Common symptoms for measles include:

• High fever (higher than 101° F)
• Cough
• Runny nose
• Red and watery eyes
• Tiny white spots (Koplik spots) that may appear inside the mouth 2-3 days after symptoms begin.
• Rash 3-5 days after other signs of illness. The “measles rash” typically starts at the face and then spreads down to the rest of the body.

Measles can cause several health complications. Common complications include ear infections and diarrhea. About 1 in 5 people who are not vaccinated in the United States who get measles will be hospitalized. Serious complications include lung infection (pneumonia), dehydration, or swelling of the brain. Before widespread vaccines in the United States, hundreds of people died from measles.

Those who are more likely to have serious complications due to measles are:

• Children younger than 5 years of age
• Pregnant people
• People with weakened immune systems

• The virus spreads easily through the air when an infected person breathes, talks, coughs, or sneezes.
• The virus can stay in the air and on surfaces for many hours, even after the infected person has left.
• The infected person can spread the disease before they have any symptoms. This could be up to four days before a measles rash appears and up to four days after the rash appears.

If you think you or your someone in your family may have measles because you or they have symptoms , have not been vaccinated against measles, and/or have been traveling:

• Stay home and call your doctor and let them know of your concerns.
• Stay away from other individuals or large groups in places such as school, daycare, and waiting rooms, before speaking to your doctor.
• If you are a health care provider whose patients have symptoms compatible with this disease, call LACDPH immediately.

If you think you have been exposed to measles:

• Call your doctor immediately to let them know you have been exposed to someone with measles.
• Your doctor may be able to determine if you have protection against measles based on your vaccine record or previous lab results.
• Your doctor may also make special arrangements to evaluate you to limit risk to other patients and staff.
• Make sure to wear a facemask that covers your nose and mouth.
• Stay away from places where there are large groups of people who are at higher risk of getting sick, such as schools, hospitals, or childcare. Do not return until your doctor says it is okay to return. This will help make sure that you do not spread measles to others.

Making sure everyone gets 2 doses of the measles-mumps-rubella (MMR) vaccine is the best way to protect yourself, your family, and community against measles. The MMR vaccine is safe and works very well in preventing measles. Two doses are 97% effective, and one dose is 93% effective in preventing measles. The spread of measles can be prevented if at least 95% of community members have received 2 doses of the MMR vaccine.

Most individuals born or attending school in the United States get vaccinated when they are children. They receive their first dose at 12-15 months of age and their second dose at 4-6 years of age. If you are an adult who is travelling internationally, you should get vaccinated against measles if you did not receive 2 doses as a child.

Learn more about who should get the MMR vaccine.

There are many places to get the MMR vaccine. If you have insurance, talk to your doctor or check with your local pharmacy to see what vaccines are offered. Most health insurances cover the cost of all recommended vaccines for children and adults.

If you are uninsured or underinsured, there are programs available to help cover the cost of vaccines. Children who are 18 years of age or younger are eligible to receive vaccines at no cost through the Vaccines for Children (VFC) Program if they are:

• Eligible for or are enrolled in Medi-Cal
• American Indian or Alaskan Native
• Uninsured (do not have health insurance)
• Underinsured (private health insurance does not cover the full cost of vaccines)

Click to see if your child is eligible to receive VFC vaccines: English | Spanish

Uninsured or underinsured adults can access free or low cost vaccines at select clinics enrolled in the Vaccines for Adults (VFA) program. For more information on who is eligible, read VFA Eligibility Based on Insurance Status. You can use the following resources for more information on locating clinics:

• A list of free and low-cost clinics in Los Angeles County.
• Interactive county map to locate free and low-cost vaccine clinics.
• LACDPH Vaccine Preventable Disease Control Program website for patients and their families to get more information on vaccines.

You can also dial 2-1-1 for a list of free or low cost vaccine clinics. This includes Vaccines for Children (VFC) provider locations that serve Medi-Cal eligible children and uninsured or underinsured adults. Learn more about specific vaccine information for different age groups:

• Vaccines for Infants and Children (LACDPH)
• Vaccines for Adolescents and Teens (LACDPH)
• Vaccines for Adults (LACDPH)

• Measles Toolkit (LAC DPH) - includes social media materials, videos, and posters.
• Measles (CDC)
• Measles Vaccination (CDC)
• Measles: It Isn’t Just a Little Rash (CDC)
• Paying for Vaccines (LACDPH)

• Consider measles in any patient with a febrile rash and clinically compatible symptoms (see below), especially if they are unvaccinated or under-vaccinated or have any of the following risk factors in the past 4 weeks:
  • Travel, especially international or domestic through an international airport.
  • Contact with someone with a febrile rash illness.
  • Exposure to a known or possible measles case.

