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Measles (Rubeola) remains a common disease in other parts of the world including areas in Europe, Asia, the Pacific and Africa. In 2000, measles was declared eliminated in the United States (U.S.). However, since the beginning of 2019, there has been a dramatic increase in the number of measles cases in the U.S.
In April 2019, the number of measles cases identified since January 2019 in the U.S. had already exceeded the total annually reported number of cases for each year from 2000 to 2018. The majority of cases have been associated with international travel (imported cases) and localized outbreaks (indigenous cases). Someone returning from international travel while sick with measles can spread the disease to susceptible people in their communities. Although measles vaccination rates in the U.S. and in California are high overall, there are some communities with high rates of unvaccinated, susceptible people.
Current Measles Fast Facts (United States)
- Of the >3400 cases reported from January 2001 to May 2019, one-third of cases have occurred in the past 18 months
- U.S. residents traveling abroad account for two-thirds of measles cases directly imported into the U.S.
- Almost 90% of cases reported since 2001 were either unvaccinated or had an unknown vaccination status – Unvaccinated infants remain the highest risk group
SOURCE: Clinician Outreach and Communication Activity (COCA) Webinar - Most Measles Cases in 25 Years: Is This the End of Measles Elimination in the United States? May 2019 (CDC)
Measles is characterized by fever followed by a descending, maculopapular rash. Measles usually begins with a high fever and one or more of the “3 Cs”: cough, coryza, conjunctivitis. The rash develops after the fever and typically appears first on the face, along the hairline, and behind the ears and then spreads downward to the rest of the body. The rash is eythematous and maculopapular, progressing to confluence in the same order as the spread of the rash. Confluence is most prominent on the face. The rash begins to clear on the third or fourth day in the same order it appeared. Fever typically peaks 2 to 3 days after rash onset.
People with measles are usually contagious from about 4 days before through 4 days after rash onset.
- CALL Contra Costa Public Health immediately (24/7) to report any suspect case of measles
Time of Day Phone # Notes Business Hours (8 AM – 5 PM, M-F excluding holidays) 925-313-6740 Communicable Disease Programs staff will answer. After Hours (including holidays) 925-646-2441 Sheriffs dispatch will answer and ask for the Health Officer on-call.
- FAX a copy of the completed CCHS Measles Case History Form to Public Health at 925-313-6465.
- NEW! Should I Test for Measles? – UPDATE to Contra Costa Measles Laboratory Testing Decision Tree (CCHS)
- Contra Costa Public Health Measles Case History Form
Laboratory testing with reverse-transcription polymerase chain reaction (RT-PCR) is the preferred testing method when there is strong clinical suspicion of measles. Serology testing is for determination of immunity only and should not be used to rule out measles in a symptomatic patient.
Coordination of lab testing through Public Health should be initiated since Public Health Laboratories are currently the only laboratories in the U.S. that offer RT-PCR testing for measles (rubeola).
- COLLECT specimens:
- Urine (10-50 mL in sterile container), AND
- Dacron swab of throat (preferred) or nasopharynx in viral transport media (VTM)
- SEND specimens to Contra Costa Public Health Laboratory
- Prior testing approval is needed from Contra Costa Public Health and obtained when reporting the suspect case.
- Individual arrangements are needed for the delivery of specimens to Contra Costa County Public Health Laboratory.
- Include completed Laboratory Requisition Slip for each specimen in the shipment.
While suspecting measles in a patient, immediately mask and isolate the patient per airborne precautions.
Place patient in a negative pressure room when available; if not, examine the patient outside the facility or in a private room with the door closed; minimize the time patient spends in the facility. Other precautions apply.
- All Facilities Letter (ALF 19-17): Recommendations for Measles Case Identification, Measles Infection Control, and Measles Case and Contact Investigations (CDPH)
- Measles Healthcare Infection Control Recommendations (CDPH)
- Guideline for Isolation Precautions: Preventing Transmission for Infectious Agents in Health Care Settings (CDC HICPAC, 2007)
- Aerosol Transmissible Disease Standards (CalOSHA)
Waiting Room Posters:
- Alert: Measles is very contagious and is spreading in our community Poster (CDPH)
- Traveled Recently? … You Could Have Measles. (CDPH)
| Tagalog | Russian | Ukrainian | Spanish
- Visiting Another Country? Protect Your Family. Think Measles. (CDPH)
| Tagalog | Ukrainian | Other Languages
- Guidance & Information (CDPH)
- Prevention and Treatment – Red Book (AAP)
- MMR (Measles, Mumps and Rubella) Vaccine Recommendations (ACIP)
- Measles Diagnostic Tool (Northern CA Kaiser)
- Clinician Outreach and Communication Activity (COCA) Webinar - Most Measles Cases in 25 Years: Is This the End of Measles Elimination in the United States? May 2019 (CDC)
- Measles Cases & Outbreaks:
- California (CDPH)
- Nationwide (CDC)
Physicians who need to report a suspected public health emergency should contact the Public Health division immediately at 925-313-6740; or after hours, call the sheriff's dispatch at 925-646-2441 and ask for the Health Officer On Call.