Think Measles: Recognizing and Addressing Measles in Pediatric Practice

1. Measles Symptoms

• High Fever
• Cough
• Coryza (runny nose)
• Conjunctivitis (red, watery eyes)
• Maculopapular Rash
  • Typically appears 2-4 days after symptoms begin.
  • Begins at hairline, spreads downward, to face, neck, and trunk.
  • Rash appears red on light complexions, but may be harder to see or appear as purple or darker than surrounding skin on dark complexions

2. Pre-Visit Telephone Triage

• For those reporting measles symptoms, assess the risk of exposure:
  • Are measles cases present in your community?
  • Did the patient spend time out of the country in the 21 days before symptom onset?
  • Has the patient ever received the MMR vaccine?
• Triage should only be completed by a clinically trained person.
• If patient will be seen in the office, provide instructions on face masks for patient (2 years of age and older) and family.
• Instruct to arrive to a side or back entrance instead of the main entrance.

3. Patients Presenting with Suspected Measles

• Provide face masks to patients (2 years of age and older) and family before they enter the facility. Patients unable to wear a mask should be “tented” with a blanket or towel when entering the facility.
• Immediately move patient and family to an isolated location, ideally an airborne infection isolation room (AIIR) if available. If unavailable, use a private room with the door closed.
• No other children should accompany a child with suspected measles.
• Patients (2 years of age and older) and family should leave face masks on if feasible. 

4. Infection Prevention Precautions

Only physicians with immunity to measles should provide care to the patient and family. Standard and airborne precautions should be followed, including:

• Use of a fit tested NIOSH-approved N95 or higher-level respirator.
• Use of additional PPE if needed for task (e.g., gloves for blood draws).
• Cleaning hands before and after seeing the patient.
• Limiting transport or movement of patients outside of room unless medically necessary.

5. Public Health Notification

• To ensure rapid investigation and testing with contact tracing, notification should occur immediately upon suspicion of measles.
• Public health departments will be able to help confirm vaccination history for U.S. residents, provide guidance on specimen collection and submission, and manage contacts of confirmed cases.
• Acute care facilities should immediately notify the hospital epidemiologist or infection prevention department.
• Outpatient settings should immediately notify local or state health departments.
• Visit CSTE for reporting contact information.

6. Clinical Care

• People with confirmed measles should isolate for four days after they develop a rash.
• If an AIIR was not used, the room should remain vacant for the appropriate time (up to 2 hours) after the patient leaves the room.
• Standard cleaning and disinfection procedures are adequate for measles virus environmental control. 

Recommendations for Exposure to Measles

Exposures to measles in a healthcare setting are defined as spending any amount of time while unprotected (i.e., not wearing recommended respiratory protection):

• In a shared air space with an infectious measles patient at the same time, or
• In a shared air space vacated by an infectious measles patient for up to 2 hours. 

Measles virus is thought to be contagious to others in the air for up to 2 hours.  

For asymptomatic physicians and practice team with presumptive evidence of immunity: 

• Postexposure prophylaxis is not necessary. 
• Work restrictions are not necessary. 
• Implement daily monitoring for signs and symptoms of measles from the 5th day after their first exposure through the 21st day after their last exposure. 

For asymptomatic physicians and practice team without presumptive evidence of immunity: 

• Administer postexposure prophylaxis in accordance with CDC and ACIP recommendations. 
• Exclude from work from the 5th day after their first exposure through the 21st day after their last exposure, regardless of receipt of postexposure prophylaxis. 
• Work restrictions are not necessary for physicians and practice team who received the first dose of MMR vaccine prior to exposure: 
  • They should receive their second dose of MMR vaccine as soon as possible (at least 28 days after their first dose). 
  • Implement daily monitoring for signs and symptoms of measles from the 5th day after their first exposure through the 21st day after their last exposure.  

For physicians and practice team with known or suspected measles:

• Exclude from work for 4 days after the rash appears.  

For immunocompromised physicians and practice team with known or suspected measles:

• Exclude from work for the duration of their illness.  

During a measles outbreak, administer measles vaccine to physicians and practice team in accordance with CDC and ACIP recommendations  

For more information visit: CDC Infection Control in Healthcare Personnel: Epidemiology and Control of Selected Infections Transmitted Among Healthcare Personnel and Patients