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News & Press: Public Health

DC Health: Guidance on Measles Testing and Control Measures

Monday, April 1, 2019  
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The following is from a notice from DC Health, Division of Epidemiology–Disease Surveillance and Investigation, posted on March 26, 2019

Health Notice for District of Columbia Health Care Providers
Guidance on Measles Testing and Control Measures

The Centers for Disease Control and Prevention (CDC) and State Health Departments are investigating measles outbreaks in multiple states. From January 1 to February 28, 2019, 206 people from 10 states (CA, CO, CT, GA, IL, NJ, NY, OR, TX, and WA) have been reported as having measles. Five outbreaks (defined as 3 or more linked cases) have been reported, in Rockland County, New York; Monroe County, New York; New York City; Washington; Texas; and Illinois. Of these outbreaks, two are ongoing from 2018. These outbreaks have been linked to travelers from other countries such as Israel and Ukraine, where large measles outbreaks are occurring.

This health notice is to inform healthcare facilities about the measles outbreaks, and to provide guidance regarding measles testing recommendations and control measures to help prevent an outbreak in Washington, DC. DC Health is urging healthcare providers to maintain an increased index of suspicion for measles in patients with clinically-compatible symptoms, and to ensure that all patients are up to date on MMR vaccine, including before international travel.

Measles is a highly contagious, acute viral disease. It is transmitted through direct contact wth infectious droplets and by airborne spread. It begins with a prodrome of fever, cough, coryza (runny nose), and conjunctivitis (pink eye). These symptoms last two to four days prior to rash onset. The rash is typically maculopapular and spreads from the head to the trunk, then lower extremities. Infected individuals are contagious from four days before to four days after the rash appears. After an infected person leaves a location, the virus remains viable for up to two hours on surfaces and in the air. The incubation period for measles from exposure to fever onset is usually about 10 days (range, 7 to 12 days) and from exposure to rash onset is usually 14 days (range, 7 to 21 days). Measles can cause severe health complications, including pneumonia, encephalitis, and death. There is no treatment for measles; the measles-mumps-rubella (MMR) vaccination is the best way to
prevent measles infection.

Recommendations for Healthcare Providers
 Discuss the importance of MMR vaccine with parents, Listen and respond to parents’ questions and prepare for questions parents may ask.
   o More information can be found on the CDC’s Provider Resources for Vaccine
Conversation with Parents
Ensure all patients are up to date on MMR vaccine (review vaccination section for more details)
 Consider measles in any patient presenting with a febrile rash illness and clinically compatible measles symptoms (cough, coryza, and/or conjunctivitis).
   o Ask patients about recent international or domestic travel to an area with an ongoing outbreak, history of measles exposures in their communities, or whether they had contact with someone with a febrile rash illness.
 Promptly isolate patients with suspected measles and immediately report cases to DC Health.
   o Immediately provide a mask or place patients in an airborne isolation room when
   o For outpatient facilities, any waiting or public areas and shared air spaces (including
those with shared air ducts) should be cleared for two hours after the patient has left the area.
 Obtain specimens for testing, including viral specimens for confirmation and genotyping

To review the full notice, including Vaccination, Diagnostic Testing, Reporting, see DC Health Notice.

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