Measles Information for Health Care Facilities

To help maintain clinic staffing and normal operations in the event of measles transmission in the community, ensure ahead of time that all health care professionals (HCP) have presumptive evidence of immunity to measles, as without proof of immunity, exposed staff will need to be restricted from the workplace through the 21st day after last exposure or until proof of immunity is shown.

• Presumptive evidence of immunity to measles for HCP includes:
  • Written documentation of vaccination with two doses of measles virus-containing vaccine (the first dose administered at age ≥12 months; the second dose no earlier than 28 days after the first dose); OR
  • laboratory evidence of immunity (measles immunoglobulin G [IgG] in serum; equivocal results are considered negative); OR
  • laboratory confirmation of disease; OR
  • birth before 1957.
• Consider vaccinating HCP born before 1957 who do not have other evidence of immunity to measles.
• CDC and the Advisory Committee on Immunization Practices (ACIP) maintain recommendations on immunization of HCP for measles.

• Provide HCP with job- or task-specific education and training, including refresher training, on preventing transmission of measles.
• Train, medically clear, and fit-test HCP for respirators (e.g., NIOSH-certified disposable N95).

• Implement mechanisms and policies that promptly alert key facility staff, including hospital leadership, infection control, health care epidemiology, occupational health, clinical laboratory, and frontline staff, about patients with suspected or known measles, and protocols on how and when to communicate with public health.
• Establish procedures for measles testing (e.g., routing specimens to public health laboratories as appropriate) and post-exposure prophylaxis.

• Procure in advance an adequate supply of personal protective equipment (PPE) (e.g., NIOSH-certified N95 respirators for HCP, other face masks for patients) and hand hygiene supplies.
• Identify airborne infection isolation rooms (AIIR) and preemptively map out workflow protocols to safely escort a patient with suspected measles into one.
• If no AIIR is available in your facility:
  • Identify in advance facilities with an AIIR where patients with suspected measles can be transferred.
  • Identify a private room(s) with a door where patients with suspected measles can wait until transferred.

• Via your clinic’s preferred communication methods (e.g., patient portal, website, automated messages, etc.), ensure that ALL patients are aware that if they exhibit measles symptoms, they should call first for instructions and avoid walking in. This may include patients with appointments for reasons other than measles-compatible symptoms.
• Precaution instructions can include information such as which door to arrive at, how to notify staff of arrival, and whether to wear a face mask upon entry (or, if unable to wear a face mask, to place a blanket loosely over their head), among other details.
• Persons with signs or symptoms of measles should be kept separate from other patients.
  • Consider having individuals wait outside and call for escorted admittance.
  • Directly escort the patient to an airborne infection isolation room (AIIR), or if no AIIR is available, a private room with a door, rather than the patient waiting room.
• Consider reviewing scheduled appointments for secondary triage by clinical staff to identify patients at high risk of measles.
• If possible, schedule high-risk patients (e.g., symptomatic or unvaccinated patients) for the end of the day so their appointment overlaps with as few other patients as possible.

• Post signs at the entrance directing people with signs or symptoms of measles on what to do upon arrival, including masking and alerting triage staff to their risk of measles.
• Provide supplies (e.g., face masks, hand hygiene) near visual alerts if possible.
• Post reminders in health care worker spaces, including signs and symptoms of measles, testing procedures, isolation protocols for patients with suspected measles, and reporting activation procedures.

• Immediately place patients with known or suspected measles in an AIIR.
• If an AIIR is not available:
  • Place the masked patient in a private room with the door closed.
  • Transfer the patient to a facility with an AIIR as soon as possible. Notify the receiving facility of suspected measles cases and plan a route that minimizes contact with individuals not essential to patient care.
• Consider evaluating a patient with signs or symptoms of measles outside the clinic (e.g., in their car, outdoors) if the patient’s condition is suitable.

• HCP should use respiratory protection (e.g., fit-tested, NIOSH-certified N95) upon entry to the care area of a patient with known or suspected measles, regardless of presumptive evidence of immunity.
• HCP without acceptable presumptive evidence of measles immunity should not enter a patient's room with known or suspected measles if HCP with presumptive evidence of immunity are available.
• During a measles outbreak, proof of two doses of measles virus-containing vaccine is recommended for all HCP, regardless of birth year.

• Immediately notify public health authorities of patients with known or suspected measles.
• Coordinate laboratory testing with public health, as appropriate, to confirm infection.
• Ensure that clinic notification chains are kept up to date.

• Centers for Disease Control and Prevention (CDC) | Stay Alert for Measles Cases
• CDC | Interim Infection Prevention and Control Recommendations for Measles in Healthcare Settings
• CDC | Expanding Measles Outbreak in the United States and Guidance for the Upcoming Travel Season
• CDC | Project Firstline Measles Micro-Learn Discussion Guide

• Preparing Your Clinic Ahead of Time for Measles
• Mitigating the Impact of Community Measles in Your Clinic
• Health Care Facility Measles Sign [Call First] | Health Care Facility Measles Sign [Call First] (En Español)
• Health Care Facility Measles Sign | Health Care Facility Measles Sign (En Español)
• Health Care Facility Measles Sign [Contagious] | Health Care Facility Measles Sign [Contagious] (En Español)