Content Information
Disease Information
Measles is an acute, highly communicable viral disease characterized by fever (generally as high as 104o-105oF), cough, coryza, conjunctivitis, and maculopapular rash (the 3 C’s plus rash).
Overview
Report Immediately by Phone
Also known as: Rubeola, Hard measles, Red measles, Morbilli
Responsibilities
- Hospital: Report by phone immediately
- Lab: Report by phone immediately
- Physician: Report by phone immediately
- Local Public Health (LPHA): Report by phone immediately. Follow-up required.
Iowa Department of Public Health
Disease Reporting Hotline: (800) 362-2736
Secure Fax: (515) 281-5698
A. Agent
Measles is caused by the measles virus (genus Morbillivirus, family Paramyxoviridae).
B. Clinical Description
Measles is an acute, highly communicable viral disease characterized by fever (as high as 103o-105oF), cough, coryza, conjunctivitis, and maculopapular rash (the 3 C’s plus rash). Koplik spots (small spots with white or bluish-white centers on an erythematous base) may be present on the buccal mucosa. The rash is red and blotchy and appears on the third to the seventh day after the onset of initial symptoms; the rash begins on the face (hairline) proceeding downward and outward, reaching the hands and feet. Complications can include diarrhea, otitis media, pneumonia, encephalitis (1 per 1,000 cases), and death (1–2 per 1,000 cases). Immunocompromised individuals are at increased risk for pneumonitis, encephalitis, and death. These complications can occur in 20–80% of people with compromised immune systems, such as HIV-infection and patients receiving chemotherapy.
C. Reservoirs
Humans are the only host.
D. Modes of Transmission
Measles is transmitted airborne by droplet spread and direct contact with nasal or throat secretions of an infected person. Measles is one of the most highly infectious diseases. Measles virus can remain infectious in the air for up to 2 hours after an infectious person leaves an area.
E. Incubation Period
The time from exposure to symptom onset is about 10 days with a usual range of 7 - 21 days. The rash usually appears about 14 days after exposure. Immune globulin given later than the third day of the incubation period, may extend the incubation period.
F. Period of Communicability or Infectious Period
From 4 days before to 4 days after the first appearance of the rash (this is calculated by counting the day of rash onset as day zero). Measles virus is highly infectious and may remain suspended in the air (thus someone may contract the disease without ever being in the same room with an infected person) and viable on surfaces for up to 2 hours. More than 90% of susceptible people who are exposed to measles will be infected.
G. Epidemiology
From 2001 through 2008, 38 outbreaks of measles were reported. From 2009 through 2014, 66 outbreaks of measles were reported. Outbreaks of measles in the United States mostly involve individuals who are directly exposed to imported measles cases or who are infected during a resulting chain of transmission, and who are either unvaccinated or had unknown vaccine status. The settings of measles transmission have included households, educational institutions (e.g., schools, day care), churches, healthcare facilities, homeless shelters, and other congregate settings. Lack of adherence to existing recommendations for measles prevention among groups at high risk (for example, individuals who travel internationally), can spread measles to susceptible populations, including infants too young to be vaccinated and unvaccinated persons by choice. Because of high population immunity, high measles vaccine effectiveness, and the immediate implementation of control measures, generally the sizes of measles outbreaks in the United States are limited. However, recent large outbreaks emphasize the importance of maintaining high levels of measles immunity across the population through routine measles vaccine coverage. The largest measles outbreak documented in the United States in more than two decades (383 cases) occurred in an under-immunized Amish community in Ohio over 4 months (March–July) in 2014. From December 2014 through March 2015, a measles outbreak consisting of 147 cases that originated in Disney theme parks in California spread to seven other U.S. states and two neighboring countries.
Responding to measles cases and outbreaks is time consuming and costly for local and state health departments. The overall costs to health departments to contain 16 outbreaks during 2011 amounted to an estimated $2.7 million to $5.3 million U.S. dollars. The economic burden of controlling measles spread in healthcare settings amounts to an estimated $19,000 to $114,286 U.S. dollars per case.
One dose of MMR vaccine induces measles immunity in about 95% of people who receive it; a second dose results in 99% immunity. Two doses, administered one month apart with the first dose being after 12 months of age, are recommended.
H. Bioterrorism Potential
None.
I. Additional Information
The Council of State and Territorial Epidemiologists (CSTE) surveillance case definitions for Measles can be found at: https://ndc.services.cdc.gov/conditions/measles/
CSTE case definitions should not affect the investigation or reporting of a case that fulfills the criteria in this chapter. (CSTE case definitions are used by the state health department and the CDC to maintain uniform standards for national reporting.)
Fact Sheets and Forms
References
- Pinkbook | Measles | Epidemiology of Vaccine Preventable Diseases | CDC. (2018, May 16). Retrieved April 17, 2019, from https://www.cdc.gov/vaccines/pubs/pinkbook/meas.html
- Surveillance Manual | Measles | Vaccine Preventable Diseases | CDC. (2018, March). Retrieved April 17, 2019, from https://www.cdc.gov/vaccines/pubs/surv-manual/chpt07-measles.html
- Heymann, D.L., ed. Control of Communicable Diseases Manual, 20th Edition. Washington, DC, American Public Health Association, 2015.