Quest Diagnostics offers several diagnostic options as well as serological testing for determining immune status. Please, see the table below.
Test Codes: 964, 5259, 18844, 34166, 34256, 39306, 70240
Consider measles in patients presenting with febrile rash illness and clinically compatible measles symptoms, especially if they recently traveled internationally or were exposed to a person with a febrile rash illness. Early symptoms include fever, cough, runny eyes, or conjunctivitis. Koplik spots (tiny white spots inside the mouth) may also show up 2 to 3 days after symptoms first appear. A maculopapular rash (a rash of both flat and raised skin lesions) that begins on the head and face and then spreads downward to the neck, trunk, arms, legs, and feet develops 2 to 4 days after early symptoms. Fevers may spike to over 104 °F when the rash appears.
The incubation period for measles is typically 11 to 12 days from exposure to the virus. The rash follows the early symptoms 2 to 4 days later and usually lasts 5 to 6 days. Measles is infectious 4 days before and 4 days after rash onset. People at risk for complications include infants and children <5 years, adults >20 years, pregnant women, and people with weakened immune systems. 1
Measles is a mandatory notifiable disease. Public health authorities are asking healthcare providers to notify them directly if they have a patient with suspected measles.1 This allows for tracking of highly suspect cases and the provision of appropriate public health follow-up.
Detection of measles-specific IgM antibody in serum and measles RNA by real-time polymerase chain reaction (PCR) in a respiratory specimen are the most common methods for confirming measles infection. Measles RNA by real-time PCR is the preferred method for confirming an acute case.1
A positive real-time PCR test confirms the measles diagnosis.1,3 While detection of IgM antibody can be diagnostic, false-positive results may occur, especially in low-prevalence populations.1 Conversion of a negative IgM result to a positive result or a 4-fold or greater increase in measles IgM titer between acute and convalescent serum specimens is diagnostic.1
False-negative IgM results can also occur if the serum sample is obtained <3 days after rash presentation, (ie, prior to IgM antibody development). Additionally, IgG seroconversion can also help diagnose recent measles infection in the absence of recent measles vaccination. Laboratory confirmation is essential for all sporadic measles cases and all outbreaks.1
Obtain both a serum sample AND a throat swab or nasopharyngeal swab from patients suspected to have measles.
- Collect throat or nasopharyngeal swab samples as soon as a measles disease is suspected. The real-time PCR test has the greatest diagnostic sensitivity when samples are collected as soon as possible in a suspected measles patient.
- Collect the first (acute phase) measles IgM/IgG serum sample as soon as possible upon disease presentation. If the acute-phase measles antibody sample collected ≤3 days after rash onset is negative, and the patient has a negative (or not yet reported) result for measles real-time PCR, a second serum sample 3 to 10 days after symptom onset may be useful. In some cases, the IgM measles antibody may not be detectable until >24 hours after symptoms appear.2
Detailed specimen collection instructions for each of the measles available tests can be found at Quest Diagnostics: Results for measles
Click on the table to open in new window (enlarged).
The Advisory Committee on Immunization Practices (ACIP) recommends revaccination regardless of number of doses received, for individuals vaccinated between 1963 -1967 with:
- Unknown measles vaccine type
- Inactivated measles vaccine
- Attenuated measles vaccine accompanied by IG or high titer measles immune globulin (no longer available in the United States)
- A very small proportion of adults (less than 5%) may have received killed measles vaccine from 1963 through 1967 during childhood. The ACIP recommends that people who don't have presumptive evidence of immunity to measles should get vaccinated against it.4,5
Revaccination is also recommended by the ACIP for those with no presumptive evidence of immunity. Presumptive evidence of immunity can be established in any of the following ways:
- Written documentation of adequate vaccines
- Laboratory evidence of immunity
- Laboratory confirmation of disease
- Birth before 1957
Healthcare providers should not accept verbal reports of vaccination without written documentation as presumptive evidence of immunity.4,5
Comprehensive recommendations from the CDC for infection prevention and control for measles in healthcare settings can be found at: https://www.cdc.gov/infection-control/hcp/measles/index.html.
Key safety precautions from the CDC when managing a patient with symptoms consistent with measles includes:
- Persons with signs or symptoms of measles should be identified, provided a facemask to wear, and separated from other patients prior to or as soon as possible after entry into a facility.
- Healthcare personnel (HCP), including phlebotomists, without acceptable presumptive evidence of measles immunity should not enter a known or suspected measles patient's room.
HCP should use respiratory protection that is at least as protective as a fit-tested, NIOSH-certified disposable N95 filtering facepiece respirator, regardless of presumptive evidence of immunity, upon entry to the room or care area of a patient with known or suspected measles.
References
- Clinical Overview of Measles | Measles (Rubeola) | CDC Reviewed July 15, 2024. Accessed March 6, 2025. https://www.cdc.gov/measles/hcp/clinical overview/?CDC_AAref_Val=https://www.cdc.gov/measles/hcp/index.html
- World Health Organization. Measles. Reviewed November 14, 2024. Accessed March 6, 2025. https://www.who.int/news-room/fact-sheets/detail/measles
- World Health Organization. Molecular epidemiology of measles and rubella. In: Manual for the Laboratory-based Surveillance of Measles, Rubella, and Congenital Rubella Syndrome. World Health Organization; 2018:chap 7. Accessed October 22, 2021. https://cdn.who.int/media/docs/default-source/immunization/vpd_surveillance/lab_networks/measles_rubella/manual/chapter-7.pdf?sfvrsn=8ac65ea0_2&download=true
- CDC. Measles, mumps, rubella vaccine (PRIORIX): recommendations of the Advisory Committee on Immunization Practices — United States, 2022. MMWR. 2022;71(46):1465-1470. doi:10.15585/mmwr.mm7146a1
- CDC. Recommendations of the Advisory Committee on Immunization Practices for use of a third dose of mumps virus-containing vaccine in persons at increased risk for mumps during an outbreak. MMWR. 2018;67(1):33-38. doi:10.15585/mmwr.mm6701a7
This FAQ is provided for informational purposes only and is not intended as medical advice. Test selection and interpretation, diagnosis, and patient management decisions should be based on the physician’s education, clinical expertise, and assessment of the patient.
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