Most people in the United States are protected against measles through vaccination, so local measles cases are uncommon. However, every year measles is brought into the United States by unvaccinated travelers (Americans or foreign visitors) who get measles while they are in other countries. They can spread measles to other people who are not protected against measles, which sometimes leads to outbreaks. It is important for health care clinics to ask patients about recent travel history when they present an illness concern.
The clinical presentation of measles is usually predictable.
- Two to four day prodrome of fever (usually 101° or higher) plus cough, coryza, and conjunctivitis (the “three Cs”).
- After two to four days of fever and 3Cs, eruption of maculo-papular rash, starting at the hairline and spreading downward.
Call us immediately (24/7) if you suspect measles. The following tool may help you evaluate rash illness for measles.
If you suspect measles
- Mask and isolate the patient (in negative air pressure room when possible), and
- Call the Health Department at (253) 798-6410 (24/7) to arrange testing at the Washington State Public Health Laboratories (WAPHL). All healthcare providers must receive approval from the Health Department prior to submission of specimens to WAPHL.
Collect the following specimens
- Nasopharyngeal (NP) swab for measles PCR and culture (preferred respiratory specimen). Swab the posterior nasal passage with a Dacron™ or rayon swab and place the swab in 2–3 ml of viral transport medium. Store specimen in refrigerator and transport on ice.
- Urine for measles PCR and culture. Collect at least 50 ml of clean voided urine in a sterile container and store in refrigerator. Make sure the urine container is leak-proof and in a separate bag. If urine leaks on the respiratory specimens, they will not be tested.
- Serum for anti-measles IgM and IgG testing- Draw at least 4-5 ml blood (yields about 1.5 ml serum) in a red or tiger top (serum separator) tube. Store specimen in refrigerator and transport on ice.