Clinical Information

The measles virus is a member of the Paramyxoviridae family of viruses, which include parainfluenza virus serotypes 1-4, mumps, respiratory syncytial virus (RSV), and metapneumovirus. The measles virus is one of the most highly contagious infectious diseases among unvaccinated individuals and is transmitted through direct contact with aerosolized droplets or other respiratory secretions from infected individuals. Measles has an incubation period of approximately 8 to 12 days, which is followed by a prodromal phase of high fever, cough, coryza, conjunctivitis, and malaise. Koplik spots may also be apparent on the buccal mucosa and can last for 12 to 72 hours.(1,2) Following this phase, a maculopapular, erythematous rash develops beginning behind the ears and on the forehead and spreading centrifugally to involve the trunk and extremities.

Immunocompromised individuals, pregnant women, and those with nutritional deficiencies, are particularly at risk for serious complications following measles infection, which include pneumonia and central nervous system involvement.(1,3)

Following implementation of the national measles vaccination program in 1963, the incidence of measles infection has fallen to below 0.5 cases per 1,000,000 population and the virus is no longer considered endemic in the United States.(4) Measles outbreaks continue to occur in the United States, however, due to exposure of nonimmune individuals or those with waning immunity to infected travelers. The measles outbreak in 2011 throughout Western Europe emphasizes the persistence of the virus in the worldwide population and the continued need for national vaccination programs.(5)

The diagnosis of measles infection is often based on clinical presentation alone. The presence of IgM-class antibodies suggests recent infection but should not be used alone to diagnose measles infection. Screening for IgG-class antibodies to measles virus aids in identifying nonimmune individuals.