Measles is a highly transmissible viral illness associated with high fever and rash. Children under the age of 5, pregnant women, and immunocompromised people are at the highest risk of complications from measles, and about 20% of those with measles will require hospitalization. Often outbreaks will occur via travel and will happen in communities with low vaccination rates. Those too young for vaccination are especially vulnerable. There has been an increase in measles cases worldwide, with Europe reporting over 30,000 cases last year. Because the measles vaccine is highly effective, those affected are often unvaccinated. Recently, a person with a confirmed case of measles traveled through a northern Kentucky airport, potentially exposing hundreds of people to the virus.
Prevention
The best protection is the MMR vaccine. MMR vaccine is recommended at 12-15 months of age and again between ages 4-6 years. For those who will be traveling or who live in an area of an outbreak, the vaccine recommendations are a little different. For more information about the MMR vaccine for travelers, visit CDC Travel.
Transmission
Measles is extremely contagious. The measles virus can live in the air for up to 2 hours after an infected person has left the room, and will infect about 90% of unimmunized people who come into contact with it. The virus lives in the nose and throat of the infected person, and is spread through coughing or sneezing, or touching a contaminated surface. Infected people spread the measles from four days before the rash appears to four days after the rash appears.
Signs/Symptoms
Symptoms usually begin 1-2 weeks after exposure. Most experience a high fever, cough, runny nose, and conjunctivitis. Some patients may develop Koplik’s spots – small red or gray spots on the roof of the mouth and inside the cheeks. The maculopapular rash appears 3-5 days after the cold symptoms start. The rash typically begins on the face and spreads down to the rest of the body. Visit CDC Measles Photos for images of the rash associated with measles.
What to do if you suspect measles
Anyone suspected of having measles should be isolated immediately. The patient should be placed in airborne precautions and placed in a negative pressure room. Any staff entering the room should wear N95 masks. If a negative pressure room is not available, the patient should be transferred to an appropriate facility. Once the patient leaves the room, it should remain vacant for at least 2 hours. A throat swab, blood work, and urine should be collected for testing. The local health department should be notified immediately.
Exposed health care workers
Any health care workers who have been exposed to measles and do not have evidence of immunity should receive post-exposure prophylaxis and should not work from day 5 (after exposure) until day 21. All health care workers should monitor for signs and symptoms daily for 21 days after exposure.
Exposed patients
In an inpatient setting, any exposed patients should be placed in airborne isolation for 21 days or until discharge. Exposed patients should also be given post-exposure prophylaxis.
In an outpatient setting, notify public health personnel so that they can perform follow up.
Post-exposure prophylaxis
People exposed to measles who do not have evidence of immunity may receive either an MMR vaccine or immune globulin. Refer to CDC Post Measles Exposure Prophylaxis for more information about prophylaxis.
Center for Disease Control and Prevention. Photos of Measles and People with Measles. 2020. http://www.cdc.gov/measles/symptoms/photos.html. Accessed February 12, 2024.
Centers for Disease Control and Prevention. Prevention of Measles, Rubella, Congenital Rubella Syndrome, and Mumps, 2013. MMWR 2013;62:1-40.
Center for Disease Control and Prevention. Traveler’s Health. http://wwwnc.cdc.gov/travel. Accessed February 12, 2024.
World Health Organization. (2023, December 14). A 30-fold rise in measles cases in 2023 in the WHO European Region warrants urgent action. Retrieved from https://www.who.int/europe/news/item/14-12-2023-a-30-fold-rise-of-measles-cases-in-2023-in-the-who-european-region-warrants-urgent-action.