Measles on the Rise - Recommendations for Identification of Cases, Reporting, and Testing
April 15, 2019
Measles cases in the U.S. in the first three months of 2019 have already surpassed the year-end totals for every year except 2014 since ongoing transmission of measles was eliminated in this country nearly two decades ago. From January 1 to April 11, 2019, 555 cases of measles have been confirmed in 20 states, including several outbreaks. Two outbreaks have been reported in California (CA) and, as of April 10, 21 measles cases, including 13 outbreak-associated cases, have been reported ( more info here ). The two CA outbreaks were linked to international travel followed by local transmission.

Several of the California cases were not isolated while at the hospital, leading to additional cases from exposure at hospitals. In Orange County (OC), we have evaluated several measles cases and exposures in recent weeks, although no cases have been confirmed in OC residents this year. Since measles is highly infectious, it is imperative that any suspect cases are immediately isolated, reported to Public Health, and appropriately tested (see Provider Recommendations below).
Provider Reommendation
  • Consider measles in patients presenting with febrile rash illness and clinically compatible measles symptoms (cough, coryza, and/or conjunctivitis), especially in patients with history of travel outside of North America or to areas in the U.S. with ongoing transmission, transit through U.S. international airports, or interaction with foreign visitors, including at tourist attractions. Measles rash generally starts on the head and descends to the rest of the body.
  • Immediately isolate any suspect measles cases.
  • Any patient suspected of having measles should be masked and immediately moved to an airborne infection isolation (negative pressure) room (AIIR) if available or to a private room with the door closed if no AIIR.
  • See infection control guidance for measles for more information.
  • Immediately report any suspect measles cases to Orange County Public Health Epidemiology at 714-834-8180 during office hours (or 714-628-7008 after hours).

For additional clinical guidance, see CDPH Measles Clinical Guidance .
Laboratory Testing
  • Obtain specimens for testing from patients with suspected measles as recommended by Public Health and in Measles Clinical Guidance
  • Polymerase chain reaction (PCR) is the preferred testing method for measles and can be facilitated through Orange County Public Health once the suspect case is reported. Serology may also be requested in certain situations.
  • Do not send suspect measles cases to a laboratory for specimen collection.
Vaccination
Contact Information
See OCHCA Measles Information for more information. If you have any questions or concerns, please contact the Epidemiology and Assessment Program at (714) 834-8180.
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