By Gary Evans, Medical Writer
Undiagnosed hospital measles introductions are notoriously labor-intensive, making it necessary to track potential exposures to patients and healthcare workers and determine immune status as necessary.
“As an infection preventionist, measles is the last thing we want to see,” said Patricia Stinchfield, MS, RN, CPNP, former director of infection prevention and control at Children’s Hospital and Clinics of Minnesota.
Now the president of the National Foundation for Infectious Diseases, Stinchfield dealt with multiple outbreaks of measles over her long tenure at Children’s.
At that time, parents were refusing childhood vaccination with the measles, mumps, rubella (MMR) shot in part because of a thoroughly debunked and retracted “study” that linked measles with autism. Since then, study after study has found there is no link whatsoever between MMR and autism.
But the anti-vaxx movement found a large, disgruntled audience with COVID-19. Vaccines are under attack, and childhood immunizations have fallen off during the pandemic. Measles has returned with recent outbreaks in central Ohio and Kentucky, the latter of which spurred a measles alert by the Centers for Disease Control and Prevention (CDC).
The CDC warned of a confirmed measles case at a large public gathering in Wilmore, KY, at Asbury University on Feb. 17-18, 2023. The confirmed case of infectious measles was unvaccinated and recently had traveled internationally. An estimated 20,000 people attended the gathering, hailing from Kentucky, other U.S. states, and other countries.
“If you attended the Asbury University gathering on Feb. 17 or 18 and you are unvaccinated or not fully vaccinated against measles, you should quarantine for 21 days after your last exposure and monitor yourself for symptoms of measles so that you do not spread measles to others,” the CDC recommended.1 “If you attended the gathering and are not up to date on your measles vaccinations, talk to your healthcare provider right away about getting vaccinated after completing your quarantine.”
Give Notice Before Going to the Hospital
People who think they may have measles or were exposed should isolate and “and call your healthcare provider, urgent care, or emergency room before arriving to be tested,” the CDC emphasizes. “Do not arrive at a healthcare facility without giving advance notice.”
As infection preventionists are well aware, measles is a highly contagious airborne virus known for the rash that appears a few days after initial symptoms of cough and fever.
“Measles can cause severe health complications, including pneumonia, encephalitis, and death,” the CDC noted. “Measles virus can remain infectious in the air and on surfaces for up to two hours after an infected person leaves an area. Infected people are contagious from four days before the rash starts through four days afterward.”
As in Kentucky, measles may come from an international source, as large outbreaks of 20 cases or more are being reported in Europe, Africa, the Eastern Mediterranean, and Southeast Asia.
“Do not allow patients with suspected measles to remain in the waiting room or other common areas of the healthcare facility,” the CDC emphasizes. “Isolate patients with suspected measles immediately, ideally in a single-patient airborne infection isolation room (AIIR) if available.”
Healthcare workers should wear N95 respirators — regardless of presumptive evidence of immunity — upon entry to the room of a patient with known or suspected measles.
Diagnosis, Testing, PEP
The CDC also recommends that clinicians consider measles as a diagnosis in anyone who attended the Kentucky event or recently traveled abroad who presents with a febrile illness and clinically compatible symptoms (e.g., rash, cough, coryza, or conjunctivitis).
The CDC recommends following its measles testing recommendations, which call for use of either a nasopharyngeal swab, throat swab, or urine specimen for reverse transcription polymerase chain reaction.2 A blood specimen also is recommended for serology from all patients with clinical features compatible with measles.
“To potentially provide protection or modify the clinical course of disease among susceptible people, either administer MMR vaccine within 72 hours of initial measles exposure or immunoglobulin (IG) within six days of exposure,” the CDC recommends. “For vaccine-eligible people aged ≥ 12 months exposed to measles, administration of MMR vaccine is preferable to using IG, if administered within 72 hours of initial exposure.”
Patients at risk for severe measles include infants younger than 1 year of age, pregnant women without evidence of immunity, and severely immunocompromised people.
They should be prioritized to receive IG, as well as those exposed in settings with prolonged, close contact, such as a daycare or a classroom.
“Do not administer MMR vaccine and IG simultaneously, as this practice invalidates the vaccine,” the CDC recommended.
- Centers for Disease Control and Prevention. Measles exposure at a large gathering in Kentucky, February 2023 and global measles outbreaks. Health Alert Network. Published March 3, 2023. https://emergency.cdc.gov/han/2023/han00488.asp
- Centers for Disease Control and Prevention. Measles (Rubeola). For healthcare providers. Last reviewed Nov. 5, 2020. https://www.cdc.gov/measles/hcp/index.html#lab