.

Actions Requested: Respond to a Suspected Measles Case

Consider measles in patients presenting with febrile rash illness and clinically compatible measles symptoms, especially if they recently traveled to an affected area; or were exposed to a person with febrile rash illness. Grant County healthcare providers are required to report suspected measles cases to Grant County Health District (GCHD).

Use the Measles Quicksheet for Providers when assessing patients with measles like illness. 

Isolate

• Have a planned triage process for patients with fever and rash so these patients are not waiting in common areas with other people. 
• Patients with rash and fever should not stay in waiting rooms or other common areas. 
• Immediately isolate patients with suspected measles in an airborne infection isolation room (AIIR) or a private room with a closed door. 
• Follow standard and airborne precautions when evaluating suspected cases, regardless of vaccination status. 
• After the patient is discharged, do not use or allow staff to enter the room for 2 hours.
• Follow recommendations for healthcare personnel that have exposure to measles. 

Notify

Report suspected measles cases to GCHD immediately by calling investigations & response staff directly at 509-766-7960 EXT 0 (or after hours, call 509-398-2083). State that you are calling about a suspected measles case.

Test

• What specimen to collect: 
  • Swab of nasopharyngeal (NP) swab for PCR testing (Preferred specimen type, if within 72 hours of symptom onset) 
  • Urine for PCR testing (In addition to the NP swab if ≤ 10 days post symptom onset) 
  • Serum for IgM 
  • How to collect: 
    • NP: Collect only using synthetic tip swabs (i.e., Dacron, Nylon, Polyester) with nonwooden shaft. Place swab directly in 2-3 ml of viral transport media (VTM). 
    • Urine: Collect in sterile screw capped specimen container. Collect a minimum of 20 ml of urine (50 ml preferred) 
    • Serum for IgM: Centrifuge blood collection tubes (10 minutes at 1000-1300 g) to separate serum from clot. Gel separation tubes should be centrifuged no more than 2 hours after collection. Aseptically transfer serum to a sterile tube that has an extremely threaded cap. Minimum serum volume 0.6 ml (1 ml preferred) 
    • When to collect: 
      • NP: Collect at illness. For optimal isolation, collect within 72 hours of symptom onset. 
      • Urine: Collect ≤ 10 days post symptom onset. 
      • Serum for IgM: Not preferred for confirmatory testing. 
    • Call GCHD for further guidance.  

Manage

• Isolation
  • Suspected Measles: A patient with suspected measles must remain ISOLATED (stay home excluded from all public places), until lab results confirm they are negative for measles. 
  • Close Contact: Susceptible close contacts to an infected individual must remain QUARANTINED (stay home, excluded from all public places), through the specified incubation period, or for at least 21 days after the last known exposure. 
• Post-Exposure Prophylaxis of Close Contacts
  • To potentially provide protection or modify the clinical course of disease among susceptible persons, either administer MMR vaccine within 72 hours of initial measles exposure, or immunoglobulin (IG) within six days of exposure.
    • Do not administer MMR vaccine and IG simultaneously, as this practice invalidates the vaccine. 
    • Individuals who should receive immunoglobulin (IG) due to severe disease and complications include:
      • Infants <12 months of age 
      • Infants 6-11 months of age can receive MMR vaccine in place of IG, if administered within 72 hours of exposure. 
      • Pregnant women without evidence of measles immunity 
      • Severely immunocompromised persons regardless of vaccination status.  
    • IG can be given to others who do not have evidence of measles immunity, however, those with intense, prolonged, close contact exposure should be prioritized.

Immunizations

• Review patient immunization records 
  • Evidence of adequate vaccination for school-aged children, college students, and students in other postsecondary educational institutions who are at risk for exposure and infection during measles outbreaks consists of 2 doses of measles containing vaccine separated by at least 28 days. 
  • Laboratory evidence of immunity or lab evidence of disease.
• Recommend the MMR vaccine for all patients over the age of one regardless of birth year. Documentation of age-appropriate vaccination with a live measles virus-containing vaccine: Immunization Schedules | Vaccines & Immunizations | CDC
• MMR recommendations for travel *Updated April, 2025*