State of California—Health and Human Services Agency
California Department of Public Health

Health Advisory

TO: Healthcare Providers

Fever and Rash? Consider Measles. Traveling Abroad? Protect Against Measles.

2/2/2024

Key Messages

Health care providers should consider measles in persons presenting with a febrile rash illness and other symptoms consistent with measles.
Multiple measles cases have been confirmed in the United States in recent weeks. Cases have been linked to overseas travel, reflecting a global rise in measles cases.
Airborne precautions should be immediately instituted to prevent nosocomial measles exposures.
Suspected measles cases should be promptly reported to the appropriate local health department (LHD) by telephone, even before laboratory confirmation.
Ensure that patients are up to date with measles vaccinations, especially if travel abroad is planned.

Background

In 2023, 58 confirmed measles cases were identified in the U.S., four of which occurred in California. The Centers for Disease Control and Prevention (CDC) has seen an increase in direct importations of measles by international travelers. From December 1, 2023 through February 1, 2024, there have been three measles cases in California, all in international travelers.

Recommendations

Providers should suspect measles if compatible symptoms AND risk factor(s) are present.

Symptoms

At least one of the “3 Cs” – cough, coryza and conjunctivitis AND
Febrile rash illness

Risk factors

In the prior 3 weeks, any of: travel outside of North America, transit through U.S. international airports, or interaction with international visitors (including at a U.S. tourist attraction)

Steps for providers to take when patients present with febrile rash illness:

Isolate patient immediately, in an airborne infection isolation room (AIIR) if possible. See CDC and CDPH (PDF) infection control guidance. Infected people are contagious from 4 days before rash onset through 4 days after rash onset.
Assess for risk factors and measles immunization status.
If measles is suspected, contact your local health department (LHD) promptly by telephone to discuss measles testing and control measures.
If advised to test for measles by your LHD, submit a specimen for polymerase chain reaction (PCR) testing. PCR is the preferred testing method for measles. Measles IgM testing is frequently falsely positive and is not recommended.

Providers should ensure that patients are up to date on measles vaccinations at all times, and especially if travel abroad is planned. Infants 6 to 11 months old need 1 dose of measles vaccine before traveling abroad. Children 12 months and older should receive 2 doses before travel. Adults born during or after 1957 without evidence of immunity against measles should have documentation of two doses of MMR vaccine prior to travel, with the second dose administered no earlier than 28 days after the first dose.