For Clinicians

ACTIONS REQUESTED OF CLINICIANS:

  1. SUSPECT measles in a patient with rash and fever ≥ 101° F (38.3°C). Ask about measles vaccination and exposure to known measles cases, international travel, or international visitors (including theme parks or other tourist attractions) in the 3 weeks prior to illness; consider the diagnosis regardless of exposure history.
  2. IMPLEMENT AIRBORNE PRECAUTIONS immediately for suspected cases. Mask and isolate patient in an airborne isolation room if possible. Do not use a regular exam room for at least one hour after a suspected measles patient has left the room. Notify your facility’s Infection Control Professional immediately.
  3. REPORT suspect measles cases immediately to ACPHD by phone at (510) 267-3250; after hours, call (925) 422-7595 and ask for the Public Health On-Call Duty Officer. CALL, DO NOT FAX.
  4. TEST suspected measles cases. Collect both urine and a throat or NP swab. HOLD specimens for testing by Public Health. Call ACPHD for approval. Proper specimen collection is very important. Follow specimen collection and storage instructions below and at: Measles Laboratory Testing Guidance.
  5. ADVISE patients with suspected measles to stay home with no visitors until at least 4 days after rash onset and/or until cleared by ACPHD to resume usual activities.
  6. VACCINATE children and non-immune adult patients for measles, unless contraindicated, according to national guidelines.
  7. CONFIRM STAFF IMMUNITY now to avoid lost work and staff time.  Health care providers who are exposed to a measles case may not go to work until they provide ACPHD with written documentation that they have received at least two doses of MMR or a serologic test showing measles immunity, have received at least two doses of MMR or a serologic test showing measles immunity.

Refer to Health Alerts: Measles Cases in Alameda County and California for additional information and updates.

Infection Control

Patients with suspected measles should be placed in an Airborne Infection Isolation Room immediately, if possible. Healthcare workers who enter the room of a suspected measles patient should have documented immunity (2 doses MMR or laboratory evidence of immunity by measles IgG) and should use a N95 respirator or higher level of protection. Limit movement of the patient for tests; if essential, mask the patient and notify receiving location of the patient’s suspected diagnosis. Note the times and locations where the patient was present, and obtain the names of all staff, patients, and visitors who were in those locations during the time the suspect measles patient was in the facility and for one hour after the patient left.
Click here for additional CA Department of Public Health Infection Control Guidance

Report and Test Suspected Cases

The Alameda County Public Health Laboratory will perform measles PCR testing on respiratory swabs and urine with approval from the ACPHD Acute Communicable Disease Unit. If suspected measles patients have had rash for more than 7 days, collect blood as well. Do not use commercial laboratories. Respiratory swabs and urine may be refrigerated and stored for up to 72 hours.

  • Respiratory swab for PCR: a throat swab is preferred (nasopharyngeal swab is acceptable), collected on a synthetic (e.g., Dacron) swab only and placed in 2-3 ml of Viral Transport Media (VTM) or Viral Culture Media (VCM). Use a tongue depressor to minimize salivary contamination.  Do not use bacterial culture media. Store and ship at 2°- 8°C.
  • Urine for PCR: collect 50-100 ml (10 ml is minimum acceptable) from the first part of the urine stream in a sterile cup. Store and ship the entire sample at 2°- 8°C. Alternatively, centrifuge at 2500 x g for 15 minutes at 4°C.  Re-suspend the pellet in 1-2 ml of VTM and then store and ship at -70°C or colder.
  • Blood for serology: collect 5 to 10 ml of blood in a red top or serum-separator tube.

Home Isolation

Measles patients are infectious for 9 days, from 4 days before rash onset until 4 days after rash onset and should stay at home with no visitors during this period. Provide patient with a supply of surgical masks (not N95 respirators). Patients should return home by car, not public transportation, and be accompanied only by someone immune to measles. ACPHD will contact the patient to advise them when they can be released from isolation.

MMR Vaccination

The current measles outbreak is considered to be statewide. ACPHD has not observed sufficient cases linked by time and space within Alameda County to recommend local changes to national MMR pediatric immunization guidelines: a dose at 12-15 months and a second at 4-6 years. Providers may administer the second MMR dose earlier than age 4 years based on clinical judgment, as long as 28 days have elapsed since the first dose.
Children ages 6-12 months who are traveling internationally should receive one dose of MMR prior to travel. However, MMR doses given before 12 months of age do not count towards the recommended course or the doses required for child care and school admission. National guidelines recommend two doses of MMR for adults who are health care personnel, traveling internationally, or attending college; other adults should receive at least one MMR dose.
For Additional Information on MMR Vaccination

MMR Vaccination for Healthcare Providers

Healthcare personnel should have documented evidence of immunity against measles, according to the recommendations of the Advisory Committee on Immunization Practices
Health care providers who are exposed to a measles case may not go to work until they provide ACPHD with written documentation that they have received at least two doses of MMR or a serologic test showing measles immunity.

MMR Vaccine Storage and Handling

MMR vaccine is a live virus vaccine that should be refrigerated between 36 and 40 ° Fahrenheit or frozen immediately upon arrival and protected from light.
It should be reconstituted just before use according to the manufacturer’s instructions. Use only the diluent supplied with the vaccine to reconstitute the vaccine.
MMR vaccine is administered subcutaneously with a 5/8 inch needle.

MMR Vaccination sites for referral of patients by clinicians who do not have vaccine availability:

Many local clinics, pharmacies, or sites found on this vaccine locator website offer MMR vaccine for a fee.  The patient should call before going to any of these sites for age limitations, availability, and cost

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