Measles Clinical Information

Information on measles for health professionals, including epidemiology, communicability, and treatment.

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On this page:
Report suspect measles cases immediately
Epidemiology of measles
Diagnosing measles
Treating measles
Communicability of measles
Determining immune status
Post-exposure prophylaxis (PEP)
Receipt of MMR after IG or IG after MMR
Measles in immunocompromised individuals
Preventing transmission of measles
Vaccination recommendations & considerations
Vaccination: Effectiveness of MMR
Vaccination: Pregnancy and breastfeeding
Contraindications to vaccination
Vaccine precautions

Report suspect measles cases immediately

If you suspect measles in a patient, call MDH at
651-201-5414 or toll-free at 1-877-676-5414. 

Health care facilities are required by law to report suspect cases of measles immediately to MDH. 

Epidemiology of measles

Measles, also called rubeola, is no longer considered endemic in the United States. However, continued success depends upon maintaining high vaccination rates, because cases continue to be brought into the U.S. by people who get infected while in other countries. It is still commonly transmitted in many parts of the world, including Europe, Africa, Asia, India and the Philippines. The majority of importations of measles into the U.S. come from U.S. residents.

Measles disease can occur anytime of the year, but is most frequently seen during late winter and spring.

Worldwide, an estimated 20 million people get measles and 146,000 people, mostly children, die from measles each year.

Measles is an acute viral illness characterized by:

  • A prodrome of fever and malaise
  • Cough, coryza, and conjunctivitis
  • A maculopapular rash
  • Koplik’s spots (exanthem present on mucous membranes) are considered to be indicative of measles and occur 1–2 days before the rash and persist for 1–2 days after the rash.

Atypical measles occurs only in persons who received inactivated (“killed”) measles vaccine (KMV) and are subsequently exposed to wild type measles virus.

Modified measles occurs primarily in patients who received immune globulin (IG) as post-exposure prophylaxis and in young infants who have some residual maternal antibody.

Measles is usually a mild or moderately severe illness; however, complications can occur.

  • 1 out of every 1,000 people with measles will develop encephalitis.
  • 1 in 4 unvaccinated people in the U.S. who get measles will be hospitalized.
  • Pneumonia occurs in 1-6 percent of measles cases.
  • Death occurs in approximately 1–3 per 1,000 reported cases.

Diagnosing measles

Many U.S. health care providers have never seen a case of measles. Without proper laboratory testing, measles cannot be diagnosed, and delay in diagnosis contributes to transmission.

If measles is suspected, measles Real-Time Polymerase Chain Reaction (RT-PCR, or PCR) is available for measles case confirmation at the MDH Public Health Laboratory (MDH-PHL). Clinical specimens for PCR should be taken as soon as measles is suspected after onset of rash.  

All viral specimens should be sent to the MDH-PHL, and serum should be sent to the health care facility’s normal reference laboratory. Refer to the MDH “Lab Testing for Measles” fact sheet for more details.

If measles is suspected, providers should ask the patient about any known exposures or travel history (domestic or international) in the 30 days prior to symptom onset.

Providers should also consider other infectious and non-infectious etiologies that may cause generalized rash, including:

  • Coxsackievirus, Echovirus, Epstein-Barr virus, Erythema infectiosum (Fifth Disease), HIV, Kawasaki disease, Roseola infantum, Scarlet fever, Pharyngoconjunctival fever
  • Dengue fever, Rocky Mountain spotted fever
  • Dermatologic manifestations of Viral hemorrhagic fevers (VHFs)
  • Toxic Shock Syndrome, cutaneous manifestations of syphilis
  • Drug reactions (e.g. antibiotics, contact dermatitis)

If a suspect measles case is identified at a health care facility, health care providers should notify MDH immediately and follow the steps in Minimize Measles Transmission in Health Care Settings.

Treating measles

There is no specific antiviral therapy for measles. Medical care is supportive to help relieve symptoms and address complications, such as bacterial infections.

Severe measles cases among children, such as those who are hospitalized, should be treated with vitamin A. Vitamin A should be administered immediately on diagnosis and repeated the next day. The recommended age-specific daily doses are:

  • 50,000 IU for infants younger than 6 months of age
  • 100,000 IU for infants 6–11 months of age
  • 200,000 IU for children 12 months of age and older

Communicability of measles

Measles is highly communicable. Secondary attack rates exceed 90 percent among susceptible persons.

  • Measles is infectious from 4 days prior to 4 days after rash onset.
  • Maximum infectiousness occurs between onset of prodrome through the first 3-4 days of rash.
  • Immunocompromised persons may shed virus for several weeks after the acute illness.
  • There are no asymptomatic infectious carriers.
  • The incubation period for measles averages 10-12 days from exposure to prodrome and 14 days (range 7-21) from exposure to rash onset.
  • Transmission can be person-to-person via contact with respiratory secretions or by contact with large respiratory droplets that are aerosolized during coughing and sneezing.
  • Airborne transmission via aerosolized droplet nuclei is the primary route of transmission and has been documented in closed areas (e.g., exam room) for up to 2 hours after a person with measles occupied the area.

Determining immune status

A person is considered immune to measles (for the purpose of post-exposure prophylaxis) if one or more of these apply:

  • one or more documented doses of a measles-containing vaccine administered on or after the first birthday for preschool-age children and adults not at high risk, or
  • laboratory evidence of immunity, or
  • birth before 1957 regardless of nationality, or
  • laboratory confirmation of disease.

