Health Advisory

Summary

• Since late-January 2025, a total of 159 measles cases have been reported as part of an ongoing outbreak in the South Plains region of west Texas. Twenty-two patients have been hospitalized and one child died. CDC also reports measles cases in 2025 occurring in Alaska, California, Georgia, Kentucky, New Jersey, New Mexico, New York City, and Rhode Island. 95% of cases either are unvaccinated or have unknown vaccination status.
• Contact the Fairfax County Health Department (FCHD) to report a suspect measles case (contact information below) and to receive guidance on testing and infection control measures.
• Rigorously apply infection prevention measures with suspect cases to reduce the risk of transmission.

Suggested Actions

• Maintain an increased index of suspicion for measles in clinically compatible cases at all times and particularly if a patient presents with fever and rash and has a history of recent exposure, domestic travel to an area with ongoing measles transmission, or international travel.
• Take the following actions for a patient with fever and a rash that you suspect may have measles.
  • Place a surgical mask on the patient as soon as possible.
  • Immediately place the masked patient in an airborne isolation (negative pressure) room, if available, or other exam room with the door closed; do not allow a suspect measles patient to remain in your waiting area. 
  • If you are aware that a suspect measles patient will be arriving at your facility, consider evaluating the patient outside (e.g., in the parking lot), to minimize exposure to others. If the patient enters the building, ensure that they are masked before doing so.
    • If referring a suspect measles patient to another health care facility, notify the facility before sending the patient so that appropriate infection control measures can be implemented at the receiving facility.
  • Only health care workers with immunity to measles should work with the patient.
  • Use standard and airborne precautions.
  • After the suspect measles patient leaves, do not use the exam room for 2 hours.
• Measles is an immediately reportable disease. Contact the FCHD Communicable Disease Unit immediately at 703-246-2433 (normal business hours) or 703-409-8449 (evenings and weekends) to report the suspected case and for guidance on testing and infection control measures.
  • PCR testing is available at the Virginia Department of Health, Division of Consolidated Laboratory Services (DCLS) with approval through the local health department.
• Ensure that all patients, particularly those traveling internationally, are vaccinated against measles.
  • While the first dose of MMR vaccine is routinely recommended at 12-15 months of age, children traveling internationally can be given measles vaccine as early as 6 months of age and at least 2 weeks before departure, if possible. These children should then receive a measles vaccine at 12-15 months of age, at least 28 days after the initial dose, and a third dose at 4-6 years of age.
  • Individuals who were vaccinated prior to 1968 with either the inactivated (killed) measles vaccine or measles vaccine of unknown type should be re-vaccinated with at least one dose of live attenuated measles vaccine. This recommendation is intended to protect those who may have received killed measles vaccine, which was available in 1963-1967 and was not effective.

Additional Information

Measles is a highly infectious viral disease with an incubation period of approximately 10 days (range 7 – 21 days) from exposure to the onset of fever and 14 days to rash onset. Patients with measles are considered infectious from 4 days before to 4 days after rash onset. Transmission is primarily person-to-person by large respiratory droplets. Airborne transmission by aerosolized droplets can occur within shared air space for up to 2 hours after an infectious person with measles has occupied that space.

The clinical case definition for measles is an acute illness characterized by:

1. generalized, maculopapular rash lasting ≥3 days, almost always beginning on the face, AND
2. temperature ≥101°F (38.3°C), AND
3. cough, coryza, or conjunctivitis.

The laboratory criteria for measles include ANY ONE of the following:

1. detection of measles-virus specific nucleic acid by polymerase chain reaction (PCR), or
2. positive IgM serologic test for measles, or
3. significant rise in measles IgG antibody, or
4. isolation of measles virus from a clinical specimen.

In general, persons may be presumed to be immune to measles if they have documentation of two doses of measles vaccine, laboratory evidence of immunity to measles, documentation of physician-diagnosed measles, or were born before 1957. Persons who are not immune should be given timely MMR vaccine or immune globulin according to Advisory Committee on Immunization Practices (ACIP) recommendations.

Individuals who work in health care facilities in any capacity are at increased risk of exposure to measles. To ensure staff are immune to measles, they must have documentation of two doses of measles vaccine or laboratory evidence of immunity to measles. Birth before 1957 is not acceptable evidence of immunity for health care providers. Susceptible personnel who have been exposed to measles should not have contact with patients or be in a health care facility from the 5th through the 21st day after exposure, regardless of whether they received vaccine or immune globulin after exposure (prophylactic IG administration may lengthen furlough period to 28 days after exposures.)

Currently, measles outbreaks are occurring in most regions of the world with health officials in many countries reporting large outbreaks. Domestic outbreaks can also be tracked on CDC’s measles case and outbreak page. Additional information about measles and measles vaccination is available at the CDC website.