Measles Alert

Measles, caused by rubeola virus, is among the most contagious of infectious diseases. Measles is spread by contact with an infected person or their respiratory secretions. The virus can remain active and contagious for up to 2 hours in the air and on surfaces. Measles is most contagious when respiratory symptoms are at peak, however, the contagious period probably extends to several days before & after onset of the rash. Incubation period is 10 to 14 days.

Symptoms of measles include a prodrome of high fever, cough, coryza, conjunctivitis and Koplik's spots, followed by an erythematous rash. Koplik's spots on the buccal mucosa are considered pathognomonic of measles and may precede onset of rash by several days. Patients who are immunocompromised or pregnant are at highest risk for complications which can include pneumonia, encephalitis, and death. The CDC suggests the diagnosis of measles should be considered in any patient with fever ≥ 101°F (38.3°C) and rash that lasts 3 days or more, along with compatible respiratory symptoms.

On June 22, 2011 the CDC released a health advisory regarding an increased number of reported measles cases in the United States. During the first six months of the year, 156 cases were confirmed, which is the highest number since 1996. Currently, several European countries, as well as Africa and Asia report measles as endemic or an outbreak. The U.S. cases to date have involved residents with an international travel history, unvaccinated visitors, and associated contacts.

Testing for suspected measles infection should include rubeola/measles IgM & IgG serology. Positive IgG results with negative IgM results indicate immunity to infection. Positive IgM results with or without positive measles IgG indicates recent infection. Negative IgM and IgG results usually indicate non-immunity and absence of current infection however, specimens drawn early in the acute phase of infection may also yield negative results. In suspected cases with negative serology, testing should be repeated in 7-10 days. The specimen requirement for measles/rubeola IgG and IgM is one red top or serum gel tube of blood.

Suspected measles patients should be isolated & reported immediately to local and/or state public health departments. Additional information, including vaccine recommendations can be found at http://www.cdc.gov/measles/index.html. 

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