Measles and Appropriate Infection Prevention Precautions

Connie Jones

The first measles outbreak to occur in North Carolina in more than 20 years began on April 4, 2013 (described above).During this outbreak, questions were raised as to the appropriate type of Infection Prevention Precautions to follow. According to the Centers for Disease Control and Prevention (CDC), airborne precautions should be used in the healthcare setting for patients known or suspected to be infected with diseases transmitted via the airborne route.  These diseases include Measles, Severe Acute Respiratory Syndrome (SARS), Varicella (chickenpox), and Mycobacterium tuberculosis.

Precautions should be initiated and maintained for all patients suspected of having measles.  Persons with measles are contagious from 4 days prior to rash onset through 4 days after rash onset.

Airborne isolation precautions consist of:

1. Standard Precautions, including appropriate:

·                 Hand hygiene

          Gloves

·                 Gowns

·                 Mask, face shield, eye protection

2. Personal respiratory protection:

·                  N95 Respirator OR Powered Air-Purifying Respirator (PAPR)

3. Airborne Infection Isolation Room (AIIR)

It is important to note that there are no CDC recommendations for patient care outside of the healthcare setting. SPICE and APIC-NC support the suggestion that public health staff or other persons enter housing areas where patients suspected of having measles (e.g., under quarantine) are located may use these same precautions.

Post-exposure prophylaxis

Vaccination with the measles/mumps/rubella (MMR) vaccine may prevent or modify disease if given within 72 hours of exposure. Immune globulin (IG) may prevent or modify disease if given within 6 days of exposure.  Individuals at risk for severe disease and complications from measles, such as infants younger than 1 year of age, pregnant women without evidence of measles, and immunocompromised individuals should receive IG. IG should not be used to control measles outbreaks.

Vaccination

Vaccination with the MMR vaccine at the appropriate age is the best way to protect against measles.  Healthcare workers should be immunized with 2 doses of MMR.

Additional Information:

Immunization of Healthcare Personnel

Recommendations of the Advisory Committee on Immunization Practices (ACIP)

http://www.cdc.gov/mmwr/preview/mmwrhtml/rr6007a1.htm?s_cid=rr6007a1_e

Measles Overview (CDC)

http://www.cdc.gov/measles/

Healthcare Infection Control Practices Advisory Committee (HIPAC) -- 2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings

http://www.cdc.gov/hicpac/2007IP/2007isolationPrecautions.html

Emergency Medical Services –

Guide to Infection Prevention in Emergency Medical Services (APIC)

http://apic.org/Resource_/EliminationGuideForm/e1ac231d-9d35-4c42-9ca0-822c23437e18/File/EMS_Guide_web.pdf