Dear Providers,

The California Department of Public Health has sent out an alert about 14 known measles cases in California.  5 of the patients recently traveled to the Philippines or had contact with international travelers.  3 patients had contact with known cases.  The majority of patients were unvaccinated.  A recent outbreak in the Philippines has resulted in over 20 deaths and thousands of cases.

These California cases highlight the need for vigilance about measles.  Your expert eye, diagnostic skills, and prompt reporting of suspect measles cases to public health authorities can make a difference in stopping the spread of this highly contagious disease.


  • Consider measles in patients of any age who have a FEVER and RASH regardless of their travel history.
  • Measles typically begins with fever, cough, coryza, and conjunctivitis.
  • Koplik’s spots may appear in 2-3 days (see 2 photos below).  These are tiny red spots with bluish-white centers on the mucosa of the cheek or palate.
  • At this time, fever can reach 104 and the rash appears.  The rash is red, blotchy, and maculopapular and it may become confluent.  It usually starts on the face (hairline and behind the ears).  It rapidly spreads to the chest, back, and finally the legs and feet (see 2 photos below).
  • Obtain a history of measles immunization, travel outside of the Americas, or contact with international travelers in recent weeks.  Simple community transmission is also possible.


  • Check with your lab, but usually you need 1-2 ml blood in a red-top tube, throat or nasopharyngeal swab using a viral culturette with viral transport media, and 10-40 ml of urine in a sterile container.


  • Post-exposure prophylaxis can be administered to contacts.  Within 72 hours of exposure use MMR vaccine.  Up to 6 days after exposure use IM immune globulin.  You should consider checking with your local health authorities.


  • If you suspect measles, MASK the patient and ISOLATE immediately in an airborne infection isolation room.  If one is not available, use a private room with the door closed.
  • All personnel entering the room should use respiratory protection at least as effective as an N95 respirator.
  • If possible, allow only personnel with documentation of 2 doses of live measles vaccine or laboratory evidence of immunity (measles IgG positive) to enter the room.
  • Do not use the room for at least 2 hours after the patient leaves.
  • ALERT YOUR LOCAL HEALTH DEPARTMENT ASAP.  The risk of measles transmission to others and large contact investigations can be reduced if control measures are implemented immediately.
  • Notify any location where the patient is being referred about the suspect measles status.  Do not refer suspect measles patients to other locations unless you know appropriate infection control measures can be implemented there.
Thank you to Gary Tamkin, MD, our VP of Provider Development and the ED Medical Director at Mercy Medical Center Merced, for alerting us to this important topic.  Some of the material in this email was copied from the CDC website and other sources.  Please feel free to contact me if you have any questions or suggestions.  Thanks.
Rob Wyman, MD | Vice President of Quality
Tel: 925-225-5837 | Fax: 925-482-2838
[email protected]


Koplik’s Spots on the cheek:                                               Koplik’s Spots on the palate:


Red, blotchy, maculopapular rash which starts           Rash spreading to the thorax:
on the face:
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