1. Either a measured or patient/family-reported fever is adequate; fever may not be measured at the time of healthcare evaluation due to normal fluctuation or to use of antipyretics (e.g., ibuprofen).  
  2. A vesicular rash is not consistent with measles, and should prompt consideration for other causes of rash (e.g., varicella/chickenpox) 
  3. Measles clinical criteria (per CSTE* case definition) include ALL of the following:  
  • Generalized maculopapular rash 
  • Fever 
  • Cough, coryza (runny nose), or conjunctivitis (also known as the “3 C’s”) 
*CSTE: Council of State and Territorial Epidemiologists: https://ndc.services.cdc.gov/case-definitions/measles-2013/

 

What to Do if you Suspect Measles

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

1

Promptly isloate the patient and collect a specimen.  See Measles Job AId for further instructions. 

2

Immediately report a suspected of measles to CDPH by completing this form and if testing is approved you will receive submission instructions and an authorization code. This system REPLACES provider reporting of suspected cases to 311. DO NOT CALL 311 or 312-743-9000 TO REPORT

3

Collect clinical specimens as soon as possible after rash onset. . Nasopharyngeal or oropharyngeal swabs are preferred. The Illinois Department of Public Health Laboratory is the only laboratory that can perform the approved measles PCR. Do not request testing from any other laboratory. 

See the Measles Provider Job Aid for instructions.

4

4)    While awaiting testing, medically stable patients can be discharged as clinically indicated to their homes. Instruct patients to self-isolate (if discharged) until the end of the 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. If they are unable to isolate at home, providers are instructed to retain the patient under airborne precautions pending test results. 

Overview


  1. Either a measured or patient/family-reported fever is adequate; fever may not be measured at the time of healthcare evaluation due to normal fluctuation or to use of antipyretics (e.g., ibuprofen).  
  2. A vesicular rash is not consistent with measles, and should prompt consideration for other causes of rash (e.g., varicella/chickenpox) 
  3. Measles clinical criteria (per CSTE* case definition) include ALL of the following:  
  • Generalized maculopapular rash 
  • Fever 
  • Cough, coryza (runny nose), or conjunctivitis (also known as the “3 C’s”) 
*CSTE: Council of State and Territorial Epidemiologists: https://ndc.services.cdc.gov/case-definitions/measles-2013/

 

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 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.

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

Measles Reporting

 To Report Suspect Cases and request testing:


Complete this form

 

For Clinical Questions:

Contact the CDPH Disease reporting hotline at 312-746-9000.
 

*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)

Schools: Please click here for reporting and management information

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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