June 21, 2019

Measles cases continue to be on the rise in the United States and across the world.  Though no case of measles has been reported at TriHealth to this point, the Infection Prevention team is well prepared if this nation-wide outbreak spreads to this region. To keep team members in-the-know, Infection Prevention will periodically provide relevant information about certain diseases, like TriHealth Measles Guidelines, through our internal communication channels. More information can be found on on the Infection Prevention page.

TriHealth Measles Guidelines:

Clinical Features
Measles is an acute viral respiratory illness. It is characterized by a prodrome of fever (as high as 105°F) and malaise, cough, coryza, and conjunctivitis -the three “C”s -, a pathognomonic enanthema (Koplik spots) followed by a maculopapular rash. The rash usually appears about 14 days after a person is exposed. The rash spreads from the head to the trunk to the lower extremities. Patients are considered to be contagious from 4 days before to 4 days after the rash appears. Of note, sometimes immunocompromised patients do not develop the rash.

Transmission
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 2 hours after an infected person leaves an area.

Patient Placement
• If measles is suspected: 
o Place patient on Airborne Precautions for 4 days after the onset of rash.
o Immune-compromised patients should remain on Airborne Isolation for the duration of the illness.

Prevention
• Follow Respiratory Etiquette:
o Provide surgical masks to all patients with symptoms of a respiratory illness.
o Provide tissues for patients who cannot wear a surgical mask.
o Provide hand hygiene materials and encourage patients with respiratory symptoms to perform hand hygiene.

Notify Infection Prevention
• Contact the hospital operator to notify the Infection Preventionist on-call.
• Infection Prevention will coordinate contact with the Ohio Department of Health (ODH). 

Laboratory Testing
• Laboratory confirmation is essential for all sporadic measles cases and all outbreaks
• Collect blood in 1 Serum Separator (SST) or red top tube and a nasopharyngeal swab in viral media.
• Order Measles IgM (serology) and Measles PCR (NP swab) - consult with Infection Prevention to confirm test processing and shipment approval (reference lab or ODH). 

thanks for the update
Posted by: Bridget Strochinsky on July 24, 2023
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