Measles in Ohio – Recognition, Reporting, and Prevention

ODH Health Alert

February 5, 2024

Summary and Action Items 

  • The Ohio Department of Health (ODH) has reported the state’s first measles case of 2024. ODH is working with Public Health – Dayton & Montgomery County and other impacted health departments to identify and notify those who may have been exposed. For more information on this case, see the Dayton & Montgomery County news release here.
  • Measles is extremely contagious and declines in measles vaccination rates globally have increased the risk of outbreaks worldwide. Ohio had one measles case in 2023, and 90 in 2022, when an outbreak centered in central Ohio totaled 85 cases. Measles prevalence has been increasing recently internationally and there have been recent reported cases in the United States as well.
  • ODH is reminding clinicians and public health officials to remain alert for signs and symptoms of measles, particularly among persons who have not yet received a measles-containing vaccine (MCV) including those who may have postponed or missed doses. Providers should also consider outreach to patients who are eligible for MCV to encourage routine immunization.
  • Measles is a Class A reportable disease. If measles is suspected, facilities should implement appropriate infection prevention and control measures and report any case, suspected case, or positive laboratory result immediately via telephone to the local public health department in which the patient resides. Prompt recognition, reporting, and implementation of infection prevention and control measures are critical to limiting the spread of disease.

Background

Measles is a highly contagious viral illness that typically begins with a prodrome of fever, cough, coryza (runny nose), and conjunctivitis (pink eye), lasting 2-4 days prior to rash onset. Modified measles can occur in infants who still have maternal antibodies and in those who received measles vaccine or immune globulin soon after exposure. Measles can cause severe health complications, including pneumonia, encephalitis (inflammation of the brain), and death. Complications from measles are more common among children younger than 5 years of age, adults older than 20 years of age, pregnant women, and people with compromised immune systems. As many as one out of every 20 children with measles gets pneumonia, the most common cause of death from measles in young children.

The virus is transmitted by direct contact with infectious droplets or by airborne spread when an infected person breathes, coughs, or sneezes. Measles virus can remain infectious in the air and on surfaces for up to two hours after an infected person leaves an area. Measles is transmitted by contact with an infected person through coughing and sneezing. Infected people are contagious from 4 days before the rash starts through four days afterward. The incubation period for measles from exposure to fever is usually about 10 days (range seven to 12 days), and from exposure to rash onset is usually about 14 days (range seven to 21 days).

The measles, mumps, rubella (MMR) vaccine is highly protective against measles infection. The Centers for Disease Control and Prevention (CDC) recommends all children get two doses of MMR vaccine, starting with the first dose at 12 through 15 months of age, and the second dose at four through six years of age. MMR vaccine can also be given to adults born after 1957 who are not vaccinated, or whose vaccination status is unknown. For people traveling abroad, CDC recommends that all persons older than six months receive MMR vaccine prior to departure.

Recognition

Consider measles as a diagnosis in anyone with a febrile illness and clinically compatible symptoms (e.g., a generalized maculopapular rash with cough, coryza, or conjunctivitis). A clinical history should include assessment for known contact to someone with measles, recent travel to areas with measles transmission, including international travel, and MMR vaccination status.

Collection of virologic and serologic specimens is recommended for confirmation of disease. For patients with suspected measles, collect both respiratory (oropharyngeal or nasopharyngeal) and serum specimens for testing. Measles testing can be performed by commercial laboratories.

Testing for measles virus is also available through the Ohio Deparment of Health Laboratory (ODHL) for eligible clinical specimens. To request approval for testing at ODHL:

  • Healthcare providers should contact the local public health department in which the patient resides.
  • Local health departments should contact the Bureau of Infectious Diseases Vaccine Preventable Disease Epidemiology program to request specimen approvals using established chains of communication.

For additional clinical information for healthcare providers, please visit the CDC website.

Reporting

Report a case, suspected case, and/or positive laboratory result immediately via telephone to the local public health department in which the patient resides. If patient residence is unknown, report immediately via telephone to the local public health department in which the reporting healthcare provider or laboratory is located. Local public health departments should report immediately via telephone the case, suspected case, and/or a positive laboratory result to ODH.

Prevention 

Recommend MMR vaccine for all eligible patients who are unvaccinated or not fully vaccinated. Immunization schedules can be found on the CDC website here.

Persons with suspected or confirmed measles infection should be isolated, including exclusion from school or childcare center, for four days following the onset of rash. Contacts who might be susceptible should be immunized with measles vaccine as soon as possible after exposure. Measles vaccine given within 72 hours after exposure may prevent or reduce the severity of disease. Immune globulin (IG) can prevent or modify measles in a susceptible person if given within six days of exposure. IG may be especially indicated for susceptible household contacts less than one year of age, pregnant women, or immunocompromised persons, for whom the risk of complications is increased.

Please see the Measles Chapter in the ODH Infectious Disease Control Manual and CDC website for additional guidance on the public health management of cases and contacts and infection prevention and control measures.

To minimize the risk of measles transmission in healthcare settings, healthcare personnel should do the following:

  1. Query patients with a febrile rash illness about a history of travel, contact with foreign visitors, transit through an international airport, or possible exposure to a person with measles in the 3 weeks prior to symptom onset. The possibility of measles should be considered for patients with such a history and symptoms consistent with measles.
  2. Mask patients with suspected measles immediately, if tolerated. Encourage respiratory etiquette.
  3. Do not allow patients with suspected measles to remain in the waiting room or other common areas; isolate patients with suspected measles immediately in an airborne infection isolation room if one is available. If such a room is not available, place the patient in a private room with the door closed. For additional infection control information, please refer to the CDC’s control measures for measles.
  4. If possible, allow only healthcare personnel with documentation of two doses of MMR vaccine or laboratory evidence of immunity to measles (i.e., measles IgG positive) to enter the patient’s room.
  5. Healthcare personnel should wear an N95 or higher-level respirator regardless of presumptive evidence of immunity. A user seal check should be performed each time the respirator is donned.
  6. If possible, do not allow susceptible visitors in the patient room.
  7. Do not use the examination room for at least two hours after the possibly infectious patient leaves.
  8. If possible, schedule patients with suspected measles at the end of the day.
  9. Notify the local health department in whose jurisdiction the patient resides immediately by telephone about any patients with suspected measles.
  10. Notify any location where the patient is being referred for additional clinical evaluation or laboratory testing about the patient’s suspected measles status, and do not refer patients with suspected measles to other locations unless appropriate infection control measures can be implemented at those locations. The patient must wear a mask, if feasible.
  11. Instruct patients with suspected measles and exposed persons to inform all healthcare providers of the possibility of measles prior to entering a healthcare facility so appropriate infection control precautions can be implemented.
  12. Make note of the staff and other patients who were in the area during the time the patient with suspected measles was in the facility and for two hours after they left. If measles is confirmed, exposed people will need to be assessed for measles immunity.
  13. For additional details about prevention measures in healthcare settings, refer to CDC’s Interim Infection Prevention and Control Recommendations for Measles in Healthcare Settings.

Contact Information 

For general questions related to measles, healthcare providers and facilities should contact their local health department. Ohio local health departments should contact the ODH Bureau of Infectious Diseases at 614-995-5599 or VPDEpi@odh.ohio.gov.

Resources

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