• Immunocompetent patients with measles typically exhibit high fever, with one or more of the “3 C’s” conjunctivitis, coryza (runny nose), and cough. Patients may have erythematous, white or grey specks on the buccal mucosa, commonly referred to as Koplik spots, prior to the onset of rash.
• Two to 4 days after initial symptoms, measles rash usually begins along face and hairline and spreads downwards to trunk. Patients are typically infectious 4 days prior to onset of rash to 4 days after rash.
• Even in previously healthy children, measles can cause serious complications. The most common reasons for hospitalizations include dehydration, pneumonia, and diarrhea. Additionally,1 out of every 1,000 measles cases will develop acute encephalitis, which often results in permanent brain damage. Tragically, 1 to 3 out of every 1,000 children who become infected with measles will die from respiratory and neurologic complications.
• Finally, subacute sclerosing panencephalitis (SSPE) is a rare, but fatal degenerative disease of the central nervous system that can occur 7-10 years after measles infection.

• Patients with signs or symptoms of measles should be rapidly identified and isolated from other patients prior to or as soon as possible after entry into the facility.
• If possible, screen patients prior to their arrival at the healthcare setting. Patients with a febrile rash and clinically compatible measles symptoms who are unimmunized or who have had international travel or other potential exposures to measles should be evaluated before clinic opens or after it has closed, to avoid exposing other patients.
• Patients with suspected measles should wear a well-fitted medical mask or respirator and be placed in an airborne infection isolation room if one is available. If this cannot take place, escort masked patient away from other patients directly to a private room for evaluation and specimen collection. Do not use this room again until 2 hours after the patient has departed the room.
• If a private room is not available, evaluation and specimen collection can be considered outside the health center, e.g., in patient’s car.

• Do not wait for laboratory confirmation, report immediately by telephone for both confirmed and suspected cases upon suspicion of measles. Public Health will guide you through the collection of specimens for testing and management of the patient under investigation as well as asymptomatic contacts for suspected or confirmed cases. Consultation is required before sending specimens to the Public Health Laboratory:
• Weekdays 8:30 am – 5:00 pm: Call 213-351-7800 - Epidemiologist on Duty
• Non-business hours/weekends: Call 213-974-1234 - Administrative Officer on Duty

• Laboratory confirmation is essential for all suspected measles cases. Healthcare providers should obtain the following 3 samples from patients suspected of having measles at first contact with patient.
• Measles Specimen Collection & Storage
  • Serum (measles-specific IgG and IgM) LAC PHL Serum - Measles IgG and IgM
  • Throat or nasopharyngeal swab (NP) (measles RNA real-time polymerase chain reaction [RT-PCR]) LAC PHL Measles NP Swab-PCR or LAC PHL Measles Throat Swab – PCR
  • Urine sample: LAC PHL Measles Urine -PCR

• MMR and MMRV vaccine are both safe and highly effective vaccines to protect against measles.
  • In immunocompetent individuals, one dose of a measles-containing vaccine is 93% effective against measles, 2 doses are 97% effective.
  • For more information on vaccines, see Advisory Committee on Immunization Practices (ACIP) Recommendations for MMR and MMRV (Measles, Mumps, Rubella & Varicella) Vaccines
• Healthcare personnel should have documented evidence of immunity against measles.
• All international travelers ages 6 months and older should be vaccinated against measles prior to travel if they do not have presumptive evidence of measles immunity. See CDC Yellow Book.
• LAC PHL Serum - Measles IgG-Immunity Testing Only
• Please report any Vaccine related adverse events to Vaccine Adverse Event Reporting System (VAERS)

• Individuals who are exposed to measles and do not have evidence of immunity should be offered post-exposure prophylaxis to protect them and modify the clinical course of disease.
• If eligible and no contraindications, patients should receive MMR or MMRV vaccine within 72 hours of initial measles exposure, or immunoglobulin (IG) within 6 days of exposure.
• Do not administer measles containing vaccine and IG simultaneously, as immunoglobulins can interfere with vaccine effectiveness.

LAC DPH

• Measles B73: Webpage | PDF
• Check List: Managing Patients Suspected of Having Measles

CDC

• Measles for Healthcare Providers
• Infection Prevention and Control for Measles in Healthcare Settings
• Plan for Travel patient measles resource
• Measles Trainings:
  • You Call the Shots
  • The Pink Book Webinar Series

CDPH

• Measles investigation Quick Sheet
• Immunization and Immunity Testing Recommendations for Healthcare Personnel