Prevention and Control of Communicable Diseases

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Measles (also called rubeola, red measles, or hard measles) is a highly contagious virus and is a serious illness that can be prevented by vaccination. Currently, measles most often occurs in susceptible persons (those who have never had measles or measles vaccine) who are traveling into and out of the United States. Once measles cases occur, there may be spread to persons or groups of people who have not been vaccinated.

Cause

Measles virus.

Symptoms

The first symptoms seem like the beginning of a cold with a high fever, watery eyes, runny nose, and cough. A red blotchy rash appears 3 to 5 days after the start of symptoms, usually beginning on the face (hairline), spreading down the trunk and down the arms and legs. The fever may still be present after the rash starts.

The rash usually lasts 4 to 7 days. Complications of measles are more common among children younger than 5 years of age and adults 20 years of age and older. These complications can include diarrhea, ear infection, pneumonia, and rarely encephalitis (inflammation of the brain). About 1 child out of every 1,000 who get measles will develop encephalitis (swelling of the brain) that can lead to convulsions and can leave the child deaf or with developmental delay.

Spread

Measles virus is spread when an infected person coughs, sneezes, or breathes out tiny droplets with measles virus into the air and another susceptible person breathes them in. The virus can sometimes float in the air and infect others for approximately two hours after a person with measles leaves a room. Measles is also spread to susceptible persons by touching contaminated objects and then touching one’s eyes, nose, or mouth.

Incubation

It takes from 10 to 12 days from the time a person is exposed until cold-like symptoms begin. The time from exposure to when the rash starts is usually 14 days, but may be up to 21 days. 

Contagious Period

From 4 days before to 4 days after the rash appears.

Exclusion

Child Care and School: Until 4 days after the rash appears. A child with measles should not attend any activities during this time period.

Exclude unvaccinated children and staff, who are not vaccinated within 72 hours of exposure or given immune globulin (IG) within 6 days of exposure. Susceptible children and staff who do not receive the above prophylaxis may be excluded for 21 days after the onset of rash in the last person who developed measles. Recommendations for exclusion should be done in collaboration with your local/state public health department.

Diagnosis

A rash may occur with many viral illnesses. If measles is suspected, a blood test for measles antibody should be done 3 to 5 days after rash begins.

Persons who have been exposed to measles should contact their healthcare provider if they develop cold-like symptoms with a fever and/or rash. They should NOT go to any healthcare facility without calling first. The child will be kept separate from others to prevent further spread.

Treatment

Recommend parents/guardians call their healthcare provider. There is no specific treatment for measles

Prevention/Control

• Measles vaccine is usually combined with mumps and rubella vaccine (MMR) and given at 12 to 15 months of age. A second MMR vaccine is recommended at 4 to 6 years of age, but may be given as soon as four weeks after the first dose. Two doses or a legal exemption are required for kindergarten and seventh grade enrollment.
• Unvaccinated people who have been exposed to measles should call their healthcare provider or local public health clinic as soon as possible to be vaccinated. Vaccination is contraindicated during pregnancy.
  • If measles vaccine is given within 72 hours of exposure, it may provide some protection. Encourage parents/guardians to notify the child care provider or school when their child is vaccinated so their records can be updated.
  • Immune globulin (IG) if given within 6 days of exposure can prevent or make the symptoms of measles milder. This should be strongly considered for contacts younger than one year of age, pregnant women who have never had measles or measles vaccine, or persons with a weakened immune system.
• Recommend staff stay home if they develop symptoms of measles. Encourage parents/guardians keep their child home if they develop symptoms of measles.
• Teach children and staff not to touch their eyes, nose, or mouth.
• Cover your nose and mouth with a tissue when coughing or sneezing, or cough/sneeze into your sleeve. Dispose of used tissues.
• Clean and sanitize mouthed objects and surfaces at least daily and when soiled. 
• Wash hands thoroughly with soap and warm running water after touching secretions from the nose or mouth. If soap and water are not available, use an alcohol-based hand sanitizer.

For more information, call the Missouri Department of Health and Senior Services (MDHSS) Bureau of Communicable Disease Control and Prevention at 573- 751-6113 or 800-392-0272 (24/7), or call your local health department.

Your child may have been exposed to:

Measles

Measles is a serious viral illness that may be prevented by vaccination.

If you think your child has Measles:

• Tell your child care provider.
• Need to stay home?

  • Child Care and School:
    Yes, until 4 days after the rash begins.

    A child with measles should not attend any activities during this time period.

If a case of measles occurs in your child care or school, consult with public health to determine how long unvaccinated children and staff need to stay home.

Symptoms

Your child may have a high fever, watery eyes, a runny nose, and a cough.

A rash appears on the third to seventh day of illness. The rash may appear red and blotchy. It usually begins on the face (in the hairline) and then spreads down the body, arms and legs. The rash may eventually cover the entire body. Rash may last for 7 days. If your child has been infected, it may take 7 to 21 days for symptoms to start. 

Spread

• By coughing and sneezing.
• By touching contaminated objects or surfaces.

Contagious Period

From 4 days before to 4 days after the rash starts.

Call your Healthcare Provider

If anyone in your home:

• was exposed to measles and has not had measles or measles vaccine in the past.
• develops cold-like symptoms with a fever and/or a rash. Keep them at home. DO NOT go to a healthcare facility without calling first. Your child will be kept separate from others to prevent further spread. A blood test may be done.

Prevention

• All children by the age of 15 months must be vaccinated against measles or have an exemption for child care enrollment. An additional dose or an exemption is required for kindergarten or two doses by seventh-grade enrollment. Potentially exposed, susceptible contacts should be excluded from the school or child care facility. Consult with public health on the duration of exclusion.
• People receiving their second dose, as well as unimmunized people receiving their first dose before or within 72 hours of exposure, generally may return to the school or child care facility.
• Parents should keep infants away from individuals with a cough illness.
• People who have close contact with infants should be up-to-date on their immunizations.
• Cover nose and mouth when coughing and sneezing. Use a tissue or your sleeve. Dispose of used tissues.
• Wash hands after touching anything that could be contaminated with secretions from the nose or mouth. Your child may need help with handwashing.
• Clean and disinfect anything that comes in contact with secretions from the nose or mouth. Use a product that kills viruses.

For more information, call the Missouri Department of Health and Senior Services (MDHSS) Bureau of Communicable Disease Control and Prevention at 573-751-6113 or 800-392-0272 (24/7), or call your local health department.