Measles
Clinical Manifestations
An acute, viral illness that is characterized by a 2-4 day prodromal period which presents with fever, runny nose, cough, and inflamed eyes. These symptoms usually worsen over three days. At this stage, Koplik spots (small white spots with a red base) may present in the mouth. By the 3rd to 7th day, a rash begins at the hairline, and within 24-48 hours spreads over the entire body. Once the legs are involved, the rash on the head and face begins to fade. The rash is typically red, with papules and macules, and is usually gone after 7 days. Classic measles usually lasts 10 days, and the cough may be the last symptom to disappear. A child with measles feels quite ill; the disease is highly contagious and transmission is through contact with droplets in the air from an infected individual through the respiratory route.
Incubation Period
About 10 days; varying from 7-18 days (from exposure to rash, the period is about 14 days).
Period of Communicability
From 1 to 2 days before the beginning of the prodromal period to four days after the appearance of the rash.
Applicable Laws For Indiana Schools
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For outbreak control in public or private schools, on the same day that a report of a suspected case of measles is received, school personnel shall conduct an inquiry into absenteeism to determine the existence of any other cases of the illness, and shall immediately report the suspect case or cases to the local health department.
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(410 IAC 1-2.3-83(D)(i)(ii))
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School personnel shall send a notice home with each student or attendee who has not presented proof of immunity, explaining that the student shall be excluded from a given date until acceptable proof of immunity, or in the case of medical or religious exemptions, until 14 days after the onset of the last reported measles case. Previously unvaccinated children who are not vaccinated within 72 hours of exposure shall be excluded for 14 days after completing vaccination. (410 IAC 1-2.3-83(D)(iii))
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Acceptable proof of immunity includes a written record which indicates the dates of vaccination (on or after the first birthday), and the type of vaccine administered, or a statement from a physician indicating the date the student had measles, or a laboratory report, showing a protective measles antibody titer.
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(410 IAC 1-2.3-83(D)(iii)(AA)(BB)(CC))
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Exclusion from school or day care centers for at least four days after appearance of rash. (410 IAC 1-2.3-83(2))
School Nursing Implications
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A single dose of live, attenuated measles virus vaccine given at an appropriate time (usually once between 12-15 months of age) is available. A second dose of measles vaccine is required for children upon entering kindergarten or the sixth grade.
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Call caregiver of child.
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Ensure child is under medical care.
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Measles may be known as just "a childhood illness," but can result in severe pneumonia and encephalitis; these complications are not uncommon and may have lifelong consequences, and can, on occasion, cause death.
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Measles vaccine given to susceptible contacts within 3 days of exposure may prevent or modify the illness.
Related Sites/Additional Information
www.cdc.gov/health/measles.htm
Measles Quick Facts
http://www.nih.gov/health/InformationIndex/HealthIndex/Pubincov.htm
www.immunize.org/catg.d/p2021.htm
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