The measles outbreak in Minnesota that began with two confirmed cases on April 12 has grown to 68 cases as of May 30. The majority of the cases are in the Minneapolis-St. Paul area (Hennepin and Ramsey Counties).

Sixty-five of the cases are children under the age of 17 and three are adults. Of the 68 affected individuals, 64 are unvaccinated.

In Iowa, the Department of Public Health (IDPH) reported on May 25 that there are currently no confirmed cases of measles in Iowa. In the last two months, 15 suspect measles cases in Iowa have been investigated and ruled out. The State Hygienic Laboratory tests all suspected cases.

IDPH urges health care providers to stay vigilant and take the following steps:

• Ensure that measles vaccinations of all patients and staff are up to date.
• Consider notifying unvaccinated patients of the recent measles activity in Minnesota and Nebraska, which significantly increases their risk of exposure. Non-immune people who are exposed to measles are at a high risk of becoming infected.
• Consider measles in anyone presenting with fever and the “Three Cs” – cough, coryza and conjunctivitis followed by rash three to five days later. These patients should be asked about recent travel in the U.S., including to locations in Minnesota where recent cases have been confirmed, and international areas with measles cases.
• If measles is suspected, isolate the patient and immediately call IDPH, which considers measles a public health emergency. During business hours, call 800-362-2736. After business hours, call the Iowa State Patrol at 515-323-4360, who will then notify the epidemiologist on call.

Measles guidance for health care providers in Iowa is available on the IDPH website. Information about measles activity in Minnesota – including education materials in English, Spanish and Somali – is available from the Minnesota Department of Health. Additional information is available on the CDC website.

IDPH provided the following key points for health care providers to help prepare for potential suspect measles cases. Additional resources are in its CADE Epi Manual, including a chapter on measles, as well as fact sheets for the public in English, Bosnian and Spanish.

IDPH recommends:

• All Iowa health care providers and their staff should have had two documented doses of MMR or serologic evidence of immunity to measles.
• During routine office visits, assure that all patients are up to date on their MMR vaccine.
• Contact public health immediately to report any Iowans (whether vaccinated or not) who possibly have been exposed to measles to discuss necessary actions.
• When examining a patient with potential measles, health care providers must make arrangements to see the patient in a manner that does not expose others. For example, have the patient come in a back door. Do not allow patients with possible measles to sit in the waiting room. See the patient immediately, document specific onset dates of cough, coryza, fever, rash and initial presentation, and spread of rash.
• Symptoms include fever, rash, coryza/runny nose, conjunctivitis and cough.