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Health Information for Medical Providers

Important Phone Numbers

If you suspect your patient has measles, isolate the patient and IMMEDIATELY call the Iowa Department of Public Health at the following numbers:

During business hours: 800-362-2736.

After business hours: Iowa State Patrol at 515-323-4360 who will then contact the epidemiologist on-call.

The epidemiologist will facilitate testing at the State Hygienic Laboratory.

Clinical Features

The measles prodrome starts three to four days before the rash. The prodrome is characterized by a high fever that can run 105º F or higher and by the "3 C's": cough, coryza (runny nose), and conjunctivitis. Towards the end of the prodrome, Koplik's spots may appear inside the cheeks. These are small, white spots, often on a reddened background. Following the prodrome, a maculopapular rash begins on the forehead and spreads downward to the feet, also affecting the palms of the hands and the soles of the feet. The measles rash gradually recedes, fading first from the face and last from the thighs and feet.

Isolation

Infected people should be isolated for four days after they develop a rash. Health care providers should follow respiratory etiquette and airborne precautions in health care settings. Regardless of presumptive immunity status, all health care staff entering the room should use respiratory protection consistent with airborne infection control precautions (use of an N95 respirator or a respirator with similar effectiveness in preventing airborne transmission). Because of the possibility, albeit low, of MMR vaccine failure in health care providers exposed to infected patients, they should all observe airborne precautions in caring for patients with measles. The preferred placement for patients who require airborne precautions is in a single-patient airborne infection isolation room (AIIR).

Measles Infographic for Clinicians

Vaccination Recommendations

Two doses of MMR are required for elementary and secondary school entry in Iowa. The first dose can be given at 12 months of age and the second dose can be administered as soon as 28 days later (however the second dose is usually administered as part of the kindergarten shots given between 4-6 years of age).

Generally, persons who started elementary school in Iowa after 1991 and were up-to-date on all school entry vaccine requirements have received two doses of MMR vaccine.

It is recommended that adults born in 1957 or later receive at least one documented dose of MMR vaccine, or have laboratory confirmation of immunity or disease, in order to be considered fully immunized. It is further recommended for adults in that age category who plan international travel or are students in a post-secondary institution to receive a second dose to be considered fully immunized.

It is assumed that persons born in the U.S. prior to 1957 were likely infected with the measles virus and therefore have presumptive immunity. For adults born prior to 1957, two doses of MMR are recommended if they plan to travel internationally.

All health care providers, regardless of year of birth, should have two documented doses of MMR vaccine, proof of immunity (positive IgG result on serology), or laboratory confirmation of disease.

Killed measles vaccine, or vaccine of unknown type, administered between 1963 and 1967 did not provide long-lasting protection and those doses should not count as valid doses. Anyone with doses of measles vaccine documented during that time frame should be revaccinated.

Vaccination in those who have already had measles or have already received the recommended vaccination is not harmful; it only boosts immunity. Therefore, if someone is unable to verify prior vaccination or history of illness, it would be appropriate to vaccinate the individual.

For more information about emerging health issues, contact Polly Carver-Kim at (515) 281-6693

or use the Contact Us system to submit a question online.