UPDATES ON MEASLES AND SYPHILIS IN VIRGINIA

via The Virginia Department of Health

Dear Colleague: 

Measles Updates

On June 5, 2025, the Virginia Department of Health reported the state’s third measles case of the year. Given the recent cases reported in Virginia and ongoing measles outbreaks in the United States please stay alert for measles.

With summer travel underway, this is a critical time for clinicians to emphasize the importance of preventing the spread of measles through routine vaccination (one dose at 12 through 15 months of age and another dose at four through six years of age or separated from the first dose by at least 28 days) and the importance of adequate vaccination before travel. Unvaccinated patients, including infants six through eleven months of age who will be traveling internationally, or to an outbreak setting, should receive one dose of MMR vaccine prior to travel. Infants who get one dose of MMR vaccine before their first birthday should still get two more doses after one year of age. Adults should be up to date on MMR vaccinations with either 1 or 2 doses (depending on risk factors) unless they have other evidence of presumptive immunity to measles, mumps, and rubella. One dose of MMR vaccine, or other evidence of immunity, is sufficient for most adults.

Healthcare providers can access the Virginia Immunization Information System (VIIS) to verify patient vaccination history or, if applicable, through their connection to VIIS from their Electronic Health Record system. Please note that VIIS will be migrating to a new system June 24. Please plan accordingly and ensure your staff have completed VIIS LMS training prior to June 22 to ensure continued access to VIIS. Healthcare providers can learn more here. Patients may also request their records by completing the Immunization Record Request Form.

It is critical that clinicians remain vigilant for cases of febrile rash that could be consistent with measles, particularly in unvaccinated persons. Consider measles in patients with fever and a generalized maculopapular rash who have recently traveled out of the country or to regions of the United States reporting measles outbreaks. Other symptoms include cough, coryza, or conjunctivitis.

If you suspect measles:

  • Isolate: Immediately isolate the patient in a single-patient airborne infection isolation room (AIIR) or in a private room with a closed door until an AIIR is available. Patients with suspected measles should not stay in the waiting room or other common areas of a healthcare facility.
  • Notify: Immediately notify your local health department to ensure rapid testing and investigation.
  • Test: Submit a nasopharyngeal (NP) swab in VTM for PCR testing and a blood specimen for serology testing at the Division of Consolidated Laboratory Services (DCLS) following instructions for specimen collection and handling. Test results are available in less than 24 hours.

Please visit VDH’s Measles Information for Healthcare Providers for more information about measles.

Syphilis Updates

Syphilis cases increased dramatically in Virginia and nationally in the past few years.  Virginia also observed significant increases in syphilis cases among women.  Syphilis infections during pregnancy can lead to babies born with congenital syphilis, including stillbirths and fetal deaths.  There were 35 cases of congenital syphilis in Virginia in 2024, an exceptionally high case count; there are 15 cases in 2025 year to date, on track to meet or exceed the total from 2024. Clinicians and allied health professionals represent our first line of defense in detecting syphilis. Please help us identify and reduce the spread of syphilis in Virginia.

  • In keeping with updated recommendations from the American College of Obstetricians and Gynecologists (ACOG), serologically screen all pregnant women at their first prenatal care visit, followed by universal rescreening early in the third trimester (28-32 weeks) and again at delivery, regardless of risk or where they live.
    • A recent study has shown that opt-out syphilis screening among pregnant women in an emergency department significantly increased syphilis screening rates and identified syphilis cases that might otherwise have been missed.
  • Screen for syphilis in all patients aged 15-44 years who are sexually active and living in a county with high incidence of syphilis, in keeping with CDC recommendationsto prevent cases of congenital syphilis.  For all other counties, continue to assess risk factors to recommend testing.  Test all symptomatic patients for syphilis, regardless of their risk factors or where they live.
  • Consider prescribing Doxycycline as post-exposure prophylaxis (DoxyPEP)for syphilis to patients for whom it is clinically indicated.  This biomedical intervention has been proven to significantly reduce rates of syphilis, as well as chlamydia and gonorrhea.
  • For additional information, visit the syphilis resource page for healthcare providers.

Thank you for your continued partnership in keeping Virginians safe and healthy.

Sincerely,

Karen Shelton, MD

State Health Commissioner