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Measles guidance for healthcare providers

Short URL: kingcounty.gov/advisories/measles

Actions requested

Remain vigilant for possible cases of measles. Consider measles as a diagnosis in anyone with fever (≥ 101°F or 38.3°C) and a generalized maculopapular rash with cough, coryza, or conjunctivitis, especially in a person who has recently traveled internationally, or domestically to a region with a known measles outbreak or has other known or suspected exposure to measles.

MMR vaccination remains the most important tool for preventing measles infections and spread from imported cases. Two doses of MMR vaccine provide 97% protection against measles while one dose provides 93% protection.

  • Isolate

    • Have a planned triage process for patients with fever and rash so these patients are not waiting in common areas with other people.
    • Patients with rash and fever should not stay in waiting rooms or other common areas.
    • Immediately isolate patients with suspected measles in an airborne infection isolation room (AIIR) or a private room with a closed door.
    • Follow standard and airborne precautions when evaluating suspected cases, regardless of vaccination status.
    • After patient is discharged, do not use or have staff enter the room for 2 hours.

  • Notify

    • Report suspected measles cases to Public Health at 206-296-4774 immediately AND before discharging or transferring patients.
    • Public Health will ensure appropriate, rapid testing and investigation.

  • Test

    •  Collect the following specimens on patients with suspected measles:
      • Nasopharyngeal swab placed in viral transport media; AND
      • Urine, minimum 20mL, in sterile leak proof container; AND
      • Serum, minimum 1mL, in red top or red-grey top tube
    • Public Health will facilitate diagnostic testing with Washington State Public Health Laboratory (WAPHL).

  • Manage

    • Health care facilities should identify potentially exposed persons at the facility (patients, visitors, staff, and volunteers).
    • Public Health will identify close contacts and recommend post-exposure prophylaxis (PEP) for eligible people.

  • Vaccinate

    • Assess immunization status at every healthcare visit.
    • Ensure all patients without evidence of immunity are up to date on MMR vaccine per routine ACIP recommendations, including for international travelers (regardless of the destination) or domestic travelers to outbreak areas:
    • Children are routinely recommended to receive 2 doses of MMR, the first at 12–15 months of age and the second at 4–6 years of age before school entry.
    • Adults not at high risk of exposure are recommended to have at least 1 documented dose of MMR in their lifetime, or other evidence of immunity (e.g., positive measles immunoglobulin G (IgG)).
      • Adults at high exposure risk, including students at post-secondary institutions, healthcare workers, and international travelers, should receive 2 doses.
    • For any international travel: also recommend infants 6-11 months of age get an early dose of MMR at least 2 weeks prior to departure.
      • An early dose of MMR before the first birthday does not count as part of the routine 2-dose series. MMR is not licensed for children <6 months of age.
    • For any domestic travel to outbreak areas, consider the same approach as for international travelers prior to departure:
      • An early MMR dose for infants 6-11 months of age
      • A second MMR dose for anyone eligible who is 12 months of age or older (2 doses at least 28 days apart)

Resources

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For healthcare providers

For infection preventionists

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