Measles (Rubeola)

Measles is a highly contagious virus that lives in the nose and throat mucus of an infected person. When that person sneezes or coughs, droplets spray into the air and can infect people around him. Measles is so contagious that if one person has it, 90% of the people close to that person who are not immune will also become infected with the measles virus. Also, measles virus can live for up to two hours in an airspace where the infected person coughed or sneezed. If other people breath the contaminated air or touch the infected surface, then touch their eyes, noses, or mouths, they can become infected.

A typical case of measles begins with mild to moderate fever, cough, runny nose, red eyes, and sore throat. Two or three days after symptoms begin, tiny white spots (Koplik’s spots) may appear inside the mouth. Three to five days after the start of symptoms, a red or reddish-brown rash appears. The rash usually begins on a person’s face at the hairline and spreads downward to the neck, trunk, arms, legs, and feet. When the rash appears, a person’s fever may spike to more than 104 degrees Fahrenheit.

Ranges for 7-21 days (average of 10-12 days) from exposure to the onset of prodromal symptoms.

Measles is the most communicable during the 3-4 days preceding rash onset. Persons with measles have been known to shed virus between 4 days prior to rash onset and up to 4 days after the rash has appeared.

Immunization is the only way to prevent measles. Measles vaccination is required for school entry in Texas.

CDC Vaccination Resources

• Measles Vaccination
• Measles, Mumps, and Rubella (MMR) Vaccination: What Everyone Should Know
• Measles, Mumps, and Rubella (MMR) Vaccination: Information for Healthcare Professionals
• Measles Vaccination for Travelers

Children with suspected or confirmed measles should be kept out of school or childcare until 4 days after the onset of rash. Rules for exclusion of sick children from school and childcare are outlined in the Texas Administrative Code, specifically Rule 97.7 for schools and Rule 746.3603 for childcare.

Report Measles Immediately at 1-800-705-8868

Reporting Form (Provider Initial Reports)

Several Texas laws (Tex. Health & Safety Code, Chapters 81, 84 and 87) require specific information regarding notifiable conditions be provided to the Texas Department of State Health Services (DSHS). Health care providers, hospitals, laboratories, schools, and others are required to report patients who are suspected of having a notifiable condition (25 Tex. Admin. Code §97.2).

Prior to vaccine introduction, annual measles incidence peaked at 85,862 in 1958 in Texas. Since the introduction of vaccine, cases have decreased by 99.9 percent in Texas. Nearly all cases and outbreaks of measles in the US and Texas since 2000 have occurred among persons exposed to imported cases from countries where measles is still endemic. Because measles is still endemic in many parts of the world and is highly contagious, measles can easily be re-introduced into Texas in unvaccinated communities. This was seen in 2013, when a person traveling to Asia returned with the measles and interacted with a vaccine-hesitant community. In a matter of weeks, 20 additional people were infected with measles. Overall, in 2013, 27 cases were reported, the highest annual case count in over 20 years. In 2019, Texas experienced an increase of measles to 23 cases, the highest case count since 2013.

• 2023 Measles Health Advisory (PDF)
• 2019 Measles Health Advisory (PDF)

Stepwise increase in fever to 103° F or higher, cough, coryza (runny nose), conjunctivitis (red or watery eyes), rash (usually beginning on face/head and moving downward/outward that lasts 5-6 days). Rash usually begins 2-4 days after fever.

Persons with measles are infectious 4 days before through 4 days after rash onset (day of rash onset is day zero). The average incubation period for measles is 10 to 12 days from exposure to prodrome (non-rash symptoms) and 14 days from exposure to rash (range: 7–21 days).

In the United States, from 1987 to 2000, the most commonly reported complications associated with measles infection were pneumonia (6%), otitis media (ear infection) (7%), and diarrhea (8%) (8). For every 1,000 reported measles cases in the United States, approximately one case of encephalitis (brain swelling) and two to three deaths resulted (9–11). The risk for death from measles or its complications is greater for infants, young children, and adults than for older children and adolescents.

MMR vaccine is recommended for the following potentially exposed groups:

• Exposed persons (6 months and older) without evidence of immunity to measles –administer MMR within three days of exposure.
• Preschool-aged children (1-4 years) or adults who have received one MMR dose with community-wide transmission – a second dose should be considered.
• Adults born before 1957 and are reasonably sure they have never been vaccinated or had disease.
• Healthcare workers/ volunteers or those with contact with children under the age of 5 with no vaccine documentation or lab evidence of disease/immunity
• Persons infected with HIV who are ≥12 months of age and who do not have evidence of current severe immunosuppression.
• Perinatal HIV infected individuals who were vaccinated before establishment of effective antiretroviral therapy (ART) with 2 appropriately spaced doses of MMR vaccine once effective ART has been established.

IG (IM) is recommended for the following potentially exposed groups:

• Infants 0-6mths – administer IG

The dose is 0.25 mL/kg body weight, with a maximum of 15 mL intramuscularly. The recommended dose of IG for immunocompromised persons is 0.5mL/kg of body weight (maximum 15 mL) intramuscularly.

IG (IV) is recommended for the following potentially exposed groups:

• Severely immunocompromised persons
• Pregnant women without evidence of measles immunity who are exposed to measles.

CHILDREN:

• Administer the 1st MMR dose at 12-15 months and the 2nd dose at 4-6 years (the second dose can be administered before 4 years, as long as there is a 4-week gap between first and second doses)
  • For internationally traveling children, administer 1 dose at 6-11 months of age before departure.  These children should be revaccinated with 2 doses of MMR vaccine at 12-15 months, and the second dose at least 4 weeks later.
  • Catch-up vaccination: ensure that all school-aged children have had 2 doses of MMR vaccine.

ADULTS:

• One dose of MMR is recommended for adults not at high risk for exposure and transmission.  A routine second dose of MMR vaccine, administered a minimum of 28 days after the first dose, is recommended for adults who are students in postsecondary educational institutions, work in a healthcare facility, or plan to travel internationally. 
• Persons who received inactivated (killed) measles vaccine or measles vaccine of unknown type during 1963-1967 should be revaccinated with 2 doses of MMR vaccine. 

There are some contraindications to keep in consideration:

• Avoid MMR in patients with a high fever, serious disease, or in pregnant women.
• Mild concurrent infections are not a contraindication, and measles vaccination is not known to exacerbate TB.
• Those with a history of an anaphylactic reaction to neomycin, gelatin, or other components of the vaccine should not be vaccinated.
• Measles vaccine is contraindicated in persons who are severely immunocompromised as a result of congenital disease, HIV infection, advanced leukemia or lymphoma, serious malignant disease or treatment with high-dose steroids, alkylating agents or antimetabolites or in persons who are receiving immunosuppressive therapeutic radiation.

MMR vaccine might cause fever (<15%), transient rashes (5%), transient lymphadenopathy (5% of children and 20% of adults), or parotitis (<1%). Febrile reactions usually occur 7–12 days after vaccination and generally last 1–2 days. The majority of persons with fever are otherwise asymptomatic.

• IOM concluded that the body of evidence favors rejection of a causal association between MMR vaccine and risk for autistic spectrum disorders (ASD), including autism, inflammatory bowel diseases, and type 1 diabetes mellitus.

One dose of measles-containing vaccine administered at age ≥12 months was approximately 94% effective in preventing measles in studies conducted in the WHO Region of the Americas. Measles outbreaks among populations that have received 2 doses of measles-containing vaccine are uncommon. The effectiveness of 2 doses of measles-containing vaccine was ≥99% in two studies conducted in the United States.