MEASLES FAQ 

What is the threat, related incubation period, and contagious period?

  • Measles is a highly contagious viral illness characterized by fever, malaise, rash, and the three famous Cs: cough, coryza, and conjunctivitis. Over the past few weeks, the organization has had increasing queries about potential measles diagnosis in patients, although in all cases measles was eventually ruled out.·      

  • Incubation period: 10-14 days (range 7-21 days); subclinical illness is unusual. ·      

  • Contagious period: estimated to be four days prior through 4 days after rash onset; rash itself begins approximately 14 days after exposure.      

  • Definition of “exposure” (health care setting): having shared airspace at the same time or in a closed area up to two hours after a person with measles has occupied the area. (https://www.health.state.mn.us/diseases/measles/hcp/control.html)

How severe and urgent is the threat – including geographic spread)?

How is it spread?

  • Measles is spread airborne and by person-to-person contact. Infectious droplets containing measles can remain airborne for up to 2 hours. ·      

  • The illness may be transmitted in public spaces, even in the absence of person-to-person contact. Measles transmission between airplane passengers in airports and during flight has been described. Large
    outbreaks can occur in areas of crowding, such as schools and densely populated communities.     

  • One measles case can lead to 12-18 people getting potentially infected (unvaccinated) - also known as the “Basic Reproductive Number.”

  • The majority of people who got measles were unvaccinated. Measles can spread when it reaches a
    community in the US, where groups of people are unvaccinated.

How can I prevent spreading and/or getting exposed/infected to measles?

  • Know containment and isolation precautions.

  • Prevention focus on the “IDENTIFY, ISOLATE and INFORM” approach - (FL DOH site). Click the link for “Suspecting Measles” (1 pg).     

  • Use FL DEPT OF HEALTH Triage Algorithm to identify and manage suspected measles cases.
    View here:     http://www.floridahealth.gov/diseases-and-conditions/measles/_documents/measles-health-care-algorithm.pdf 

  • Immediately isolate all cases of suspected measles by ordering airborne precautions for the patient. Keep any family members within the isolation room and notify the Infection Preventionist on-call (use PerfectServe icon on the desktop).

  • The patient should wear a surgical mask if it is necessary to be outside isolation room – including any transportation.

  • Airborne Precautions ·      

    • All (health care professionals) HCPs entering the airborne isolation area (regardless of presumptive evidence of immunity) should use respiratory protection at least as protective as a fit-tested, NIOSH-certified disposable N95 filtering face-piece respirator.

    • Continue precautions for four days after the onset of rash or duration of illness for immunocompromised patients.

    • Limit visitors to those necessary for well-being and care. Visitors without evidence
      of immunity should not enter the room.

    • Refer to Orlando Health policies and also the following link: https://www.cdc.gov/infectioncontrol/pdf/guidelines/isolation-guidelines-H.pdf

How do I diagnose the condition?
What other things are in the differential diagnosis?

  • Taking a picture of the rash can also be useful in assisting with an empiric diagnosis before laboratory confirmation is available.

  • Differential diagnosis: see the table of other measles-like conditions to consider.

  • Serum measles IgG and IgM are orderable in Sunrise. Urine and nasal swab samples can be tested by PCR if approved by the Florida DOH; the Infection Preventionist will guide the testing process.

  • FROM FL DOH:

    • Laboratory Testing
      • Nasopharyngeal (NP) or oropharyngeal (OP) swab* in universal viral transport media for
      measles RT-PCR AND
      • Urine* in a sterile cup for measles RT-PCR**
      AND
      • Serum for measles specific IgG and IgM***

    • Preferred specimens:

      • **Measles RT-PCR is not available at commercial laboratories and is available
        at the Bureau of Public Health Laboratories, after prior authorization by the County
        Health Department.
        *** Serum specimens should be collected ≥72 hours after rash onset. In a
        vaccinated patient, a negative measles IgM does NOT exclude measles, RT-PCR is preferred.

How do I treat/manage the clinical condition?

  • Severe measles cases among children, such as those who are hospitalized, should be treated with
    vitamin A. (Refer to CDC and other resources listed below for details). There is no specific antiviral therapy for measles. Medical care is supportive and helps relieve symptoms and address complications such as
    bacterial infections.

Who do I call if I or others are exposed to the threat?

  • CONTACT INFECTION PREVENTION at PerfectServ DURING NORMAL BUSINESS HOURS with any
    questions/concerns about work-related measles exposure/infection. After hours /
    weekend, please contact the Infection Preventionist on-call using Perfect Serve.     This will ensure the InfectionPrevention dept. not only knows when the call was placed but who placed the phone call, so an Infection Prevention team member can quickly respond.

  • Note: lack of data to clearly define exposure
    – Airborne survivability of measles virus up to 2 hours
    https://www.cdc.gov/measles/about/transmission.html
    – Sometimes difficult to determine shared air space

  • USUAL PROTOCOL for ALL EXPOSURES:

    • Infection Prevention and Control will notify managers of departments that provided care or services to the index case and physicians who were in contact with the patient of the potential exposure.

    • Managers or their designees must notify all potentially exposed team members and initiate appropriate follow up with Occupational Health. Physicians will be asked to inform any ARNPs or PAs working under their direction.

    • Infection Prevention and Control will contact the companies of contracted employees and schools of students to report the exposure The Infection Preventionist will send an email to PG-EXPOSURE
      INCIDENT.

  • Do not report to work if you suspect you have been exposed to measles. 

  • Do not come to the Emergency Department if you have been exposed or have symptoms of measles to avoid exposing others. Call Infection Prevention for guidance during regular business hours.  

  • Management of Exposures

    • CDC recommendations have not changed:
      Post-exposure prophylaxis – Offer to people who cannot readily show that they have evidence of
      immunity against measles; note specific recs for infants, pregnant women, and severely immunocompromised patients

    • For HCPs without evidence of immunity, MMR within 72 hrs or Immunoglobulin within six days, and exclude from duty from day five after first exposure to day 21 after last exposure regardless of post-exposure vaccine

  • Refer to: https://www.cdc.gov/vaccines/adults/rec-vac/hcw.html

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    Who else can I call for more information?

  • Director, Occupational Health – Ken Michaels, DO: (321) 841-8056

  • Infection Prevention (hospital-specific and/or on-call): PerfectServe

  • Director, Infection Prevention – Eve Early: (678) 789-6461

  • Hospital Epidemiologist – Asim Jani, MD,MPH : (407) 230-9015 (24/7 cell)

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What are key resources to learn more (online links and literature)?