Case Study

Spotting a Public Health Risk

Jasmine presents with a facial rash and what the Centers for Disease Control and Prevention (CDC) call the “three C’s”: cough, coryza (runny nose), and conjunctivitis. Her symptoms could indicate an allergy, a common cold virus, or something far more serious. More than ever, health-care providers must be on alert when they see the three C’s. “Think measles,” the CDC recommends. Know the signs and symptoms of measles:

  • Three C’s and high fever (103 degrees Fahrenheit or higher) appear before a rash.
  • Koplik’s spots—small, white spots in a cluster—visible on reddened mucus membranes of the cheeks also generally appear before a rash.
  • Red, blotchy maculopapular rash begins on forehead, spreads down to palms and feet.

The growing U.S. measles outbreak requires providers to be vigilant. A misdiagnosis can delay public health measures necessary to stop the spread of this highly contagious, sometimes life-threatening disease. This year alone, the CDC found measles misdiagnosed as:

  • A cold virus.
  • Kawasaki's disease.
  • Scarlet fever.
  • Dengue.

Your exam of Jasmine finds Koplik’s spots inside her cheeks and a fever of 103 degrees Fahrenheit. Her mother says Jasmine’s blotchy rash began at the top of her forehead, then spread over her face and neck and gradually spread downward all over her body, including hands and feet. The rash is a maculopapular eruption. The mother reports not allowing Jasmine to get the MMRV vaccine because a friend warned it could affect Jasmine’s brain. You assure the mother the vaccine protects against measles, mumps, rubella, and varicella and that side effects are rare.

“Has Jasmine traveled outside the country recently, or have you had international guests at home?” You ask because measles can spread from unvaccinated travelers from other countries. The mother reports that she and Jasmine have been staying with family friends who live in an apartment complex popular with international college students.

Jasmine was unprotected against measles and now has the contagious disease. She needs plenty of fluids and rest. The mother must isolate Jasmine at home to avoid exposing others. The couple hosting Jasmine and her mother do not have children but children may be living in the apartment complex. Jasmine also must stay away from her child-care center for at least four days after onset of the rash.

portrait of young girl with red dots on her forehead
4 years

What first step should you take as part of Min’s Texas Health Steps checkup to address the teen’s mental health status?

Give Jasmine the MMRV vaccination, alert staff and other families in your clinic, notify the nearest hospital, and sanitize your offices

Report to the state health department, obtain a viral specimen from Jasmine, notify staff and other families in your clinic, call Jasmine’s child-care center and the apartment complex where she lives temporarily, and sanitize your offices.

Close your practice for the day, reschedule today’s patients for two weeks from now, and sanitize your offices.

Notify the CDC and Jasmine’s child-care center and the apartment complex where Jasmine is living temporarily, offer free MMRV vaccines for other unvaccinated patients in your clinic, and sanitize your offices.

Related Texas Health Steps course

child pointing at a bandaid on their arm


Effectively communicate vaccine information to patients and families, apply the national immunization and catch-up schedules, and identify vaccine contraindications and precautions. Includes current ACIP guidelines.

Credit hours: 1.75 CE


About Texas Health Steps

Texas Health Steps’ award-winning online program offers FREE CE courses for primary care providers and other health professionals. These courses offer updated clinical, regulatory, and best practice guidelines for a range of preventive health, oral health, mental health, and case management topics.