Health Advisory

SUMMARY

• A measles cases has been identified amongst an unvaccinated individual with recent international travel. Multiple exposure locations have been identified in the Fairfax Health District.
• Fairfax County Health Department (FCHD) is contacting people known to have been exposed in the Health District to provide public health guidance. See table below for the current exposure sites and times.
• Individuals exposed to a case may develop signs and symptoms as late as February 24, 2022.

SUGGESTED ACTIONS

• Maintain an increased index of suspicion for measles in clinically compatible cases at all times and particularly if a patient presents with fever and rash and has history of being at one of the exposure sites listed in the press release during the period of concern.
• Take the following actions for a patient with fever and a rash that you suspect may be measles.
  • Immediately triage the patient; do not allow such patients to remain in your waiting area.
    • If you are aware that a suspect measles patient will be arriving at your facility, consider evaluating the patient outside (e.g., in the parking lot), if feasible, to minimize exposure to others. If the patient enters the building, ensure that the patient is masked before doing so.
    • If referring a suspected measles case to another health care facility, notify the facility before sending the patient so that appropriate infection control measures can be implemented at the receiving facility.
  • Place a surgical mask on the patient as soon as possible.
  • Place the masked patient in a private, negative pressure room if available, or a room with a closed door. This room should not be used for 2 hours after the suspect measles patient leaves.
  • Use standard and airborne precautions.
  • Only health care workers with immunity to measles should work with the patient.
• Measles is an immediately reportable disease. Contact the Health Department’s Acute Communicable and Emerging Disease Program immediately at 703-246-2433 (normal business hours) or 703-409-8449 (evenings and weekends) to report the suspected case and for guidance on testing and infection control measures.
• Ensure that all patients, particularly those traveling internationally, are vaccinated against measles.

ADDITIONAL INFORMATION

Measles is a highly infectious viral disease with an incubation period of approximately 10 days (range 7 – 21 days) from exposure to the onset of fever and 14 days to rash onset. Patients with measles are considered infectious from 4 days before to 4 days after rash onset. Transmission is primarily person-to-person by large respiratory droplets. Airborne transmission by aerosolized droplets can occur within shared air space for up to 2 hours after an infectious person with measles has occupied that space.

The Centers for Disease Control’s (CDC’s) clinical case definition for measles is an illness characterized by:

1. Generalized maculopapular rash beginning on the face, AND
2. Temperature > 101°F (38.3°C), AND
3. Cough, coryza, or conjunctivitis.

The laboratory criteria for measles include ANY ONE of the following:

1. Detection of measles-virus specific nucleic acid by polymerase chain reaction,
2. Positive IgM serologic test for measles,
3. Significant rise in measles IgG antibody, or
4. Isolation of measles virus from a clinical specimen.

In general, persons may be presumed to be immune to measles if they have documentation of two doses of measles vaccine, laboratory evidence of immunity to measles, documentation of physician-diagnosed measles, or were born before 1957. Persons who are not immune should be given MMR vaccine or immune globulin according to Advisory Committee on Immunization Practices (ACIP) recommendations.

Individuals who work in health care facilities in any capacity are at increased risk of exposure to measles. To ensure staff are immune to measles, they must have documentation of two doses of measles vaccine or laboratory evidence of immunity to measles. Birth before 1957 is not acceptable evidence of immunity for health care providers. Susceptible personnel who have been exposed to measles should not have contact with patients or be in a health care facility from the 5th through the 21st day after exposure, regardless of whether they received vaccine or immune globulin after exposure.

Children traveling internationally or who have been exposed to a case can be given measles vaccine as early as 6 months of age. These children should then receive a measles vaccine at 12-15 months of age, at least 28 days after the initial dose. Additional information about measles and measles vaccination is available at the CDC website.