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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.
Promptly isloate patients with suspected measles to avoid disease spread.
Immediately report the suspected measles case to CDPH by calling 312-743-9000 during business hours or 311 after-hours, weekends, and holidays.
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.
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.
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.
In the absence of a more likely diagnosis, an illness that meets the clinical description with:
No epidemiologic linkage to a laboratory-confirmed measles case; and
Noncontributory or no measles laboratory testing.
Testing & Submission Guidelines
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
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.
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
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.