Photo credit: CDC
Measles (rubeola) is a highly contagious, acute viral respiratory illness. It is a vaccine-preventable disease. Measles can result in complications such as pneumonia, encephalitis and death.
Prior to the 1960’s and the advent of an available and effective vaccine, measles was commonplace in the US. Due to concerted mass vaccination efforts by the CDC, and the Advisory Committee on Immunization Practices (ACIP), the American Academy of Pediatrics (AAP), and the American Academy of Family Physicians (AAFP) recommendation for a second dose of MMR (Measles/Mumps/Rubella) vaccine for all children, Measles was declared eliminated from the US in 2000.
It is critically important that population vaccination rates stay above 90 percent to ensure “herd immunity” for people who can’t get the vaccine, such as infants who aren’t old enough and people with a weakened immune system, for example if they have HIV/AIDS or cancer. Recent outbreaks in the US are occurring in communities with poor vaccination coverage or pockets of unvaccinated members.
Measles’ symptoms appear about seven to 14 days after exposure and usually include:
- high fever,
- runny nose, and
- red, watery eyes
Measles rash usually appears 3 to 5 days after symptoms begin. Patients are actually contagious for several days before to several days after the rash appears. The rash starts as flat red spots appearing on the face and spreads downward to the neck, trunk, arms, legs and feet. Small raised bumps may also appear on top of the flat red spots. With the rash, a person’s fever may spike to more than 104° Fahrenheit. Immunosuppressed patients may not develop the rash. Some infected also develop tiny white spots (Koplik spots) inside the mouth.
Measles is a vaccine-preventable disease; once it develops there is no specific antiviral therapy for measles. Medical care is mostly to relieve the symptoms and to avoid complications such as bacterial infections, e.g., pneumonia.
Outbreaks and cases in the US
From January 1 to July 25, 2019, 1,164 individual cases of measles have been confirmed in 30 states. (Map of reported measles cases by state, 2019).This is the greatest number of cases reported in the U.S. since 1992 and since measles was declared eliminated in 2000.
Measles remains a common, highly contagious disease in many parts of the world, due to under vaccination. Many cases in the US resulted from international travel, from unvaccinated travelers who got infected in other countries. Unvaccinated travelers can spread measles to other people who are not protected against measles, which can lead to outbreaks. Any unvaccinated traveler is at risk for exposure.
- CDC Measles information for international travelers
- CDC Travel Notices on Measles for specific countries
Clinicians- reporting, lab testing
A throat swab specimen and a blood specimen should be collected from all patients with clinical features compatible with measles, according to CDC. Local health departments can provide guidance on where to submit specimens and how to ship them.
Transmission prevention in healthcare settings
Clinicians can help prevent transmission in healthcare settings. CDC’s current interim recommendations include:
- Ensure Healthcare Workers (HCW) have evidence of presumptive immunity
- Rapid identification and isolation for cases with known or suspected measles
- Adhere to both Standard and Airborne precautions
- Cover the cough – respiratory hygiene and cough etiquette
- Appropriate management for HCW with known or suspected measles
Infected people should be isolated for four days after they develop a rash; airborne precautions should be followed in healthcare settings. Healthcare staff entering the room should use respiratory protection consistent with airborne infection control precautions (use of an N95 respirator or a respirator with similar effectiveness in preventing airborne transmission). The preferred placement for patients who require airborne precautions is in a single-patient airborne infection isolation room (AIIR), according to CDC.
Women of childbearing age (including adolescent girls and premenopausal adult women), especially those who grew up outside the US where under-vaccination against measles can be common, should be vaccinated with 1 dose of MMR vaccine or have a positive serum test for rubella (aka “German measles” or ”3 day measles”) antibody (evidence of prior exposure/immunity to rubella).
Rubella is very dangerous for a pregnant woman and her developing baby. Women should make sure they are protected from rubella before they get pregnant. Women known to be pregnant or attempting to become pregnant should not receive rubella vaccine; women should not get pregnant for 4 weeks (28 days) after rubella or MMR vaccination.
Pregnant women who are exposed to rubella should contact their doctor immediately. Pregnant women who contract rubella are at risk for miscarriage or stillbirth, and their developing babies are at risk for severe birth defects with devastating, lifelong consequences. Congenital rubella syndrome (CRS) can occur in a developing baby when the mother is infected with the rubella virus.
The most common birth defects from CRS can include:
- Heart defects
- Intellectual disabilities
- Liver and spleen damage
- Low birth weight
- Skin rash at birth
- CDC – Measles (Rubeola)
- CDC – “Interim Infection Prevention and Control Recommendations for Measles in Healthcare Settings” (July, 2019)
- CDC – Resources for parents and child care providers
- FDA – Statement on safety and effectiveness of MMR vaccine (April, 2019)
- IDSA – Infectious Diseases Society of America – Measles vaccination: Myths and facts