Official State of Rhode Island website

State of Rhode Island Department of Health

Measles Information for Healthcare Professionals

Measles activity in the United States has increased substantially since early 2025, with several large and prolonged outbreaks reported. This resurgence is largely due to declining coverage with the measles, mumps, and rubella (MMR) vaccine.

Measles is still endemic in many regions globally and is highly transmissible, particularly in communities with low vaccination coverage. Ongoing transmission is facilitated by travel, as unvaccinated people can get infected domestically or internationally and introduce measles into susceptible populations. 

This summer, FIFA World Cup 2026 is coming to New England with an expected influx of close to a million visitors to the region. Now is a good time to verify patients’ MMR vaccination history.

Vaccination is the best way to prevent measles. One dose of the MMR vaccine is 93% effective, and two doses are 97% effective. Clinicians should verify that all patients are up to date with MMR vaccination according to the American Academy of Pediatrics' (AAP's) recommended vaccinations for children and adolescents and the American Academy of Family Physicians' recommended vaccinations for adults. Clinicians should prioritize timely vaccine administration, especially for people at increased risk or without documented immunity.

Delayed recognition of measles can increase the risk of transmission. In Rhode Island, suspected or confirmed cases must be reported to the Rhode Island Department of Health (RIDOH) immediately, and no later than 24 hours after identification.

Clinical Presentation

Measles is a highly contagious, acute viral illness affecting both children and adults. Children younger than age 5 are at the highest risk for severe disease and complications.

Measles typically presents with a prodrome of fever, cough, coryza, and conjunctivitis (“the 3 Cs”), followed by the development of a generalized, maculopapular rash. Early symptoms often resemble a viral upper respiratory infection with high fever, cough, rhinorrhea, and red, watery eyes. Koplik spots—blue-white spots on the buccal mucosa—may be present, particularly in pediatric patients, and typically appear 1-2 days before rash onset. The rash usually starts on the face and along the hairline and spreads downward to the trunk and extremities, sometimes involving the palms and soles. It generally lasts several days and fades in the order of appearance. Patients are considered infectious from 4 days before through 4 days after rash onset. Clinical Overview of Measles | CDC

Measles typically lasts 1-2 weeks. It can result in significant complications including diarrhea, otitis media, pneumonia, hepatitis, and encephalitis. Severe outcomes can occur, including neurologic sequelae (e.g., seizures, deafness, blindness) and death, but they are less common in the US. In 2025, approximately 12% of reported US measles cases required hospitalization, and deaths were reported. 

What You Should Do

  • Report all suspected cases of measles to RIDOH immediately

    Immediately report all suspected cases of measles to RIDOH—24 hours a day—at the time of initial clinical suspicion. Call 401-222-2577 Monday-Friday, 8:30 a.m.-4:30 p.m. or 401-276-8046 after hours. Don’t wait for laboratory confirmation to report.

  • Collect specimens

    Collect specimens in patients presenting with febrile rash illness, clinically compatible symptoms, and clinically compatible measles symptoms, and with epidemiological risk factors, such as travel or exposure to traveler. Follow RISHL's specimen collection guidance for Measles PCR.

    • Contact RIDOH for help submitting specimens to the Rhode Island State Health Laboratories (RISHL) for testing. Follow CDC’s testing recommendations and collect both a nasopharyngeal swab for reverse transcription polymerase chain reaction (RT-PCR) and a serum specimen for serology from all patients with clinical features compatible with measles. 
    • RISHL cannot accept throat swabs at this time. Please only collect a nasopharyngeal swab and a blood specimen for RISHL submissions.
    • Follow these specimen transport instructions:
       
      • Refrigerated: Transport and deliver to RISHL within 72 hours of collection at 2-8°C in a cooler able to maintain specimen temperature. A plug-in electric cooler is recommended. A cooler packed with excess frozen gel packs is acceptable as long as the transport temperature stays at 2-8°C.
      • Frozen: If specimen was previously frozen, it must be transported on frozen gel packs in an insulated shipper.

  • Ensure all patients are up to date on their MMR vaccine

    Measles is almost entirely preventable through vaccination. The measles, mumps, and rubella (MMR) vaccine remains the best protection against measles. MMR vaccines are safe and highly effective: 2 doses are 97% effective against measles and 1 dose is 93% effective. When more than 95% of people in a community are vaccinated (coverage >95%) most people are protected through community immunity (herd immunity).

