The following information is a summary of infection prevention guidance from sources including the Centers for Disease Control and Prevention (CDC). Healthcare workers developing processes to prepare for a patient with possible measles could consider using this document as a guide.

• Document the MMR immunization status of all employees and make sure this information is readily available
• Ensure that all healthcare workers have been fit-tested for a N-95 or equivalent respirator
• Review and have written documentation of the airflow (HVAC compartments) in your clinical areas
• Perform symptom screening of all patients upon arrival
  • Cough with/without fever- provide all 2 years of age and older patients and caregivers/family a surgical mask.
  • Fever and rash- provide patient and caregivers/family a mask and if the patient is not immunized for measles or varicella or has a recent exposure, move the patient to a single room and close the door.
• Define and practice a process to quickly identify patients with highly contagious illness and minimize exposures
  • Consider evaluating patients with fever and rash who are unimmunized via telemedicine or while outside the clinic to avoid exposure to staff or other patients.
• Stock personal protective equipment such as gowns, surgical masks, and N95 respirators

When to Consider Measles

Question 1: What symptoms does the child have?

• Prodrome: classic symptoms- fever, cough, conjunctivitis and coryza (rhinorrhea)
• Rash: maculopapular rash starting around the hairline and progressing down the body

Question 2: What is the child’s immunization status? (1 MMR =93% effective, 2 MMR =97% effective in the population)

Question 3: Is there a potential exposure- recent domestic or international travel or exposure to someone with measles?

What to Do if You Have a Patient with Possible Measles in Your Clinic

Identify

• Identify patients with possible measles (symptoms, immunization status and exposure) as quickly as possible, ideally, before they come through the door.
• Ensure that staff who perform intake and triage are aware of signs and symptoms.

Isolate

• Give the patient and everyone accompanying the patient a mask.
• For children under 2 years of age or those unable to tolerate wearing a surgical mask, cover with a light sheet or blanket.
• Move the patient and accompanying family members to an Airborne Infection Isolation Room (AIIR) or single room if an AIIR is not available and close the door. If not in an AIIR, the patient/caregivers should continue to wear a mask.
• Staff should wear an N-95 (fit-tested) respirator when providing care to a patient with known or suspected measles or varicella infections.

Inform

• Contact other facilities prior to the patient’s arrival if you are referring a patient with suspected measles to another facility for care.
• If the patient is being evaluated in an emergency department or other setting affiliated with a hospital, contact the associated Infection Prevention Department.
• Otherwise, call Public Health 1-866-PUB-HLTH (1-866-782-4584).

Testing for Measles: Please contact Georgia Department of Public Health for guidance regarding testing

• Testing for measles requires approval by the Department of Public Health.
  • NP or throat swab for measles real-time RT-PCR
  • Urine for measles real-time RT-PCR
  • Serum IgM

Period of Contagiousness and Isolation

• A patient is considered contagious with measles from 4 days before the onset of the rash until 4 days after the onset of the rash.
• Guidance for quarantine and isolation will be provided by the Georgia Department of Public Health.

The information contained herein should not be used as a substitute for a physician’s independent judgement as to appropriate medical care and treatment.  There may be variations in treatment that are recommended based on individual facts and circumstances. 

References

Preparing and Responding to Measles: Checklist for Healthcare Workers