Vaccination rates have fallen, and cases of measles are increasing in England.
Any patient with fever and a rash is potentially infectious and should be isolated and directed to a side room on arrival.
Measles starts with a 2 to 4 day ‘prodromal’ phase before the rash appears, with coryza, cough, conjunctivitis and a fever. See conjunctivitis and rash images below.
Fever typically increases, to peak around rash onset.
Rash generally starts behind the ears, spreads to the face and then expands onto the trunk and can become generalised. The rash is red, blotchy, maculopapular (not itchy) and lasts around 3 to 7 days.
The rash is more difficult to spot on dark skin.
Koplik spots may appear around the time of the rash and last for 2 to 3 days so can easily be missed. They are small white or bluish/white lesions on the buccal mucosa. They can be confused with other lesions in the mouth and so their suspected presence is an unreliable marker of measles.
See poster for images of conjunctivitis, koplik spots and measles rash on light and dark skin.
The infectious period spans 8 days, cases are infectious from 4 days before rash onset and for 4 full days after.
Several other common rash illnesses have similar presentations (especially in young children), for example, roseola, parvovirus infection and scarlet fever, and so identification on clinical features alone may be unreliable.
Direct anyone presenting with a rash and fever to a side room on arrival.
If the patient is calling, advise them to seek medical advice from their GP over the phone or NHS 111, if this is appropriate.
If an in-person review is needed, reception staff should be alerted. The patient should be directed to a side room on arrival.
Report to your local UKHSA health protection team (HPT) urgently by phone to facilitate prompt risk assessment and public health action for vulnerable contacts (under one year old, pregnant, immunocompromised).
If you suspect measles call your local HPT to notify and conduct a risk assessment.
Check for epidemiological factors that increase likelihood of measles:
Exclude from nursery, educational setting or work until full 4 days after onset of rash.
Routinely check vaccination history of patients.
Offer vaccine if not fully protected:
Check all your staff are fully vaccinated. Staff should have documented evidence of 2 doses of the MMR vaccine or have positive antibody tests for measles and rubella.
