Never vaccinated - either not offered or opted out
History of exposure to someone w/Measels, travel to country w/low vaccination rates -- and patient never vaccinated or didn't respond to vaccination
Main seasons: winter/spring in US
Higher risk for complications if malnourished, chronically ill, under resourced environments, infants, immunocompromised, pregnancy
Symptoms
Incubation period 7-14d
Then prodome lasting 2-4 days of fever, cough, conjunctivitis, runny nose, malaise
Erythematous macular/papular rash, starting 2-4d after fever
Rash tends to appear first on head/face, then trunk and extremities; can be confluent
Over next 3-5 days, rash fades, typically in the order in which it appeared
In uncomplicated cases, full recovery within 7 days of onset rash
Complications include: otitis media (7-9%); pneumonia (1-6%); diarrhea (8%); post infections encephalitis (.1%); death (.1%); subacute sclerosing panencephalitis (.01%) --> progressive degenerative dz w/onset 5-10 y after infection
Physical Exam Findings
High fever
Conjunctivitis, runny nose
Blue-white (Koplick's) plaques on oral mucosa occur in up to 70%; If complications: otitis media, lung findings of pneumonia, confusion/altered mental status/neuro deficits with encephalitis
Tests
Elevated IgM antibody levels, PCR for virus in respiratory secretions, blood, other fluides
Clinical suspicion, exclusion of other possible infections
Suspected cases should be reported prior to definitive diagnosis