As of March 7, 45 cases of measles have been diagnosed among U.S. residents in 2024, including 2 cases among California residents. In comparison to 2023, there were 58 cases of measles among U.S. residents during the entire year. Many of the 2024 cases have been linked to international travelers. There have been no confirmed cases of measles in Monterey County in 2024 to date. Measles is a highly infectious viral illness. While one person with COVID-19 can infect one to three others, one person with measles can infect as many as 18 other susceptible individuals. One in five people who get measles will require hospitalization for their illness. One in 1,000 will develop severe complications including encephalitis, respiratory complications, and death. Infants, children under five years of age, pregnant women, and people with compromised immune systems are at higher risk for severe disease.
Recommendations for Medical Providers
Encourage your patients to get vaccinated.
Children should get 2 doses of MMR vaccine: the first at 12-15 months of age and the second at 4-6 years of age. One dose is recommended prior to international travel for unvaccinated infants ages 6 to 11 months.
Adults born during or after 1957 who do not have evidence of immunity should get at least one dose of MMR vaccine. Two doses are recommended for healthcare workers, post-high school students and international travelers. See the CDC website for detailed recommendations and contraindications at https://www.cdc.gov/vaccines/vpd/mmr/hcp/recommendations.html.
Ensure your clinic is prepared to isolate a person with suspected measles by reviewing the California Department of Public Health’s Healthcare Facility Infection Control Recommendations for Suspected Measles Patients available at https://www.cdph.ca.gov/Programs/CID/DCDC/CDPH%20Document%20Library/Immunization/Measle s-HCFacilityICRecs.pdf.
Keep an eye out for measles symptoms.
Measles starts with a mild fever accompanied by cough, coryza, and conjunctivitis.
Two to three days later the fever spikes, often to 104-105°F, and a red blotchy maculopapular rash appears, usually first on the face, along the hairline. This slightly itchy rash rapidly spreads downward.
Patients with rash and fever and recent travel to countries with current measles outbreaks are at higher risk of measles. A list of countries with measles outbreaks is available at https://www.cdc.gov/globalhealth/measles/data/global-measles-outbreaks.html.
Follow the attached guide from the California Department of Public Health to determine whether to test for measles.
Immunization in the last month with MMR or MMRV can be a cause of measles-like rash. Check the patient’s immunization history. Testing is not indicated if the patient was immunized against measles in the last month AND the patient’s exposure history (see attached guide) is negative.
Act immediately if you suspect measles.
Implement airborne infection control precautions immediately. Mask and isolate the patient.
Call the County of Monterey Health Department immediately at (831) 755-4521. After normal business hours, call (831) 755-5100 and ask for the Hazardous Materials Team, who will connect you with the on-call Public Health Official.
Only allow medical personnel who are immune to measles to be near the patient.
If screening is indicated, expedite measles testing through the County of Monterey Public Health Laboratory (831-755-4516). Use of commercial labs may delay diagnosis and expose others needlessly.
Collect 10-15 mL of urine in a sterile collection container AND a throat specimen using a synthetic swab (e.g., Dacron) placed in liquid viral or universal transport medium.
Do not use any regular exam room for 2 hours after a suspected measles patient has left the room.
For More Information
Contact the Communicable Disease Unit at (831) 755-4521 or visit our website at www.mtyhd.org.
Review the California Department of Public Health’s measles testing guidelines at http://eziz.org/assets/docs/IMM-1269.pdf.
Visit the Centers for Disease Control and Prevention’s (CDC’s) website: http://www.cdc.gov/measles/
Watch the CDC’s Clinical Outreach and Communication Activity (COCA) Call on YouTube entitled “We Must Maintain Measles Elimination in the United States: Measles Clinical Presentation, Diagnosis, and Prevention”: https://emergency.cdc.gov/coca/calls/2023/callinfo_081723.asp.
Should I Test For Measles? A Guide for California Health Providers (as part of the attached printable version of this Update.
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