If a person is not immune, they should be considered susceptible.

Serologic testing for immunity to measles is not necessary for persons documented to be appropriately vaccinated or who have other acceptable evidence of immunity. Documented doses of MMR serve as acceptable evidence of immunity, even if titer results are equivocal or negative.

Health care workers should refer to Health Care Worker Measles Immune Status and Exposures in Health Care Settings for more information.

Post-exposure prophylaxis (PEP)

  • Live measles vaccine (MMR) may prevent disease if given within 72 hours of exposure.
  • Immune globulin (IG) may prevent or modify disease and provide temporary protection if given within 6 days of exposure.
  • People at high risk for severe illness and complications from measles should be prioritized to receive immune globulin (IG). These include: infants <12 months, susceptible pregnant women, and severely immunocompromised individuals.
  • IG is not indicated for household contacts who have received 1 dose of vaccine at 12 months of age or older unless they are immunocompromised.
  • Individuals given PEP will be monitored for signs and symptoms of measles for at least one incubation period by public health staff.*
  • Individuals (except health care workers) who received MMR vaccine within 72 hours of exposure or IG within 6 days of exposure may return to school, daycare, work or other activities.*  
  • If a person does not receive either MMR vaccine or IG within the recommended timeframe, they should be excluded from school, daycare, work, or other public areas for 21 days after initial exposure to measles.* 
  • Follow Measles Post-Exposure Prophylaxis for Non-Symptomatic Susceptible Contacts (PDF:73KB/1 page).

*Post-exposure prophylaxis, exclusion, and isolation recommendations should be made in collaboration with MDH or the local health department.

Receipt of MMR after IG or IG after MMR
Any susceptible person exposed to measles who received IG should subsequently receive MMR vaccine, which should be administered (provided the person is 12 months of age or older and the vaccine is not otherwise contraindicated):

  • No earlier than 6 months after IGIM administration
  • No earlier than 8 months after IGIV administration

Ideally, IG should not be administered within 2 weeks following the administration of MMR vaccine or within 3 weeks following varicella vaccine.

  • Should this occur, the individual should be revaccinated, but no sooner than 6 months after IGIM administration or 8 months after IGIV administration.

Measles in immunocompromised or pregnant individuals

Measles illness during pregnancy results in a higher risk of premature labor, spontaneous abortion, and low-birth-weight infants.

Measles in an immunocompromised person may be severe, with a prolonged course and is reported almost exclusively in persons with T-cell deficiencies (certain leukemias, lymphomas, and AIDS). The rash may be atypical.

Preventing transmission of measles

Vaccination is the best way to prevent measles.

Vaccine recommendations & considerations

MMR vaccine provides long-lasting protection against all strains of measles.

  • Children should receive 2 doses of MMR vaccine–the first dose at 12 through 15 months of age and the second dose 4 through 6 years of age. Giving the second dose of the vaccine earlier is allowed at any time as long as it is at least 28 days after the first dose.
  • Unless they have evidence of measles immunity, college and other students, health care personnel, and international travelers need 2 appropriately spaced doses and other adults need 1 dose.
  • If traveling internationally, infants 6 through 11 months old should receive 1 dose of MMR vaccine before departure. Infants who receive a dose of MMR vaccine before their first birthday should receive 2 more doses of MMR vaccine, the first of which should be administered when the child is 12 through 15 months of age and the second at least 28 days later.
  • All persons born in or after 1957 should have documentation of at least 1 dose of MMR or other evidence of measles immunity.

Vaccination: Effectiveness of MMR
One dose of MMR vaccine is about 93 percent effective at preventing measles; 2 doses are about 97 percent effective.

  • Almost everyone who does not respond to the measles component of the first dose of MMR vaccine at age 12 months or older will respond to the second dose. Therefore, the second dose of MMR is administered to address primary vaccine failure.
  • Very few people—about 3 out of 100—who get 2 doses of measles vaccine will still get measles if exposed to the virus.

Vaccination: Pregnancy and breastfeeding
Women known to be pregnant should not receive measles vaccine. Pregnancy should be avoided for 4 weeks following MMR vaccine. Close contact with a pregnant woman is not a contraindication to MMR vaccination of the contact. Breastfeeding is not a contraindication to vaccination of either the woman or the breastfeeding child.

Contraindications to vaccine
Patients who are severely immunocompromised for any reason should not be given MMR vaccine.

Persons receiving large daily doses of corticosteroids (>2 mg/kg per day or >20 mg per day of prednisone) for 14 days or more should not receive MMR vaccine because of concern about vaccine safety. MMR and its component vaccines should be avoided for at least one month after cessation of high dose therapy.

Administration of blood products and immune globulin require varying intervals before administration of measles vaccine.

Vaccine precautions
MMR may be administered to egg-allergic children without prior routine skin testing or the use of special protocols. MMR vaccine does not contain penicillin. A history of penicillin allergy is not a contraindication to vaccination with MMR or any other U.S. vaccine.

Persons receiving low dose or short course (<14 days) corticosteroid therapy, alternate- day treatment, maintenance physiologic doses, or topical, aerosol, intra-articular, bursal, or tendon injections may be vaccinated.

Patients with leukemia in remission who have not received chemotherapy for at least 3 months may receive MMR or its component vaccines.

Updated Tuesday, March 31, 2015 at 02:58PM