Summary: Recognize measles and notify the Health Department.
Consider measles as a diagnosis in anyone who:
- Has fever ≥101°F and a generalized maculopapular rash with cough, coryza, or conjunctivitis.
- And has recently traveled internationally.
- Or has travelled domestically to a region with a known measles outbreak or has other known or suspected exposure to measles.
If you suspect measles, call the Health Department before the patient leaves the clinic using the reporting line: (509) 524-2650, Monday–Friday, 8 a.m.–4 p.m. or (509) 524-1928 after business hours.
Background
There is a large, ongoing measles outbreak in Texas. Several other states have reported smaller outbreaks of measles. Here in Washington, 4 cases have been reported this year. Three of these cases were associated with international travel and one was a secondary case associated with exposure at a healthcare facility where one of the cases sought care. These outbreaks are a reminder to remain alert and take steps to prevent an outbreak in Walla Walla County.
Recommendations for healthcare professionals
- Prevent and prepare:
- Ensure all patients have evidence of immunity and are up to date on MMR vaccine per ACIP recommendations.
- Ask patients about international travel plans in the upcoming months. Measles continues to be a common disease in many parts of the world. Encourage families to complete their MMR vaccines before international travel. You can consider the same recommendation for domestic travel to outbreak areas.
- Children 6–11 months of age are eligible for a dose outside of the routinely recommended vaccination schedule if they are traveling internationally or to a place within the United States with a local outbreak. Infants who get an early dose will still need an additional two doses of MMR, as routinely recommended.
- Healthcare workers and clinical support staff should have documentation of immunity to measles before an exposure, ideally as a condition of employment. Maintain readily available documentation of immunity.
- Review your internal communication plan for suspected measles cases. This should include notifying public health, your infection preventionist, and leadership. You should identify potentially exposed people at the facility (patients, visitors, staff, volunteers). Public health will work with you to coordinate testing and recommend post-exposure prophylaxis (PEP) as needed for eligible people.
- Identify:
- Use this Measles Assessment Checklist to help assess the likelihood of measles.
- Be alert for potential cases among people who have recently traveled internationally or to areas of the United States with outbreaks.
- Measles presents as a prodrome of fever, cough, coryza and conjunctivitis. About three days after fever onset, the person will develop a maculopapular rash that usually starts along the hairline and spreads downward. Fever overlaps the rash and then drops about 1-3 days after the rash onset. People with measles usually appear significantly ill.
- Isolate :
- Immediately isolate patients with suspected measles in an airborne infection isolation room (AIIR) or a private room with the door closed. Follow standard and airborne precautions when evaluating suspected cases, regardless of vaccination status. Keep the door closed. Ask the patient to wear the mask for the duration of time in the clinic.
- Only staff with documented immunity to measles should enter the patient’s room. Even staff with immunity should wear PPE. Modified measles cases have occurred in vaccinated healthcare workers with evidence of immunity.
- After the patient is discharged, close the door and do not enter the room for 2 hours.
- Inform public health immediately. If you suspect measles, call Walla Walla County Department of Community Health before the patient leaves the clinic using the reporting line: (509) 524-2650, Monday–Friday, 8 a.m.–4 p.m. or (509) 524-1928 after business hours.
- Public health will review your measles assessment and can coordinate diagnostic testing with Washington State Public Health Laboratory (WAPHL) and follow up communication plan with the clinic.
Resources
- Suspect Measles Evaluation Worksheet—DOH
- Plan for travel | Measles—CDC.
- Measles cases and outbreaks—CDC.
- Measles Information for Providers.
- Measles one-pager—AAP/Project Firstline.
- Interim infection prevention and control recommendations for Measles in healthcare settings—CDC.
- Measles resources—DOH.
- Measles playbook—APIC.
- Measles post-exposure prophylaxis for non-symptomatic susceptible contacts—DOH.
We are here to help.
Monday-Friday, 8 a.m.—4 p.m.: (509) 524-2650
24-hour emergency line: (509) 524-1928
EpiDept@co.walla-walla.wa.us
Confidential fax: (509) 524-2642
If you cannot reach WWCDCH, please call Washington State Department of Health′s 24-hour reporting line: 1 (877) 536-4344.