With the ongoing multistate measles outbreak, it is imperative to review what we know about this highly infectious but vaccine-preventable disease since most clinicians have never seen a case. While there have been no confirmed measles cases in Florida residents, we have seen confirmed cases in visitors, some of whom were evaluated by Florida healthcare providers but not tested or diagnosed.
Measles is a highly contagious disease, transmitted by respiratory aerosols when an infected person coughs or sneezes. The virus can live for up to two hours on surfaces or in an airspace where the infected person coughed or sneezed. The incubation period ranges from 7-21 (average 10-12) days and an individual can pass the virus to others before feeling ill. The prodromal signs and symptoms of measles include: fever, malaise, coryza, cough, conjunctivitis, and the pathognomonic enanthema—Koplik spots—on the oral mucosa. Please note: the presence of Koplik spots confirms measles, but the absence of Koplik spots does not rule it out, as it is present in only a small percentage of cases.
An erythematous maculopapular rash typically appears ~3 days after onset of illness and the ill person continues to be infectious for about 4 days after rash appears. The rash initially appears behind the ears and on the forehead, spreading down the neck, upper extremities, trunks, and lower extremities (including palms and soles). Rash may last for 5-7 days before fading. Complications from measles may include: otitis media, bronchopneumonia, laryngotracheobronchitis, diarrhea, acute encephalitis, and death. The attached document and following link provide an overview of what a patient infected with measles looks like, www.cdc.gov/measles/about/photos.html.
Please isolate and report suspect measles cases to the county health department immediately (www.floridahealth.gov/CHDEpiContact and www.floridahealth.gov/DiseaseReporting). For patients presenting with fever, rash and other symptoms, consider measles in your differential and inquire about MMR vaccine status, recent international travel, and exposure to a person with febrile rash illness. Collect serum, nasopharyngeal swab, and clean catch urine sample for IgM or RNA from suspect patients and isolate them until four days after the onset of rash while awaiting laboratory results. Local health department staff will conduct a contact investigation and provide guidance as needed.
Remember, the best way to prevent the spread of measles is to ensure full MMR vaccine coverage in our community. Identify and offer vaccine to patients that have not received the full series (www.cdc.gov/measles). Thank you for your help in keeping our community safe and healthy.
Anna Marie Likos, MD, MPH
State Epidemiologist and Director,
Division of Disease Control & Health Protection
Florida Department of Health- Updated Measles Resources
Department’s Newsroom- Measles Update