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ODH Reminds Healthcare Workers of Protocol for Treating Measles Patients

The United States is experiencing its worst measles outbreak since 2019, reinforcing the importance of vaccination and reminding healthcare workers of the proper protocol for treating infected patients. As of March 30, Ohio is one of five states reporting a measles outbreak, with 11 confirmed cases. Ten of those cases are linked to a single outbreak in Ashtabula County.

As states see a rise in cases, the Ohio Department of Health (ODH) is asking clinicians to remain alert for signs and symptoms of measles, and suggested outreach to patients who are eligible for a measles-containing virus to encourage routine immunization.

A highly contagious viral illness — one person can infect up to as many as 18 unvaccinated individuals — measles can cause severe health complications, including encephalitis, pneumonia and death.

Transmitted by direct contact with infectious droplets — including airborne when an infected person breathes, coughs or sneezes — measles can remain infectious in the air and on surfaces for up to two hours after an infected person leaves an area.

Infected individuals are contagious from four days before rash onset to four days after, with an incubation period from exposure to fever of typically 10 days, and from exposure to rash onset of about 14 days.

Preventing the Spread of Measles

The measles, mumps, rubella (MMR) vaccine provides strong protection against measles infection and should be recommended to all unvaccinated or not fully vaccinated patients. One dose of the vaccine can provide approximately 93% effectiveness, and a second dose can provide about 97% effective prevention.

Children under five and adults older than 20, pregnant woman and people with compromised immune systems are more susceptible to complications — with one in 20 children with measles getting pneumonia, the most common cause of death in young children.

Patients with suspected or confirmed measles infection need to be isolated for four days following the onset of rash. Unvaccinated individuals should be vaccinated as soon as possible after exposure — if given within 72 hours, prevention or reduction in severity of measles may occur. The Ohio Department of Health (ODH) states that Immune globulin can prevent or modify measles in a susceptible person if given within six days of exposure.

According to the ODH and Centers for Disease Control and Prevention (CDC), to minimize the risk of measles transmission in healthcare settings, healthcare personnel should do the following:

1. Ask patients with a febrile rash illness about a history of travel (including international travel or travel to outbreak areas within the U.S.), contact with foreign visitors, transit through an international airport, or possible exposure to a person with measles in the three weeks prior to symptom onset. The possibility of measles should be considered for patients with such a history and symptoms consistent with measles.

2. Mask patients with suspected measles immediately, if tolerated. Encourage respiratory etiquette.

3. Do not allow patients with suspected measles to remain in the waiting room or other common areas; isolate patients with suspected measles immediately in an airborne infection isolation room if one is available. If such a room is not available, place the patient in a private room with the door closed.

4. If possible, allow only healthcare personnel with documentation of two doses of MMR vaccine or laboratory evidence of immunity to measles (i.e., measles IgG positive) to enter the patient's room.

5. Healthcare personnel should wear an N95 or higher-level respirator regardless of presumptive evidence of immunity. A user seal check should be performed each time the respirator is worn.

6. If possible, do not allow susceptible visitors in the patient room.

7. Do not use the examination room for at least two hours after the possibly infectious patient leaves.

8. If possible, schedule patients with suspected measles at the end of the day.

9. Notify the local health department in whose jurisdiction the patient resides immediately by telephone about any patient with suspected measles.

10. Notify any location where the patient is being referred for additional clinical evaluation or laboratory testing about the patient's suspected measles status, and do not refer patients with suspected measles to other locations unless appropriate infection control measures can be implemented at those locations.

11. Instruct patients with suspected measles and exposed persons to inform all healthcare providers of the possibility of measles prior to entering a healthcare facility so appropriate infection control precautions can be implemented.

12. Make note of the staff and other patients who were in the area during the time the patient with suspected measles was in the facility and for two hours after they left. If measles is confirmed, exposed people will need to be assessed for measles immunity.

13. For additional details about prevention measures in healthcare settings, refer to CDC's Interim Infection Prevention and Control Recommendations for Measles in Healthcare Settings.

Testing and Reporting

Measles should be considered as a diagnosis in anyone presenting with a febrile illness and symptoms such as generalized maculopapular rash, along with cough, coryza, or conjunctivitis. Once diagnosed, clinicians should implement appropriate precautions and take the following steps:

• Determine MMR vaccination status.
• Assess any known contact to someone with measles, including any recent travels to outbreak areas.
• Collect virologic and serologic specimens for confirmation of disease.
• Collect both respiratory (oropharyngeal or nasopharyngeal) and serum specimens for testing.

Testing for the measles virus is available through the ODH laboratory (ODHL) for eligible clinical specimens. To request approval for testing at ODHL, healthcare providers should contact the local public health department in which the patient resides. Local health departments should contact the Bureau of Infectious Diseases Vaccine Preventable Disease Epidemiology program to request specimen approvals using established chains of communication.

To report a suspected case or a positive laboratory result, immediately contact the local public health department in which the patient resides. Local public health departments should immediately report the case, suspected case or positive laboratory result to ODH.