The Indiana State Department of Health (ISDH) is urging physicians and other Indiana clinicians to be aware of increased measles activity in the U.S. At press time, no cases of measles had been reported in Indiana, and the ISDH was not investigating any pending cases. 
 
Recently, however, outbreaks have occurred or are continuing in New York and Washington, with additional cases in Georgia and Oregon. Worldwide, outbreaks have occurred in Israel and across Europe.
  
Measles is a highly contagious viral illness transmitted by nose and throat secretions of an infected person. Patients infected with measles are considered most infectious about four days before rash onset through four days after rash onset. Prodromal symptoms begin 10-14 days after exposure and include fever, cough, coryza and conjunctivitis. Around the fourth day of illness, fever increases and a maculopapular rash appears on the face or near the hairline and spreads downward and outward to the rest of the body. This rash usually lasts around four to five days before slowly fading.

When considering a measles diagnosis in patients, health care providers are encouraged to ask about measles vaccination history, travel within the past month and contact with individuals exhibiting symptoms within the past month. Health care providers should especially consider travel to any states or countries that are experiencing outbreaks when evaluating a patient with measles-like symptoms.   
 
Suspected cases of measles should be self-isolated and immediately reported to the local health department or the ISDH to ensure a prompt public health response. Clinicians should collect a nasopharyngeal swab within three days of symptom onset for individuals presenting with measles symptoms (fever, cough, conjunctivitis, coryza and rash) for PCR testing at the ISDH laboratory. 

The current recommendation for immunization against measles is two doses of the measles, mumps and rubella (MMR) vaccine. Children should get a first dose at 12 through 15 months of age and a second dose at 4 through 6 years of age. Two doses of MMR vaccine are considered about 97 percent effective in preventing measles infection. 

For questions or to report a suspected case, please contact Payton Revolt, ISDH vaccine-preventable disease epidemiologist, or at (317) 233-7277 or contact Ali Bianco, vaccine-preventable disease public health investigator, or at (317) 233-7112. 

To report a suspected case after business hours (8:15 am-4:45 pm, M-F), please contact the ISDH epidemiologist-on-call at (317) 233-1325.