In 2002, which was right after the most important spikes in COVID-19, there was a significant global resurgence of measles in African countries; just one year after COVID, there were at least 40 countries reporting significant measles increases of thousands of cases and thousands of deaths. Global vaccination dropped below 20 percent. In 2023, we saw significant spikes in Europe, a 10-fold increase in the number of measles cases that were driven mostly from importation from endemic countries. Soon after we saw similar trends in the U. S. and Canada, including a significant drop in vaccinations. There are some headlines saying the United States is on the brink of losing its measles-free status.”
“ It’ s the most contagious pathogen or infectious diseases that exists out there,” Torres emphasized.“ It can remain in the air for at least two hours, which is a lot. And transmission is basically via respiratory, which is the new framing from the WHO instead of using the terms airborne or droplets to avoid more confusion. Essentially, it’ s transmitted via respiratory secretions from infected individuals. The incubation period is between 10 and 14 days after onset of rash. Symptoms include high fever, cough, runny nose, and conjunctivitis. The infected individual remains contagious until the rash is completely crusted. When it comes to treatment and prevention, there is a vaccine that is 97 percent effective after two doses.”
Torres addressed transmission trends, noting,“ What we’ re seeing right now is something that was not fully expected after COVID-19. In 2002, which was right after the most important spikes in COVID-19, there was a significant global resurgence of measles in African countries; just one year after COVID, there were at least 40 countries reporting significant measles increases of thousands of cases and thousands of deaths. Global vaccination dropped below 20 percent. In 2023, we saw significant spikes in Europe, a 10-fold increase in the number of measles cases that were driven mostly from importation from endemic countries. Soon after we saw similar trends in the U. S. and Canada, including a significant drop in vaccinations. There are some headlines saying the United States is on the brink of losing its measles-free status.”
Kley reviewed IPC measures to help combat measles, including screening, patient management and other key considerations.
“ Speaking from experience, a case of measles in your facility can be incredibly disruptive, especially if you have exposures and you almost inevitably will,” Kley said.“ In my last hospital, we experienced several back-to-back measles cases during the 2014-2015 outbreak. Over the course of about six weeks, my time was completely consumed with exposure investigation and management. I was a sole IP, so nothing else got done for those six weeks, which is not preferred. So, because measles is so highly contagious, early identification is crucial to reduce the number of exposures. Point-of-entry staff should have a high suspicion index for measles when the patient has signs and symptoms consistent with the disease, especially if cases have been reported in your area or an outbreak has been declared by public health authorities, or the patient has had recent international travel. Also, if the patient reports having been exposed to someone who has fever and rash or was exposed to a known confirmed case.”
Kley emphasized the importance of understanding and recognizing the three Cs of measles: Cough, Coryza and Conjunctivitis.“ If you have identified a suspected measles patient, what do you do next? First and foremost, staff should promptly notify infection control that a suspect case is inhouse. And the IP should instruct the staff on appropriate infection control measures, including the importance of getting these patients masked, if not already, and immediately placed in a single-patient, airborne isolation room with the door kept closed. Staff are going to need to wear a respirator – N95 or higher – and non-immune staff should not be assigned to these patients. This patient should remain in isolation precautions for four days after their rash onset. And if the patient happens to be immunocompromised, you should continue those precautions for the entire duration of their stay or of their illness. Although measles is primarily spread by the airborne route, transmission is possible from contaminated surfaces, so with that said, environmental cleaning is per routine with special attention to high-touch surfaces. We should be using an EPA-registered, healthcare-grade disinfectant that is effective against the measles virus. Again, remember, if you’ re not seeing the measles virus on your product, check the master label on the EPA website, just because you don’ t see it on the label, doesn’ t mean they don’ t have a claim. And just like H5N1, EVS staff should delay room entry until we’ ve had sufficient air exchanges.”
Kley also addressed exposure management. The CDC defines an exposure as having spent any time while unprotected( i. e., not wearing recommended respiratory protection) in a shared airspace with an infectious measles patient( even if patient masked), or vacated by an infectious measles patient within the prior two hours. She noted,“ Be mindful that your local public health authorities might have a different definition, and they may not necessarily follow the CDC definition.”
Kley continued,“ The IP should start a line-list of potentially exposed patients, visitors, and staff, regardless of the length of unprotected time spent in that shared airspace and for up to two hours after that patient left, your employee health person should be able to provide you with the names of non-immune staff. This will help you prioritize your response. Individuals considered immune for measles is anyone born before 1957, those having written documentation of adequate vaccination, or possessing lab evidence that demonstrates immunity. For healthcare workers who are lacking this evidence, we should consider vaccinating them if they were born before 1957 and if they received the vaccine between 1963 and 1967, because in that time period, there was a live and an attenuated version of the vaccine and no one really knows what they received. These folks should be um have the vaccination series repeated. In terms of post-exposure prophylaxis, the clock is ticking and there are two options for measles. Susceptible individuals should receive the vaccination within 72 hours of exposure, but only if the person is vaccine-eligible, because this is a live-virus vaccine. If it’ s been greater than 72 hours, but you’ re within that six-day window, administer immunoglobulin. A note of caution here, do not administer both the vaccine and immunoglobulin because the immunoglobulin will invalidate the vaccine. Now, if it’ s been greater than six days, you can still consider offering the vaccine, but otherwise quarantine and monitor for signs and symptoms. If the healthcare worker develops measles, they should be excluded from duty until four days after their rash onset.”
jul-aug 2025 • www. healthcarehygienemagazine. com •
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