Clinical Guidance for Measles

Screen/Diagnose

• Although symptoms of measles usually begin 7-14 days after exposure, they can appear up to 21 days after exposure and may include:
• High fever (may spike to over 104˚F).
• Cough, runny nose, red, watery eyes (conjunctivitis).
• Tiny white spots on the inner cheeks, gums, and roof of the mouth (Koplik Spots) two to three days after symptoms begin.
• A rash that is red, raised, and blotchy; usually starts on the face, and spreads to the trunk, arms, and legs three to five days after symptoms begin.
  
  
• Consider measles especially if:
• Unvaccinated or vaccination status is unknown (look up in MICR).
• Travel to a known outbreak location in the last 21 days.

• For additional clinical guideline with visuals of the rash, click here.

Testing

• When ordering measles testing, please instruct patients not to present directly to the hospital. Instead, they should call the hospital lab in advance. If they contact Munson’s Switchboard and request the lab, staff will coordinate next steps.

• To expedite test result turnaround times, Munson is routing specimens to the Mayo Clinic Laboratories. A separate specimen is also being sent to MDHHS for epidemiology. 

• The following lab tests are recommended to confirm/rule out a possible case of measles:
• Respiratory: Throat swab, collected by swabbing back and forth over mucosal surface of the throat to maximize recovery of cells. Swab must be placed into viral transport media. PCR testing is recommended as the first-line test if a patient has symptoms of measles.
• Urine specimen: Collected in urine collection plastic cup, may be a random urine sample and no preservatives needed.
• Serum measles IgM

• Collection of both respiratory and blood (if able) samples for analysis is recommended to increase the likelihood of detecting the virus.

• The following orderables are available in PowerChart:
• MMEASR: Measles virus molecular detection, PCR, throat
• MMEASU: Measles virus, molecular detection, PCR random urine
• MROM: Serum measles IgM

Treat

• For guidance on how to treat, read the MDHHS guidance.

Isolate

• Patients with either suspected (rule out) or active Measles should be placed in an Airborne Infection Isolation (AII) room that has monitored negative air pressure (when available) with the door closed.

• Wear National Institute for Occupational Safety and Health (NIOSH)-approved respiratory protection when entering the room.

• For more on isolation precautions and PPE guidelines, refer to MHC system policy Standard and Transmission-Based Isolation Precautions.

Clinician Guidance for Healthcare Team Exposure

• Munson checks titers of new employees and vaccinates if not immune upon hire.

• For staff who were granted an MMR exemption and have been exposed to measles, have them follow the post-exposure prophylaxis plan.

Prevent

• MDHHS recommends unvaccinated individuals ages ≥12 months receive measles-mumps-rubella (MMR) vaccination to protect themselves and those around them.

Report

• Immediately report any probable case of measles to local health department of the patient’s residence.

Additional Clinician Resources

• Grand Traverse County Health Department Measles Checklist
• MDHHS Measles Investigation Guidelines
• MDHHS Vaccine-Preventable Disease Investigation Guidelines – Lab test summary
• Measles Flowsheet
• Munson Healthcare For Providers website | Measles

Questions? Joanna Benchley, 231-935-2018