Skip survey header

Measles Close Contact Investigation Form

If you have been exposed to someone with measles, please complete this entire form. Wood County Health Department is collecting this information as part of our public health investigation to better understand who may have been exposed, assess potential risk, and help prevent measles from spreading in our community.

The information you provide will be reviewed by our infectious disease team and may be used to determine whether additional follow-up, guidance, monitoring, or other actions are needed. A member of our team may contact you if we need additional information or have specific recommendations based on your exposure.

If you are experiencing symptoms of measles such as fever, runny nose, cough, red, watery eyes, or rash, please contact your healthcare provider immediately. Call before going to a healthcare facility so staff can take appropriate precautions to protect other patients and visitors.

For more information about what to do after a possible measles exposure, visit woodcountyhealth.org.

If you have questions, call Wood County Health Department Infectious Disease at 419-354-4306.
1. Where you at any of these locations during these times? (please select all that apply) *This question is required.
This question requires a valid date format of MM/DD/YYYY.
calendar
2. What is your sex?
2. What state do you live in? *This question is required.
2. Which county do you live in?
This question requires a valid email address.
2. When did you receive your first measles, mumps, and rubella (MMR) vaccine dose?
2. When did you receive your second MMR vaccine dose?
2. If you did NOT receive the MMR vaccine, do you have proof of immunity (lab tests, previous infection)
If you become sick with measles-like symptoms, including fever, rash, runny nose, cough, or “pink eye”, contact your healthcare provider immediately.

Even if the reason for your medical visit is not related to measles symptoms, it is important to call ahead before arriving at any healthcare facility and inform them you have been exposed to measles and what symptoms you are experiencing, so that they can take precautions to keep others from being exposed. 
2. Please upload proof that you received your MMR vaccine.
2. Please upload proof of previous lab result or healthcare provider written diagnosis for measles