Measles (rubeola) is highly contagious; one person infected with measles can infect 9 out of 10 unvaccinated individuals with whom they come in close contact with. While there are still international countries where measles is endemic, the U.S. has continued to see an increase in measles cases and outbreaks. As of December 31, 2024, 285 U.S. measles cases were reported to CDC. Of these cases, 89% were not vaccinated or had an unknown vaccination status, 42% were children under the age of 5, and 40% of the total cases were hospitalized. So far in 2025, there have been 1,333 cases in the U.S. reported to the CDC, 92% were not vaccinated or had an unknown vaccination status, 37% are children under the age of 5, and 13% have been hospitalized at this time. This has been an increase compared to 2023, which had a total of 59 cases in the U.S. The risk of widescale spread is low in most U.S. communities where population immunity is high; however, pockets of low MMR vaccination coverage leave some communities at higher risk for outbreaks.

Providers are reminded to:

§  Consider measles infection in patients with compatible symptoms, including:

·       Prodrome of fever, cough, coryza, and conjunctivitis for 2-4 days

·       Generalized maculopapular rash that usually begins on the face at the hairline and then spreads to the neck, trunk, and extremities

·       Koplik spots may appear on buccal mucosa 1-2 days prior to rash

§  Please review travel/exposure history.

§  Recommendations should be made to stay home while ill. Please note measles is a restrictable disease in childcare, schools, and healthcare per IDAPA code 16.02.10.

§  Report suspected cases of measles to Panhandle Health District. If calling during normal business hours, please contact the Epidemiology main line 208-415-5235. If calling outside normal business hours, please contact the Epidemiology Duty Officer at 208-771-0271.

§  Be prepared for the possibility of patients with measles at your facility. Infection prevention and control specialists with the Idaho Division of Public Health Healthcare Associated Infections Program are available at 208-334-5871. 

In urgent/emergency healthcare settings:

§  Patients with suspected measles should wear a mask covering the nose and mouth and be triaged immediately away from waiting rooms, in airborne isolation if available. 

In outpatient clinic settings:

§  Schedule suspected measles patients to be seen at end of day, if possible, and keep them out of waiting rooms

·       Use standard and airborne infection control precautions

·       Only staff with documented immunity to measles should enter patient’s room

·       After the suspect patient is discharged, do not have additional patients or staff enter the room for 2 hours. 

All healthcare settings:

§  Healthcare personnel should use respiratory protection (i.e., a respirator) that is at least as protective as a fit-tested, NIOSH-certified, disposable N95 filtering facepiece respirator, regardless of presumptive evidence of immunity, upon entry to the room or care area of a patient with known or suspected measles. 

Testing for measles

§  RT-PCR: is the preferred test. It can be performed on respiratory (nasopharyngeal or throat) swabs and on urine. RT-PCR is most sensitive within 3 days of rash onset but can be positive up to 10 days after rash onset. Ideally, specimens should be collected at first patient contact once measles is suspected and should be paired with serology testing (IgM) for evaluation of all suspect measles cases

§  IgM: Detection of measles IgM can confirm measles. IgM is the most sensitive 3 or more days after rash onset, so a negative IgM within 3 days of rash onset should be interpreted with caution. False-positive IgM can occur due to cross-reactivity with other causes of febrile rashes (e.g., Parvovirus). Ideally, RT-PCR and serology should be performed together for all suspected measles cases.

§  IgG: The presence of measles-specific IgG indicates a recent or prior exposure to measles virus or measles vaccine and is appropriate to test for evidence of immunity.

§  Please reach out to Panhandle Health District if there is a suspicion of measles samples may be able to be sent to the state lab.  

Vaccination

§  Two doses of MMR vaccine are 97% effective at preventing measles and 1 dose is 93% effective.

§  Presumptive evidence of immunity for measles:

·       Written documentation of one or more doses of a measles-containing vaccine administered on or after the first birthday for preschool-age children and adults not considered high risk

·       Written documentation of two doses of measles-containing vaccine for school-age children and adults at high risk, including students at post-high school secondary educational institutions, healthcare personnel, and international travelers

·       Laboratory evidence of immunity

·       Laboratory confirmation of disease

·       Birth before 1957

§  Third dose of MMR is not recommended if there is documented evidence of immunity.

§  Panhandle Health District does have MMR vaccine available and can also perform a MMR titer to verify immunity.

§  For more information about the MMR vaccine please visit Routine MMR Vaccination Recommendations: For Providers | CDC.  

Measles prophylaxis:

§  Individuals that do not have immunity to measles and are exposed to someone with measles should discuss with their primary care physician about getting a MMR vaccine.

§  If MMR vaccine is given with in 72 hours of exposure to measles, you may get some protection or have a milder illness.

§  Immunoglobin (IG) can also be given within 6 days of exposure to measles, which may provide some protection or may result in a milder illness.

Travel to areas with measles outbreaks:

·       If a patient is traveling to an area where there is an ongoing measles outbreak or a potential for exposure the following should be considered.

o   If the patient has no documented immunity vaccination can be discussed. They should plan to be fully vaccinated at least 2 weeks prior to their trip. If the trip is less than 2 weeks away they should still receive 1 dose of the MMR vaccine. 

o   Infants under 12 months old who are traveling to areas with measles outbreaks or where measles exposure could happen an early dose of the MMR vaccine should be discussed. If an early dose is given, they can still receive a dose at 12 months and then again at 4-6 years old.

o   Children over 12 months that have not received the MMR vaccine can get the first dose immediately and the second dose can be given 28 days later.

o   Individuals should not travel when sick and should monitor their health for 3 weeks after traveling to an area where an exposure to measles may have occurred.

o   For information please visit: Plan for Travel | Measles (Rubeola) | CDC

 Resources

·       Measles, Mumps, and Rubella (MMR) Vaccination: What Everyone Should Know:https://www.cdc.gov/vaccines/vpd/mmr/public/index.html

·       CDC Measles Cases and Outbreaks:https://www.cdc.gov/measles/data-research/index.html#cdc_data_surveillance_section_7-mmr-vaccine-coverage-for-kindergarteners-by-school-year-2009%e2%80%932024

·       Idaho Healthcare Associated Infections Program: https://healthandwelfare.idaho.gov/providers/infection-prevention-and-control-antibiotic-resistance-and-antimicrobial-stewardship

·       Idaho Public Health Districts: https://healthandwelfare.idaho.gov/health-wellness/community-health/public-health-districts

·       Routine MMR Vaccination Recommendations: For Providers | CDC: https://www.cdc.gov/vaccines/vpd/mmr/hcp/recommendations.html

·       Plan for Travel | Measles (Rubeola) | CDC: https://www.cdc.gov/measles/travel/index.html