What are the signs and symptoms healthcare providers should look for in diagnosing measles?

Healthcare providers should suspect measles in patients with a febrile rash illness and the clinically compatible symptoms of cough, coryza (runny nose), and/or conjunctivitis (red, watery eyes). The illness begins with a prodrome of fever and malaise before rash onset. A clinical case of measles is defined as an illness characterized by

• a generalized rash lasting 3 or more days, and
• a temperature of 101°F or higher (38.3°C or higher), and
• cough, coryza, and/or conjunctivitis.

Koplik spots, a rash present on mucous membranes, are considered pathognomonic for measles. Koplik spots occur from 1 to 2 days before the measles rash appears to 1 to 2 days afterward. They appear as punctate blue-white spots on the bright red background of the buccal mucosa. Pictures of measles rash and Koplik spots can be found at www.immunize.org/clinical/image-library/measles/.

Providers should be especially aware of the possibility of measles in people with fever and rash who have recently traveled abroad or to an area with an ongoing outbreak in the United States, or those who have had contact with people from an outbreak area or international travelers. Providers should immediately isolate and report suspected measles cases to their local health department and obtain a nasopharyngeal, throat, and/or urine specimen for diagnosis confirmation and virus genotyping. Providers should also collect blood for serologic testing during the first clinical encounter with a person who has suspected or probable measles.