For Clinicians

Clinicians are requested to:

  1. Consider/suspect measles in patients with a rash and fever ≥101°F (38.3°C) regardless of travel history. Ask about measles vaccination and exposure to known measles cases, international travel, or international visitors in the three weeks prior to illness.
  2. Prepare your facility for the possibility of patients with measles. Ask patients to call ahead first if they have fever and rash. Post signage that directs patients with fever and rash to notify staff. Train staff to immediately implement airborne precautions if measles is suspected.
    • Mask and isolate the patient in an airborne isolation room
    • Do not re-use exam room for at least one hour after the patient has left the room
    • Ensure airborne precautions at other healthcare facilities if referring the patient
  3. Report suspected measles cases immediately, while the patient is still in your office to ACPHD Acute Communicable Disease Section 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 in consultation with ACPHD Acute Communicable Disease Section:
    • Collect a throat swab (for measles PCR) with a Dacron swab and place in Viral Transport Media
    • Collect a urine specimen (for measles PCR) in any container (does not need to be sterile)
    • Draw blood (for measles IgM and IgG) if and only if it is already Day 4 or later after rash onset
    • Collecting specimens while the patient is at your facility will prevent delays in confirmation and limit the potential for additional healthcare visits/exposures. Refer to CDPH Measles Testing Guidance for details on specimen collection and storage.
    • Please HOLD specimens for testing by public health
  5. Advise patients with suspected measles to stay home with no visitors until at least four days after rash onset and/or until cleared by ACPHD Acute Communicable Disease Section to resume normal activities. Patients should go home by private vehicle, not take public transportation, and should only be accompanied by someone immune to measles.
  6. Confirm immunity of contacts and health care staff with unknown vaccination status by ordering Measles IgG only. DO NOT order measles IgM testing for asymptomatic individuals, as there is a substantial possibility of a false positive IgM result. Confirm staff immunity now to avoid staff exclusion from work in the event of an exposure.
  7. Vaccinate children and non-immune adults, unless contraindicated, according to national guidelines.

 

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

Click here for more information on ACPHD most updated Health Advisory

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

Resources for Clinician Education and Training

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