Overview

Measles is a highly contagious virus that lives in the nose and throat mucus of an infected person. It can spread to others through coughing and sneezing. Measles can live for up to 2 hours in an airspace where the infected person coughed or sneezed.

Measles Job Aid - please read if you are planning to call to discuss measles testing.

Measles is so contagious that if one person has it 90% of the people close to that person who are not immune will become infected. Infected individuals can spread measles to others from 4 days before through 4 days after the rash appears. Measles infection is a vaccine-preventable illness.
The average incubation period for measles is 10-12 days (range: 7-21 days) from the date of the initial exposure until early signs and symptoms appear.

  • Early signs and symptoms of measles starts with fever (as high as 105°F) and malaise associated with cough, coryza (runny nose) and conjunctivitis (red/watery eyes), colloquially the three “C’s”.

  • 2-3 days after symptoms begin tiny white spots may appear inside the mouth (Koplik spots).

  • 3-5 days after symptoms begin, a maculopapular skin rash develops that begins on the face at the hairline and spreads downward to the neck, trunk, arms, legs, and feet. Small raised bumps may also appear on the top of the flat red spots. The spots may become joined together as they spread. As rash appears an individual’s fever may spike.

When considering measles, healthcare providers should take into account the progression of symptoms. The onset of the three “C’s” almost always appears before the onset of a rash and the rash starts on the face and head and spreads towards the extremities. Also, consider other viral exanthems as appropriate.



What do I do if an individual presents with rash and fever?
Query patients about a history of international travel, history of domestic travel to areas with ongoing outbreaks, contact with foreign visitors, transit through an international airport, or possible exposure to a measles patient in the three weeks prior to symptom onset. Suspect measles in patients with compatible clinical presentation and such a history.

Measles: Clinical Features & Diagnosis

CDC’s Dr. Manisha Patel describes clinical features of measles, how to diagnose it in a patient, and what to do if you suspect you have a case. Includes images of children with measles infection.

What to do if you suspect measles

Query patients about a history of international travel, history of domestic travel to areas with ongoing outbreaks, contact with foreign visitors, transit through an international airport, or exposure to a measles patient in the three weeks prior to symptom onset.

Suspect measles in patients with compatible clinical presentation and such a history.

1

Promptly isloate patients with suspected measles to avoid disease spread.

2

Immediately report the suspected measles case to CDPH by calling 312-743-9000 or 311.

3

Collect clinical specimens as soon as possible after rash onset. Nasopharyngeal or Throat swabs are preferred. The Illinois Department of Public Health Laboratory is the only laboratory that can perform measles PCR, which is the preferred test to confirm a measles infection.

See the Measles Provider Job Aid for instructions.

4

Instruct patients to self-isolate (if discharged)  until the end of infectious period (4 days before through 4 days after the rash appears) and avoid contact with infants under a year of age and those who have not been vaccinated.

Case Definition

Confirmed Case:

An acute febrile rash illness with:

  • Isolation of measles virus from a clinical specimen; or

  • Detection of measles from a clinical specimen using PCR; or

  • IgG seroconversion or a significant rise in measles immunoglobulin G antibody using any evaluated and validated method; or

  • A positive serologic test for measles immunoglobulin M antibody; or

  • Direct epidemiologic linkage to a case confirmed by one of the methods above.

Testing & Submission Guidelines

Testing

Collect specimens as soon as possible after rash onset. Nasopharyngeal or Throat swabs are preferred.

If you suspect measles, call CDPH immediately for guidance and coordination of diagnostic testing which includes measles IgM antibody testing and the measles RNA real-time polymerase chain reaction (RT-PCR).

Viral culture is an alternative method if PCR is not available. A positive RT-PCR test or a positive culture confirms the diagnosis.

Guidelines for Submitting Measles Specimens to IDPH Lab

1

Suspected measles is reportable immediately (within 3 hours).  Call 311 for consultation with a medical director or 312-743-9000.  If approved, you will obtain an authorization code which is required for shipping specimens to the IDPH Laboratory.

2

Complete the IDPH Communicable Diseases Laboratory Test Requisition Form. On the top of the form in the box labeled “Laboratory Specimen Number” write the authorization code that was provided by CDPH.

3

Reference the following Instructions for Specimen collection and shipping when collecting a specimen. Remember to label the specimen.

4

Once specimens have been collected, an authorization number has been obtained, and the requisition form has been completed, ship specimens to:

Illinois Department of Public Health Laboratory
Attn: Virology
2121 W. Taylor Street
Chicago, IL. 60612

IDPH Lab Contact Number: (312) 793-4760

5

Clinicians or infection control practitioners that have access to enter reportable diseases into the Illinois National Electronic Disease Surveillance System (I-NEDSS) should also enter the case’s information. Clinicians or infection control practitioners can register for a portal account here I-NEDSS Web Portal. If training is needed please contact the CDPH VPD program.

6

Complete the CDPH Measles Case Report Form as soon as possible.

Prevention

The best way to prevent measles infection is through vaccination with the MMR vaccine.

Children should receive 2 doses:

  • 1st dose at 12-15 months of age

  • 2nd dose between 4-6 years of age

Adults might also need the vaccine if they were not immunized as children.

Vaccines containing measles antigen currently licensed in the United States are the multi-antigen vaccines MMR II and MMRV (manufactured by Merck). Both are live attenuated virus vaccines.

(archived) Outpatient Infection Preventionist Webinar, April 2019:
Preparing for Measles in Chicago

Current 2019 Measles Guidance

Please see below for links to these alerts which contain information on measles guidance.

IDPH Measles Health Alert - issued May 15, 2019 (includes information on IDPH recommendations and vaccine guidelines)

Updated Measles prevention guidance and healthcare personnel immunity - issued May 15, 2019

Update from CDC on Nationwide Measles Outbreaks and Adult Vaccination Recommendations including Local Chicago Preparations - issued May 3, 2019

Measles Reporting

For Clinical Questions Or To Report Suspect Cases, Contact:

The CDPH Disease Reporting Hotline at
312-743-9000

*After hours, weekends, and holidays, call 311 and ask for the communicable disease physician on-call (or 312-744-5000 if outside the City of Chicago)

Suspect Cases should be reported within 24 Hours. Do not wait for laboratory confirmation.


Please consult the Measles Job Aid  if you are planning call to discuss measles testing.

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Measles Contacts

Clinical Questions

Dr. Marielle Fricchione:
312-746-5382

Report Suspected Cases

312-743-9000 or 311

Outside Business Hours

311 or 312-744-5000 (if outside Chicago)