Measles Information for Healthcare Professionals

Measles cases have been increasing rapidly in the US since early 2025 with large, extended outbreaks. Delayed recognition of measles can increase the risk of transmission.

Clinical Presentation

The clinical presentation of measles in adults and children is an acute, viral illness characterized by fever followed by a generalized, maculopapular rash. Additional symptoms may include the 3 Cs: cough, conjunctivitis and coryza. Koplik spots, blue-white spots on the buccal mucosa, are occasionally present.

The rash usually starts on the face, proceeds down the body, and may include the palms and soles. The rash, which lasts for several days, fades in order of appearance. Patients are considered infectious 4 days before and 4 days after rash onset. Measles can be severe. Complications include diarrhea, otitis media, pneumonia, hepatitis, and encephalitis. In 2025, 12% of reported measles cases in the United States were hospitalized and 3 people died from measles.

What You Should Do

1. Report all suspected cases of measles to RIDOH immediately

   Report all suspected cases of measles to RIDOH immediately—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.

   • Review the clinical features of measles.
   • Maintain a high index of suspicion for measles in people with compatible febrile rash illness.

2. 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.

3. 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 Centers for Disease Control and Prevention’s (CDC’s) Measles Cases and Outbreak 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

   Children and students

   Children should get a first dose of MMR at age 12-15 months and a second dose at age 4-6 years. Two 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

   Adults who have not been vaccinated against measles, those who have only gotten one 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 harm in giving MMR to a person who may already be immune to 1 or more of the vaccine viruses.

   • If you were born after 1967 and know you were vaccinated against measles as a child, you do not need a booster shot.
   • If you were born before 1957, you’re generally considered immune to measles.
   • If you were born between 1958 and 1962 or vaccinated against measles from 1963-1967, you may need a new dose of the live MMR vaccine. This is because you may not have been vaccinated or you got an inactivated (killed) vaccine version that is not as effective as modern vaccines. If you got the inactivated vaccine or aren’t sure what type of vaccine you got, talk with your healthcare professional about the possibility of getting a titer to check for immunity. Insurance may not cover the cost of a titer.
   • Pregnant women should not get any live virus vaccine during pregnancy, including MMR.

   Travelers

   Anyone age 6 months and older who will be traveling internationally or to areas known to have measles cases should be protected against measles. Vaccinations should occur before that travel.

   Children 12 months and older need 2 doses separated by at least 28 days, and teenagers and adults who do not have evidence of immunity against measles need 2 doses separated by at least 28 days. Infants who get a dose of MMR from age 6-11 months still need the 2 recommended doses at age 12-15 months and 4-6 years.

   Learn more about preventing measles before and after travel.

   Healthcare workers

   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.

4. Prepare for measles cases

   • Review infection control plans for assessing patients who may have measles or who may have been exposed.
   • Screen for fever with rash at the point of entry into a healthcare facility and place symptomatic individuals in airborne isolation immediately. Don’t allow patients with suspect measles to remain in waiting rooms. If a negative pressure room isn’t available, place the patient in an exam room with a closed door, and don’t use that room for at least 2 hours after the patient has left.
   • Healthcare workers should adhere to standard and airborne precautions when evaluating suspect cases, regardless of their vaccination status.
   • All healthcare workers should have documented evidence of immunity to measles.