5
Fitzgerald Health Education Associates, Inc., March 2015 fhea.com
Isolation Precautions
Measles is transmitted by direct contact with infec-
tious droplets or by airborne spread when an in-
fected person breathes, coughs, or
sneezes. Therefore, airborne pre-
cautions must be implemented for
all persons suspected of having
measles. In the hospital setting,
this means isolating immunocom-
petent patients in an airborne-in-
fection isolation room with air-
borne precautions for 4 days after
the onset of the rash; persons who
are immunocompromised should be isolated for
the duration of the illness.
8
Healthcare providers
must put on a well-fitted respirator mask before
they enter the patient's room.
If measles is suspected in the clinic or office set-
ting, providers should immediately ask the patient
to wear a mask and have the patient wait in a pri-
vate room with the door closed (or
in an airborne-infection isolation
room if one is available) rather
than in the common waiting area.
9
If this isn't possible, the patient
should be placed as far away as
possible from other patients. In ad-
dition, staff and patients who may
have been exposed to measles (ie,
those who were in the area during
the suspected measles patient's visit and for 2
hours afterward) should be documented so that
they can be assessed for measles immunity should
measles be confirmed. Patients who do not require
hospitalization should be voluntarily quarantined
while testing is completed.
Diagnosis and Reporting
Laboratory confirmation by detection of serum
rubeola IgM antibody is necessary for all sporadic
measles cases and all outbreaks.
2
Measles is a noti-
fiable disease and must be reported to the state
and/or public health authorities; healthcare
providers should contact their local or state health
department to determine the reporting require-
ments in their county and state.
10
The full case def-
inition for classification of measles cases can be
found in the CDC's
Manual for the Surveillance of
Vaccine-Preventable Diseases
.
10
Complications
Complications of measles are common. Diarrhea is
often reported. Superimposed acute otitis media,
seen in up to 10% of children, can result in perma-
nent hearing loss.
11
Pneumonia occurs in up to 6%
of cases and is the most common reason for
measles death in children younger than 5 years.
Encephalitis affects 1 child in 1000, putting them
Clinical Update: Measles
C
ontinued from page 3
Figure 2. Head and shoulders of boy with measles; third day
of rash.
Image
courtesy
of
CDC
Airborne precautions
must be implemented
for all persons suspected
of having measles.