Synopsis
Recognise three notifiable viral infections, isolate suspected measles immediately, protect vulnerable contacts and pregnancy, and use the current UK immunisation schedule accurately.
- Measles causes high fever, cough, coryza and conjunctivitis followed by Koplik spots and a blanching rash that begins on the face or hairline and spreads downwards.
- Isolate suspected measles from shared air and notify the health protection team immediately on clinical suspicion; do not wait for oral-fluid confirmation.
- MMR-containing vaccine within 72 hours of measles exposure can protect eligible susceptible contacts; selected vulnerable contacts may need human normal immunoglobulin as soon as possible and up to six days.
- Mumps usually causes painful unilateral or bilateral parotid swelling, but orchitis, aseptic meningitis, pancreatitis and hearing loss can dominate the presentation.
- Rubella is often mild, with low fever, fine rash, posterior auricular or suboccipital lymphadenopathy and adult arthralgia, yet maternal infection can cause congenital rubella syndrome.
- MMR and MMRV are live vaccines and are contraindicated during pregnancy and substantial immune suppression; vaccinate susceptible patients after pregnancy when safe.
- Children born on or after 1 January 2025 are offered routine MMRV at 12 and 18 months in England; transitional cohorts and catch-up follow their date-of-birth schedule.
- There is no routine specific antiviral for uncomplicated measles, mumps or rubella: care is supportive while infection control, complication treatment and prevention remain decisive.
Key red flags
Suspected measles in a waiting room, ward or emergency department requires immediate airborne isolation and public-health notification before test confirmation.
Hypoxia, respiratory distress, dehydration, encephalopathy, seizure or focal neurology during measles requires hospital assessment for pneumonitis, bacterial complication or encephalitis.
Mumps with severe headache, neck stiffness, altered consciousness, testicular pain, abdominal pain or hearing change suggests meningitis, orchitis, pancreatitis or sensorineural injury.
Any suspected rubella illness or exposure during pregnancy needs same-day obstetric, virology and health-protection assessment because congenital risk depends on gestation and true maternal infection.
A rash illness in a substantially immunosuppressed person may be atypical, prolonged and severe, so absence of classic morphology does not safely exclude measles or rubella.
An infant, pregnant contact or severely immunosuppressed contact exposed to measles needs urgent health-protection risk assessment while post-exposure prophylaxis remains possible.
High fever with cough, coryza, red watery eyes and malaise precedes the rash; tiny white Koplik spots may appear on the buccal mucosa.
A blanching erythematous maculopapular rash begins behind the ears or at the hairline, spreads down the trunk and limbs and may become confluent.
Investigation priorities
Identify probable measles and vulnerable contacts before laboratory confirmation.
Management branches
Fever with cough, coryza, conjunctivitis or a descending rash creates clinical suspicion of measles.
- Keep the patient out of common waiting space, place them in an appropriate airborne isolation room and use respiratory protective equipment under local infection-control policy.
- Notify the proper officer or health protection team immediately, recording rash onset, vaccination, travel, exposure, pregnancy, immune status and places attended while infectious.
- Obtain oral-fluid and any rapid PCR samples advised by UKHSA without sending the patient through shared clinical areas or delaying treatment of complications.
- Assess oxygenation, hydration and neurology, admit severe disease safely, and treat bacterial superinfection or organ failure while providing supportive measles care.