April 26, 2019:  Measles are making a comeback in the United States, and this new outbreak in California is nothing to sneeze at. Hundreds of confirmed cases of measles have been reported all over the country, making this the highest number of reported measles cases in the United States in the past 20 years. The potential devastation of this returning virus means it is imperative for healthcare providers to know how to recognize measles (view the AFL here).

Measles is one of the most contagious of all infectious diseases; up to 9 out of 10 susceptible persons with close contact to a measles patient will develop measles. The virus is transmitted by direct contact with infectious droplets or by airborne spread when an infected person breathes, coughs, or sneezes. Measles virus can remain infectious in the air for up to two hours after an infected person leaves an area.

All healthcare personnel should have documented evidence of immunity by providing written documentation of adequate vaccination, laboratory evidence of immunity, laboratory confirmation of measles, or proof that they were born before 1957. Healthcare professionals who receive the MMR vaccine may continue to work. There are no reports of recently vaccinated people transmitting live attenuated measles, mumps, or rubella viruses to susceptible contacts. At this time, it would be beneficial to document the immunization status of all staff by requesting evidence of immunity, if not already in their personnel file.

This outbreak also begs the question, “What about our residents”? The CDC recommends adults who do not have evidence of immunity should get at least one dose of MMR vaccine.

What happens if we suspect a case of measles in a resident?

• Isolate them immediately and if not contraindicated have the resident wear a surgical mask; All personnel MUST wear N95 masks per CAL OSHA requirement upon suspicion of, and for an hour after transfer of, an infected resident.
• Notify the local public health department for your county or city
• Collect specimens for testing in consultation with public health
• Use infection control measures until resident can be moved to a facility with airborne isolation rooms as soon as feasible
• Wait a minimum of an hour before occupying or cleaning room.
• Make note of name and contact information of all staff, visitors, and other residents who were in the area during the time the suspect resident was in the facility and for one hour after the suspect resident left. If measles is confirmed in the resident, potentially exposed people will need to be assessed for measles immunity.

For any additional information please contact DeAnn Walters, Director of Clinical Affairs.