How should I assess and manage a suspected measles case?

For a suspected measles case in the UK, manage it as follows, assuming a typical patient presenting with fever + maculopapular rash + cough/coryza/conjunctivitis.

1) Assess quickly for likelihood and severity

Clinical features consistent with measles are rash for ≥3 days, fever for ≥1 day, and at least one of cough, coryza or conjunctivitis; Koplik spots may help but are not always present. Measles is highly infectious from 4 days before to 4 days after rash onset. [1]

Look specifically for:

• dehydration / reduced intake
• respiratory distress or pneumonia
• encephalopathy, confusion, seizures
• otitis media
• pregnancy, immunosuppression, infancy, frailty or significant comorbidity
  Measles can be more severe in infants, pregnant people and the immunocompromised. [1]

2) Immediate infection control / public health actions

• Isolate immediately and minimise exposure to others.
• Notify the local UKHSA Health Protection Team promptly on clinical suspicion — do not wait for laboratory confirmation. [1]
• Arrange testing through the local public health pathway; oral fluid testing for measles IgM and/or viral RNA is recommended, and oral fluid samples should be obtained from all notified cases. [1]

3) Investigations

Usually:

• oral fluid for measles IgM / PCR
• consider serum if oral fluid is unavailable
• further tests only if needed to assess complications or alternative diagnoses. [1]

4) Clinical management

There is no specific antiviral treatment for uncomplicated measles; treatment is mainly supportive:

• fluids
• antipyretics/analgesia
• treat complications as they arise
• admit if clinically unwell or complications are suspected. [1]

5) When to escalate/admit

Have a low threshold for hospital assessment/admission if:

• hypoxia, tachypnoea, focal chest signs, or suspected pneumonia
• encephalopathy, seizures, severe lethargy
• inability to maintain hydration
• pregnancy, significant immunosuppression, or young infant
• diagnostic uncertainty with severe illness. [1]

6) Contacts / post-exposure prophylaxis

UKHSA-led contact tracing is important. For susceptible contacts:

• MMR can be offered ideally within 3 days of exposure
• immunoglobulin may be needed for certain high-risk contacts, especially immunocompromised patients, young infants, and selected pregnant contacts. [1]