Measles

Last content update: 12/2/24

Healthcare providers are required to immediately report suspected or confirmed cases of measles to the Public Health Department. Call Public Health immediately, while the patient is still in your office, at (408) 885-4214 and select option 3. After hours, call (408) 998-3438 and ask for the Health Officer on call. Call, do not fax.

The Centers for Disease Control and Prevention (CDC) is reporting an increase of measles in the United States. Between January 1, 2024 and March 28, 2024, at least 97 cases were reported in the United States and five cases were reported in California.

Due to the recent cases, health care providers should be on alert for patients who have: (1) febrile rash illness and symptoms consistent with measles, and (2) have recently traveled abroad, especially to countries with ongoing measles outbreaks. Infected people are contagious from 4 days before the rash starts through 4 days afterwards.

When to suspect measles

Healthcare providers should consider measles in patients with:

Fever, rash, and any of the “3 Cs” – cough, coryza (runny nose), or conjunctivitis
In the prior 3 weeks, any: travel outside of North America, transit through U.S. international airports, or interaction with international visitors (including at U.S. tourist attractions).

Ask about measles vaccination status, onset and duration of fever and rash, exposure to other persons with febrile rash illness, travel history, and international visitors in the three weeks prior to illness. When suspecting measles in your patient, immediately mask and isolate the patient per airborne precautions. Infected people are contagious from 4 days before rash onset through 4 days after rash onset.

Recommendations for suspected cases of measles

Mask and Isolate: Mask and isolate the patient immediately. Do not allow patients with suspected measles to remain in the waiting room or other common areas of the healthcare facility. Isolate patients in a single-patient airborne infection isolation room (AIIR) if available, or in a private room with a closed door until an AIIR is available.
1. Healthcare providers should be adequately protected against measles and should adhere to standard and airborne precautions when evaluating suspect cases regardless of their vaccination status. All healthcare personnel entering the patient room, regardless of immune status, should use respiratory protection at least as effective as an N95 respirator per Cal/OSHA requirements.
Notify: Healthcare providers are required to immediately notify the Public Health Department of any suspected case of measles to ensure rapid testing and investigation. Call Public Health immediately, while the patient is still in your office, at (408) 885-4214 and select option 3. After hours, call (408) 998-3438 and ask for the Health Officer on call. Call, do not fax.
Test: If advised to test for measles by Public Health, collect a nasopharyngeal swab or throat swab and urine sample for reverse transcription polymerase chain reaction (RT-PCR). Collect specimens in-office rather than sending the patient to a laboratory. Specimens should be dropped off at the Public Health Laboratory along with a submission form.
Manage: If discharged home: provide patient suspected to have measles with instructions to isolate at home until test results return. If transferred to a higher level of medical care: directly inform EMS and the accepting facility so that appropriate precautions can be put in place. In coordination with the Public Health Department, provide appropriate measles post-exposure prophylaxis (PEP) to close contacts without evidence of immunity, either MMR or immunoglobulin.
Vaccinate: Make sure all your patients are up-to-date on the MMR (measles, mumps, and rubella) vaccine, especially before international travel. People 6 months of age or older who will be traveling internationally should be vaccinated against measles.

Vaccination

Measles can be prevented with measles-containing vaccine, which is primarily administered as the combination measles-mumps-rubella (MMR) vaccine. One dose of MMR vaccine is approximately 93 percent effective at preventing measles; two doses are approximately 97 percent effective.

The MMR vaccine is included in the routine childhood immunization schedule. CDC recommends children get two doses of MMR vaccine, starting with the first dose at 12 to 15 months of age, and the second dose at 4 to 6 years of age. Teens and adults should also be up to date on their MMR vaccination, and all international travelers over the age of 6 months should be vaccinated against measles before traveling.

For more information on the MMR vaccine, refer to the CDC’s Measles, Mumps, and Rubella (MMR) Vaccination: Information for Healthcare Providers webpage.

Measles and international travel

Measles cases often originate from unvaccinated or undervaccinated U.S. residents who travel internationally and then transmit the disease to people who are not vaccinated against measles. All international travelers over the age of 6 months should be vaccinated against measles before traveling.

Before traveling abroad:

Infants 6 to 11 months old need 1 dose of MMR vaccine
Children 12 months and older need 2 doses of MMR vaccine
Adults born during or after 1957 without evidence of immunity against measles need documentation of two doses of MMR vaccine at least 28 days apart

After traveling abroad:

Patients should monitor for fever and rash for 3 weeks after international travel

In the news

March 29, 2024 - Bay Area Health Officials urge vigilance as measles cases rise in the US

July 8, 2024 - Public Health Department responds to public measles exposure in Santa Clara County