More than 90% of the United States (U.S.) population is vaccinated against measles, and in 2000, measles was declared eliminated from the U.S. However, measles cases and outbreaks do occur every year because measles is still commonly transmitted in many parts of the world, and international travel can result in measles entering the United States and subsequent transmission that may occur from these imported cases. Measles is more likely to spread and cause outbreaks in populations where groups of people are unvaccinated.
Measles should be suspected in a patient who has an acute illness characterized by:
- Generalized, maculopapular rash lasting ≥3 days; and
- Temperature ≥101°F or 38.3°C; and
- Cough, coryza, or conjunctivitis.
Suspicion of measles should be higher if the patient also has had recent international travel or known or suspected exposure to someone with measles.
If you suspect measles, contact your local health department immediately to discuss the case and arrange for state public health laboratory testing as appropriate.
Public health laboratory testing may also be approved by the local health department for persons who are not eligible for measles vaccine for whom measles immune status needs to be established.
Measles incubation period: Symptoms may begin within 7–21 days after exposure with an average of 10 days after exposure. The rash usually appears within 14 days of exposure.
Period of communicability: Generally from 4 days before rash onset through 4 days after the appearance of the rash. Immunocompromised patients may spread the virus for the duration of their illness.
Measles is a rapidly reportable condition in Virginia. As soon as the diagnosis is suspected, healthcare providers must immediately contact their local health department to discuss testing, infection control, and prevention measures.
Measles must be reported by directors of laboratories, physicians, and directors of medical care facilities.
For the list of all reportable diseases in Virginia, see here.
Infection Control and Personal Protective Equipment
If you suspect measles, the following actions are recommended:
- Assess travel history of all patients.
- Immediately isolate suspected cases. Do not allow such patients to remain in your waiting area.
- Immediately report suspected cases to your local health department (after hours call 866-531-3068).
- Use standard and airborne precautions.
- Immediately provide a surgical mask to the patient, preferably before entering the building.
- Place the masked patient in a private negative pressure room, if available, or a room with a closed door. This room should not be used for 2 hours after a suspect measles patient leaves.
- An airborne infection isolation room (AIIR) should be used if available. A suspect or confirmed measles case should take precedence over a suspect or confirmed COVID-19 case for use of an AIIR.
- If an AIIR is not available, transfer the patient as soon as possible to a facility where an AIIR is available.
- Healthcare workers entering the patient’s room should use, regardless of presumptive immunity status, fit-tested N-95 respirators, single use (not extended use).
- Patients with measles should remain in Airborne Precautions for 4 days after the onset of rash (with onset of rash considered to be Day 0). Immunocompromised patients with measles should remain in Airborne Precautions for the duration of illness due to prolonged virus shedding in these individuals.
- Permit only healthcare workers with measles immunity to attend to the patient.
- Limit visitors to patients with known or suspected measles to those who are necessary for the patient’s well-being and care.
- Limit transport of patients with known or suspected measles to essential purposes.
- If a patient is being transported to a healthcare facility or moved within a facility, staff should be notified ahead of time about suspected measles or exposure.
- For patients being transported by EMS, EMS and the receiving hospital should be notified before arrival so the masked patient may be directed immediately to an appropriate exam room.
- Implement environmental infection control. Standard cleaning and disinfection procedures are adequate for measles virus environmental control in all healthcare settings.
- Use an EPA-registered disinfectant for healthcare settings, per manufacturer’s instructions.
Manage used, disposable PPE and other patient care items for measles patients as regulated medical waste according to federal and local regulations.
For more information:
Vaccination is the best way to prevent measles. Vaccination provides long-lasting protection against measles.
Measles vaccine is available combined with mumps and rubella vaccines as MMR, or MMR combined with varicella vaccine as MMRV. The MMR vaccine is a live-attenuated (weakened) vaccine that produces a mild, non-infectious response.
CDC’s Advisory Committee on Immunization Practices (ACIP) recommends that MMR be used when any of the individual components is indicated. Single-antigen measles vaccine is not available in the United States.
Infants: 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 at the recommended ages and at least 28 days apart.
Children: 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 as long as it is at least 28 days after the first dose.
