Let’s Talk Measles….Again

The measles outbreak continues. Cases have been confirmed in 30 states. As of July 25, 2019, there have been 1,164 cases reported, which is the largest reported number of cases since 1992 and since measles was declared eliminated in 2000.

In order to address this ongoing issue, the CDC published additional guidance in July to provide healthcare workers specific direction to prevent spread of the illness and protection when caring for patients.

Exposure to measles is defined as time spent without proper respiratory protection in these circumstances:

• In the same air space as an infected patient
• In the same air space where a measles patient left within the prior 2 hours

The CDC outlines the baseline for protection in a healthcare setting:

• Ensure healthcare providers (HCP) have presumptive evidence of immunity to measles.
• Quickly identify and isolate patients with known or suspected measles.
• Adhere to Standard and Airborne Precautions for patients with known or suspected measles.
• Routinely promote and facilitate respiratory hygiene and cough etiquette.
• Appropriately manage exposed and ill HCP
• What is Presumptive Evidence of Measles Immunity for the HCP?
• Written documentation of vaccination with 2 doses of measles virus-containing vaccine (the first dose administered at age ≥12 months; the second dose no earlier than 28 days after the first dose); OR
• Laboratory evidence of immunity (measles immunoglobulin G [IgG] in serum; equivocal results are considered negative); OR
• Laboratory confirmation of disease; OR

Birth before 1957.The CDC also recommends considering vaccinating HCP born before 1957 who do not have other evidence of immunity to measles.While these measures create a baseline of protection there are additional measures which should be implemented whenever possible.Appointment scheduling – When scheduling by phone for a person who may be infected, provide specific instructions on how to enter the practice. The goal is to quickly provide a facemask for the patient and move them immediately into an exam room.

Arrival at the practice – Any person with an indication of measles infection should be provided a mask and promptly placed in a room with the door closed. Signs of the illness include high fever, dry cough, runny nose, sore throat, conjunctivitis and Koplik’s spots. Only HCP who have known immunity to measles should be involved the care of this patient. These workers should also use respiratory protection that is at least as protective as a fit-tested N95 respirator. Many outpatient facilities have not implemented this level of respiratory protection and should perform a risk analysis of the potential for contact with measles patients and the need to implement a respiratory protection program.

Respiratory Hygiene and Cough Etiquette is another effective measure to reduce the spread of this illness. Each facility should have a strong program in place and educate patients on the process. Elements of an effective program include:

• Visuals – Signs or posters in the appropriate language at the facility entrance and other common areas.
• Hand hygiene supplies – Make these supplies, along with tissues, available, especially in waiting areas.
• Personal Protective Equipment – Masks should be readily available.

Once the patient visit has ended, the exam room should remain closed for a period of two hours to ensure adequate air exchange has occurred.

A critical key to reducing the spread of measles is of course, individual vaccination. For those in healthcare, education is imperative to ensure the proper message is sent about the safety and need for appropriate prevention measures. Know the immune status of your workers and patients! Educate when necessary to create a safer patient and work environ