Clinical Presentation and Management of Measles and Rubella

Clinical Characteristics

Measles is characterized by a prodrome of high fever, cough, coryza, and conjunctivitis followed by a maculopapular rash that begins on the face and spreads downward 1
The incubation period of measles averages 10-12 days from exposure to prodrome and 14 days from exposure to rash 1
Rubella is characterized by a milder presentation with low-grade fever, lymphadenopathy, and malaise 2, 3
The incubation period of rubella ranges from 12 to 23 days 2
Subclinical infection occurs in 25-50% of rubella cases 2, 3

Measles is a highly contagious respiratory disease transmitted through direct contact and airborne spread 1
Patients with measles are contagious from 4 days before to 4 days after rash onset 1
Rubella is less contagious than measles 2
The period of maximal communicability for rubella extends from a few days before to 7 days after rash onset 2, 3

Diarrhea is the most common complication of measles, followed by middle ear infection and bronchopneumonia 1
Encephalitis occurs in approximately 1 per 1,000 cases of measles 1
Death occurs in 1-2 per 1,000 reported cases of measles in the United States, primarily from pneumonia and acute encephalitis 1, 4
Arthralgia and arthritis are common complications of rubella, particularly in adult women (up to 70% of cases) 3
Encephalitis occurs at a lower rate in rubella than in measles (1 per 6,000 cases) 3

Measles is associated with increased rates of premature labor, spontaneous abortion, and low birth weight infants 1, 4
Congenital rubella syndrome (CRS) is a primary concern when rubella infection occurs during pregnancy, especially in the first trimester 2, 3
Classic triad of CRS includes cataracts, congenital heart defects, and sensorineural deafness 3

Both measles and rubella are preventable through vaccination with the combined measles-mumps-rubella (MMR) vaccine 1, 5
The first dose of MMR vaccine is recommended at 12-15 months and the second dose at 4-6 years 5
Healthcare workers should have acceptable evidence of measles and rubella immunity 5
Rubella was declared eliminated from the United States in 2004 2

Healthcare workers with measles should be excluded from work until ≥4 days following rash onset, as recommended by the Centers for Disease Control and Prevention 6
The MMR vaccine administered within 72 hours of exposure can prevent or modify disease, according to the Centers for Disease Control and Prevention 6, 7
Immune globulin (IG) 0.25 mL/kg IM (maximum 15 mL) can prevent or modify infection if given within 6 days of exposure, particularly when vaccine is contraindicated, as recommended by the Centers for Disease Control and Prevention 7, 8

Exposed healthcare workers without immunity should be excluded from work days 5-21 after exposure, as recommended by the Centers for Disease Control and Prevention 6, 9
All staff caring for measles patients should use N95 respirators regardless of immunity status due to ~1% vaccine failure rate, according to the Centers for Disease Control and Prevention 6, 9

After MMR vaccination, mild measles-like symptoms may occur 5-14 days post-vaccination due to limited viral replication, as reported by the Centers for Disease Control and Prevention 7, 8