Students/travelers/health care personnel: Unless they have evidence of measles immunity, college and other students, health care personnel, and international travelers need 2 doses that have been given on or after age 1 and at least 28 days apart.
Adults: All other adults born in or after 1957 should have documentation of at least 1 dose of MMR or other evidence of measles immunity.
Persons receiving postexposure prophylaxis IG: Refer to VDH’s Postexposure Prophylaxis (PEP) Guidance for Measles Exposures for details about postexposure prophylaxis. MMR vaccine should be administered no earlier than 6 months after IGIM administration or 8 months after IGIV administration. Once the time interval has passed, follow age-appropriate dosing recommendations
Contraindications and precautions to MMR vaccination
Patients who are severely immunocompromised for any reason should not be given MMR vaccine. However, HIV-infected individuals may receive MMR vaccination if they are not severely immunosuppressed. HIV-infected children may receive MMR vaccine if CD4+ T-lymphocyte count is >15 percent; HIV-infected adults may receive MMR vaccine if they are not severely immunocompromised (i.e., CD4 count is 200 cells/µL or greater).
Persons known to be pregnant should not receive the measles vaccine. Pregnancy should be avoided for 4 weeks following 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 it can lead to complications. Avoid MMR vaccination for at least one month after stopping high dose steroid therapy.
Administration of blood products and immune globulin require waiting a certain period before administering measles vaccine.
Refer to the most current Vaccine Information Statement for measles.
Additional Vaccine Information
- Close contact with a pregnant woman is not a contraindication to vaccination of the contact with MMR vaccine.
- Breastfeeding is not a contraindication to vaccination of either the woman or the breastfeeding child.
- 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.
- For more information:
Effectiveness of MMR vaccine
MMR vaccine is about 93% effective at preventing measles after 1 dose and about 97% effective after 2 doses.
- The second dose of MMR is administered to provide a second chance to respond to vaccination.
- Very few people who get 2 doses of measles vaccine will still get measles if exposed to the virus.
Other Postexposure Prophylaxis (PEP)
Persons who are at risk of severe disease and/or complications from measles who cannot be vaccinated should receive immunoglobulin (IG):
- Administer intramuscular immunoglobulin (IMIG) to those <6 months of age
- Administer intravenous immunoglobulin (IVIG) to immunocompromised persons
- Perform serologic testing (IgG) of pregnant persons and administer IVIG if they test negative
Refer to VDH’s Postexposure Prophylaxis (PEP) Guidance for Measles Exposures for details about PEP for persons exposed to the measles virus.
Healthcare providers may contact their local health department to acquire IG.
The recommended dose of IMIG is 0.5 mL/kg of body weight (maximum dose = 15 mL) and the recommended dose of IVIG is 400 mg/kg.
Note: Infants <6 months do not need serologic testing because they are known to be unvaccinated, and immunocompromised patients do not need serologic testing because IVIG is recommended regardless of immune status.
No patient should receive both vaccine and immunoglobulin. If possible, vaccination or IG should be administered as close together as possible to family members so that their period of quarantine is the same or similar.
Information for Labor and Delivery and Caring for Pregnant Patients
Refer to these measles resources for guidance on labor and delivery:
- American College of Obstetricians and Gynecologists (ACOG)’s Management of Pregnant and Reproductive Aged Women during a Measles Outbreak
- University of Washington Department of Obstetrics and Gynecology’s Measles & the MMR Vaccine: Recommendations Around Pregnancy, Including the Periconception and Postpartum Periods
- CDC HICPAC 2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings
- VDH Measles website
- VDH How to locate and contact your local health department for consultation
- VDH Postexposure Prophylaxis (PEP) Guidance for Measles Exposures
- VDH Assessment Tool for Healthcare Personnel Exposed to Measles
- CDC Information for Healthcare Providers about Measles
- CDC Measles Clinical Diagnosis Fact Sheet in English and in Spanish
- CDC Measles Outbreak Toolkit for Healthcare Providers
- CDC Measles Vaccine Information
- CDC Response to Afghan Evacuees
- Immunization Action Coalition: Healthcare Vaccination Recommendations
Last updated: November 30, 2021