Measles requires vigilance, rapid investigation of cases
Remove from common areas quickly
In response to ongoing measles outbreaks due to imported cases, the Centers for Disease and Prevention issued an April 2, 2008, health advisory that includes the following key points:
Rapid investigation: Aggressive public health action is needed in response to measles cases. Case investigation and vaccination of household or other close contacts without evidence of immunity should not be delayed pending the return of laboratory results. Preparation for other control activities may need to be initiated before laboratory results are known. Control activities include isolation of known and suspected case-patients and administration of vaccine (at any interval following exposure) or immune globulin (within six days of exposure, particularly contacts ≤ 6 months of age, pregnant women, and immunocompromised people, for whom the risk of complications is highest) to susceptible contacts. For contacts that remain unvaccinated, control activities include exclusion from day care, school, or work and voluntary home quarantine from seven to 21 days following exposure. Health care providers assessing a suspected measles case should schedule the patient at the end of the day after other patients have left the office. They should inform clinics or emergency rooms if they are referring a suspected measles patient for evaluation so that airborne infection control precautions can be implemented. Health care providers should maintain vigilance for measles importations and have a high index of suspicion for measles in people with a clinically compatible illness who have traveled abroad or who have been in contact with travelers.
Preventing transmission in health care settings: To prevent transmission of measles in health care settings, airborne infection control precautions should be followed stringently. Suspected measles patients (i.e., people with febrile rash illness) should be removed from emergency department and clinic waiting areas as soon as they are identified, placed in a private room with the door closed, and asked to wear a surgical mask, if tolerated. In hospital settings, patients with suspected measles should be placed immediately in an airborne infection (negative-pressure) isolation room if one is available and, if possible, should not be sent to other parts of the hospital for examination or testing purposes.
All health care personnel should have documented evidence of measles immunity on file at their work location. Having high levels of measles immunity among health care personnel and such documentation on file minimizes the work needed in response to measles exposures, which cannot be anticipated. Recent measles exposures in hospital settings in three states necessitated verifying records of measles immunity for hundreds or thousands of hospital staff, drawing blood samples for serologic evidence of immunity when documentation was not on file at the work site, and vaccinating personnel without evidence of immunity.
Recommendations for vaccination: MMR vaccine is routinely recommended for all children at 12-15 months of age, with a second dose recommended at ages 4 to 6 years. Two doses of MMR vaccine are recommended for all school students and for the following groups of persons without evidence of measles immunity: students in post-high school educational facilities, health care personnel, and international travelers who are ≥ 12 months of age. Other adults without evidence of measles immunity should routinely receive one dose of MMR vaccine. During a measles outbreak, additional vaccine recommendations should be considered: 1) children ≥ 12 months of age should receive their first dose of MMR vaccine as soon after their first birthday as possible and their second dose four weeks later; 2) health care facilities should strongly consider recommending one dose of MMR vaccine to unvaccinated health care personnel born before 1957 who do not have serologic evidence of immunity or physician documentation of measles disease; and 3) one dose of measles or MMR vaccine should be considered for infants ≥ 6 months of age.
In response to ongoing measles outbreaks due to imported cases, the Centers for Disease and Prevention issued an April 2, 2008, health advisory that includes the following key points:You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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