    Vaccination coverage among US kindergartners has decreased over time, but Rhode Island has a very high MMR vaccination rate. Approximately 97% of Rhode Island kindergarteners have completed the MMR series, above the national average of 92.5%.

    The CDC’s Measles Cases and Outbreaks page reports that more than 90% of current measles cases in the US were unvaccinated or had an unknown vaccination status.

    Review tips on having vaccine conversations and addressing concerns about the MMR vaccine.

    Vaccination Recommendations and Requirements

    Not all patients have immunization information in the Rhode Island Child and Adult Immunization Registry (RICAIR). Learn more about immunization records.

    Children should get a first dose of MMR at age 12-15 months and a second dose at age 4-6 years. In Rhode Island, 2 doses of MMR are required for entry into kindergarten and all later grades. Two doses of MMR are also required for entry into Rhode Island colleges and universities. For any child who cannot be vaccinated for medical reasons, a healthcare professional can provide information on additional prevention measures. 

    Learn more about immunization for schools and child care facilities and workers.

    Adults who are not at high risk for measles should have at least 1 dose of the MMR vaccine or other presumptive evidence of immunity (laboratory evidence of immunity, laboratory confirmation of disease, or birth before 1957).

    Adults who got a measles vaccine from 1963-1967 should check their records to learn if they got the inactivated measles vaccine that was found to be ineffective. If they did or if they don’t know, they should get at least 1 dose of MMR. 

    Non-high-risk adults who have not been vaccinated against measles, those who have only gotten 1 dose of MMR, or those who are not sure of their immune status can still be vaccinated. If they were not vaccinated against or do not have evidence of immunity against measles, they should get at least 1 dose of MMR. There’s no contraindication in giving MMR to a person who may already be immune to one or more of the vaccine viruses. 

    • People born before 1957 are generally considered immune to measles. 
    • People born from 1958-1962 or vaccinated against measles from 1963-1967 may need a new dose of the live MMR vaccine. This is because they may not have been vaccinated or they got an inactivated (killed) vaccine version that's not as effective as modern vaccines. If they got inactivated vaccine or aren’t sure of the type of vaccine, titer to check for immunity. It may be useful to get laboratory evidence of immunity through measles immunoglobulin G (IgG) in serum. Equivocal titer results are considered negative.
    • Pregnant women should not get any live virus vaccine during pregnancy, including MMR.

    Adults at high risk for measles should have 2 doses of MMR vaccine given at least 28 days apart or other presumptive evidence of immunity (laboratory evidence of immunity, laboratory confirmation of disease, or birth before 1957). This group includes: 

    • Students at post-high school educational institutions
    • Health care workers (HCW), including all paid and unpaid people working in healthcare settings
    • Close contacts of immunocompromised people
    • People with HIV without evidence of severe immunosuppression
    • Although birth before 1957 is considered presumptive evidence of immunity, for unvaccinated HCWs born before 1957 who lack laboratory evidence of immunity or laboratory confirmation of disease, healthcare facilities should consider vaccinating them with 2 doses of MMR vaccine at least 28 days apart.

    Before traveling outside of the United States:

    • Children age 12 months and older and adults should have 2 doses of the MMR vaccine, separated by at least 28 days, to maximize their protection.
    • Clinicians may consider accelerated dosing for children age 12 months and older by giving the second dose at least 28 days after the first dose without waiting until the child is age 4.
    • Infants age 6-11 months should get 1 dose of the MMR vaccine. These children will still need their regularly scheduled 2 MMR doses at age 12 months and older. 

    In the event of an outbreak in Rhode Island or regionally, RIDOH will provide clinicians with further vaccination guidance.

    Learn more about preventing measles before and after travel.

    MMR is required for all healthcare workers in certain facilities. For healthcare workers born before 1957 who lack laboratory evidence of measles immunity or laboratory confirmation of disease, 2 doses of MMR are recommended. Those without 2 doses of MMR or who were born before 1957 will also be required to be fully vaccinated during outbreaks.

    • RIDOH Resources

    CDC Resources

    Other Resources