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. In rare cases, the measles virus can affect the brain years after a child has recovered from illness, causing brain damage and death. Before widespread vaccines in the United States, hundreds of people died from measles every year.

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 for up to two hours, even after the infected person has left.
• The infected person can spread the disease 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 have been exposed to someone with 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.
• Do not leave your house until your doctor says it is okay. In particular, 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. 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 your community against measles. The MMR vaccine is safe and works very well at 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 did not receive vaccine as a child, you should get vaccinated against measles.

Learn more about who should get the MMR vaccine.

If you are an adult who is planning international travel or traveling within the United States in known measles outbreak areas, you should get vaccinated against measles if you did not receive 2 doses as a child.

If your child is 6-11 months old and you’re planning international travel or traveling to an area in the United States experiencing an outbreak, you should speak to your child’s provider to get an early dose of vaccine against measles. After that, your child should follow the recommended schedule and get:

• Another dose at 12 through 15 months.
• A final dose at 4 through 6 years.

If you are or your child is 12 months old or older and planning international travel or traveling to an area in the United States experiencing an outbreak, you should receive your first dose of vaccine against measles immediately. You can get a second dose as soon as 4 weeks after your first dose.

You should plan to be fully vaccinated against measles at least 2 weeks before you depart. If your trip is less than 2 weeks away and you're not protected, you should still get a dose of MMR.

Watch your health for 3 weeks after you return from your trip. Measles is very contagious and can spread to others through coughing and sneezing.

Call your doctor immediately if you or your child gets sick with a rash and fever. Tell your doctor you traveled abroad, and whether you have received MMR vaccine.

• Measles symptoms typically include:
  • High fever (may spike to more than 104° F)
  • Cough
  • Runny nose (coryza)
  • Red, watery eyes (conjunctivitis or pink eye)
  • Rash (starts 3-5 days after other symptoms start)

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)

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.

You can also call 1-833-540-0473 (Public Health InfoLine) 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 (WHO)
• Measles Vaccination (AAP)
• Paying for Vaccines (LACDPH)
• Measles Resources (CDPH)

Posters in multiple languages (CDPH)

• Visiting Another Country? Think Measles (before + after)
  • English | Español | Русский | Tagalog | українська | Tiếng Việt | Additional Languages
• Traveled Recently? (fever + travel)
  • English | Español | Русский | Tagalog | українська

• Consider measles in any patient with a febrile rash and clinically compatible symptoms (see Clinical Presentation 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.

• 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. Alternatively, they can be screened in a car (if available).
• 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.
• 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 at least one hour 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 clinical 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 (option 8) - 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.
• Serum for measles-specific IgG and IgM (LAC PHL Serum - Measles IgG and IgM)
• Throat or nasopharyngeal swab (NP) for measles RNA real-time polymerase chain reaction [RT-PCR] (LAC PHL Measles NP Swab-PCR or LAC PHL Measles Throat Swab – PCR)
• Urine for measles RNA real-time polymerase chain reaction [RT-PCR] (LAC PHL Measles Urine -PCR)
• Measles Specimen Collection & Storage

• MMR and MMRV 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 the American Academy of Pediatrics (AAP) Recommendations for MMR (Measles, Mumps, & Rubella) and MMRV (Measles, Mumps, Rubella & Varicella) Vaccines.
• Healthcare personnel should have documented evidence of immunity. This includes:
  • Documentation of two doses of measles vaccine given in 1968 or later, separated by at least 28 days, with the first dose on or after the first birthday
  • If no documentation of two doses of measles vaccine, a documented IgG positive test for measles
  • Laboratory confirmation of previous disease.
• All individuals ages 6 months and older should be vaccinated against measles prior to international travel or domestic travel in areas experiencing measles outbreaks.
• For immunity (IgG) testing, you can use a commercial lab or LA County’s Public Health Lab (PHL). If using PHL, fill out this form to accompany the specimen: LAC PHL Serum - Measles IgG-Immunity Testing Only
• Please report any Vaccine related adverse events to the 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.