For Health Care Providers

For exposure general measles information and locations and guidance for people who may have been exposed, see the following pages.

Establish a process to screen incoming patients before they enter your facility. Follow the Washington State Department of Health’s (DOH) Guidance for Preventing Measles in Health Care Settings to reduce exposures within the health care facility.

Follow airborne isolation precautions and standard precautions when:

• You suspect measles based on symptoms (use precautions until measles is ruled out or the patient is no longer infectious (day five after rash onset)
• Seeing non-immune, exposed people who present for care; these individuals should be cared for with precautions from day five after first exposure through day 21 after the date of last exposure 

Standard precautions may require gown, gloves, and eye protection, in addition to fit-tested N95, depending on the patient’s symptoms and what care is being provided.

More in-depth infection control guidance from can be found in the Centers for Disease Control and Prevention’s (CDC) Interim Infection Prevention and Control Recommendations for Measles in Healthcare Settings.

Fact Sheets and Flyers for Staff

• Washington State Department of Health Measles Flyer
• Centers for Disease Control and Prevention Measles Clinical Diagnosis Fact Sheet

Please refer to the following:

• Centers for Disease Control and Prevention Steps for Responding to Measles Exposures in Healthcare Settings
• Centers for Disease Control and Prevention Measles Preparedness and Response in Healthcare Settings

If a Negative Pressure Room Is Not Available or Adherence to Airborne Precautions Cannot Be Maintained

If you do not have a negative pressure room or are not able to adhere to airborne precautions, take these measures for safety:

• Have the patient mask. If the patient is a baby and cannot mask, then place a cover over the child, like a blanket, to provide a barrier between the baby and the shared air space.
• Keep the patient isolated in a private room with the door closed at all times, except when entering the room, only as necessary.
• Have all who enter the room wear PPE for airborne (fit-tested N95) and standard precautions (based on symptoms, but may include gloves, gown, and eye protection).
• To the extent possible, bundle care to limit opening the patient’s door.
• If the patient must leave the room for any reason, ensure they are wearing a face mask or are covered by a blanket for source control.
• Attempt to ensure that people in the same hallway or nearby have immunity (vaccination, born prior to 1957, or positive IgG titer). If this is not possible, ensure that people at higher risk of measles complications, including those <12 months old and people who are immunocompromised, are as far away as possible and in another space, when possible.

Call Spokane Regional Health District (SRHD) and follow this assessment tool: Measles Assessment Quicksheet for Providers 

• For patients who have known exposure to a measles case, please consider a low threshold to conduct measles testing.
• SRHD will determine if the specimen should be tested at the Washington State Public Health Laboratories (PHL) and will coordinate with the provider to have the specimen shipped to PHL.

Follow these procedures for collecting specimens from the Washington State DOH:

• Specimen Collection & Shipping Guide
• Urine and respiratory sample (NP preferred) collection
• IgM
• IgG

Be familiar with patient management. See guidance from the CDC: Clinical Overview of Measles

Referring To Other Facilities

If a patient is exposed or has symptoms, ensure that you communicate the measles risk with the receiving facility so they can implement infection control measures.

Post-Exposure Prophylaxis

See Measles Post-Exposure Prophylaxis (PEP) for Non-Symptomatic Susceptible Contacts, DOH 420-250 

• Be aware of which patients require post exposure prophylaxis.
• Ensure that you are aware of your organization’s access to MMR and immune globulin.

For prophylaxis guidance, see CDC's Prevention of Measles, Rubella, Congenital Rubella Syndrome, and Mumps, 2013 .

For a detailed review of measles, including post exposure prophylaxis recommendations, see CDC's Chapter 7: Measles | Manual for the Surveillance of Vaccine-Preventable Diseases.

Ensure that all health care personnel (HCP) have presumptive evidence of immunity to measles. See Table 3 in CDC's Prevention of Measles, Rubella, Congenital Rubella Syndrome, and Mumps, 2013 for acceptable presumptive evidence.

• During a measles outbreak, two doses of measles virus-containing vaccine separated by at least four weeks (28 days) are recommended for unvaccinated HCP who lack laboratory evidence of measles immunity or laboratory confirmation of disease, regardless of year of birth.
• HCP without acceptable presumptive evidence of measles immunity should not enter a known or suspected measles patient's room if HCP with presumptive evidence of immunity are available.

Follow CDC’s Measles Infection Control in Healthcare Personnel to determine who is exposed and how to manage exposures.

Please ensure that people who are not vaccinated and were exposed to someone with measles are managed as described in Appendix G of the Washington State Department of Health Measles Reporting and Investigation Guideline.

Follow guidance in CDC’s Appendix A: Considerations when Evaluating a Person for Exposure to Measles in a Healthcare Setting