Measles 101: The Basics for Nurses

By Betsy Todd, MPH, RN, CIC, AJN clinical editor

Measles rash/CDC

Measles rash/CDC

While debates about measles vaccination swirl around the current U.S. measles outbreak, most U.S. nurses have never actually seen the disease itself, and right now we are a lot more likely to encounter a case of measles than of Ebola virus disease. Here, then, is a measles primer.

Symptoms. Measles is an upper-respiratory infection with initial symptoms of fever, cough, runny nose, red and teary eyes, and (just before the rash appears) “Koplik spots” (tiny blue/white spots) on a reddened buccal mucosa. The maculopapular rash emerges a few days after these first symptoms appear (about 14 days after exposure), beginning at the hairline and slowly working its way down the rest of the body.

Infected people who are severely immunosuppressed may not have any rash at all. “Modified” measles, with a longer incubation period and sparse rash, can occur in infants who are partially protected by maternal antibodies and in people who receive immune globulin after exposure to measles.

Transmission. The virus spreads via respiratory droplets and aerosols, from the time symptoms begin until three to four days after the rash appears. (People who are immunosuppressed can shed virus and remain contagious for several weeks.) Measles is highly contagious, and more than 90% of exposed, nonimmune people will contract the disease. There is no known asymptomatic carrier state, and no nonhuman animal is known to carry or spread the virus. The virus survives for less than two hours in the air or on surfaces, and is rapidly inactivated by heat, light, acids, and disinfectants.

Isolation. When measles is suspected, airborne isolation is necessary. If negative pressure is not available, the patient should be placed in a room with the door closed. Only immune staff wearing N-95 masks should enter the room.

Diagnosis. The usual test for measles is serologic testing for immunoglobulin M (IgM) antibody; a positive test confirms the diagnosis. IgM is often evident as soon as the rash appears, and can be detected for about a month. A negative IgM test on a specimen taken within 72 hours of rash onset may be a false negative; the test should be repeated.

Measles virus can be cultured from a nasopharyngeal aspirate, throat swab, urine sample, or heparinized blood, but only specialized labs can perform these cultures and results are not available for several days. While cultures therefore do not provide a quick diagnosis, molecular testing can be done on culture isolates, and this is epidemiologically important during an outbreak.

Exposures. Measles vaccine given to a nonimmune person within 72 hours of exposure, or immune globulin given within six days of exposure, may prevent or modify infection. Whether or not postexposure prophylaxis is used, the exposed nonimmune person should be excluded from school, child care, or health care/child care work from five days after their first date of measles exposure through 21 days after their last date of exposure.

Complications. Complications are most common in children under five or adults older than 20. Diarrhea, otitis media, or pneumonia occur in a small percentage of measles infections. Seizures (with or without fever) affect less than one percent of patients. Acute encephalitis occurs in about one of every thousand measles infections, and permanent neurological damage is possible. If nonimmune pregnant women contract measles, there is an increased risk of premature labor, spontaneous abortion, and low-birthweight babies. In developed countries, there are about two deaths per 1,000 cases of measles.

You are considered immune to measles if you were born before 1957, have received two doses of live attenuated measles vaccine, had lab-confirmed measles infection, or have a detectable serum level of IgG measles antibody titer.

For links to excellent resources as well as the latest information about measles and about the current outbreak, visit the CDC Web site.

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Clinical editor, American Journal of Nursing (AJN), and epidemiologist


  1. Ashley Ingram November 26, 2016 at 2:22 pm

    It is ridiculous that we are having reoccurrence of an eradicated disease because of uneducated parents who are easily persuaded by media to not vaccinate their children. I never thought that we would have to deal with diseases that should have been gone a long time ago. It is upsetting and I feel like health providers should not sway away from educating parents. I also think we should hold parents accountable for not vaccinating their children, I mean it is a neglectful. I know that we have a right to do what we want to our bodies but I don’t feel that this is okay by any means. Hopefully, an improvement will come soon.

  2. Betsy Marville RN February 11, 2015 at 5:34 pm

    I remember July 4, 1962 well. I was 4 years old and could not go to see the town fireworks because I was just getting over the measles. I had to watch from my neighbors’ driveway. I had been warned not to speak to or get near my friend Ian next door who had the measles, but I sat and spoke to him through the chain link fence. I will never forget the hot New Jersey summer sick and covered in itchy red spots. The treatment was topical cold cornstarch, baby aspirin and my Mom’s slowly brushing my hair at night to relieve my scalp itching. Luckily my illness left me with no deficits. My sister had to stay outside when i was downstairs during the day because she never had the measles. She caught me a jar-full of lightning bugs to release and watch fly away in a blinking swarm. A few years later she was vaccinated when it became available.
    When she turned 28 however, one rock concert later, she broke out in measles, not realizing she needed a booster to preserve her immunity. She was very sick and developed lingering myalgia from the disease.
    We must now look at not only childhood vaccinations, but the revised adult schedule from the CDC. As nurses we need to reassure parents of the safety of vaccines and the need to be ever vigilant against those still dangerous diseases that we take for granted are not a threat, but clearly still are waiting to make a comeback.
    Thank you for this update.

  3. dayspringacres February 11, 2015 at 12:35 pm

    Reblogged this on The Grandmother Club and commented:
    A reason to immunize against measles – 90 percent of non-immune exposures contact the disease. Virus sheds for about 2 weeks. You never know if that snuggly cold on the bus next to you is s cold, or measles just taking hold.

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