Health Advisory

Summary

• Over the past several weeks, three measles cases occurred, two in infants and one in an adult, living in or transiting through the National Capitol Region. Each individual had traveled internationally where the exposure occurred. While no case resided in the Fairfax Health District, these cases serve as a reminder to remain vigilant and prepared in the event of a suspect case of measles, and to consider prevention for persons who travel internationally.
• 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.

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 recent exposure or international travel.
• 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 Communicable Disease/Epidemiology Unit 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. PCR testing is available at the Virginia Department of Health, Division of Consolidated Laboratory Services (DCLS) with approval through the local health department.
• Ensure that all patients, particularly those traveling internationally, are vaccinated against measles. While the first dose of MMR vaccine is routinely recommended at 12-15 months of age, children traveling internationally can be given measles vaccine as early as 6 months of age and at least 2 weeks before departure, if possible. These children should then receive a measles vaccine at 12-15 months of age, at least 28 days after the initial dose, and a third dose at 4-6 years of age.        

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 clinical case definition for measles is an acute illness characterized by: 

1.  generalized, maculopapular rash lasting >3 days, almost always 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 (PCR), 
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 5^th through the 21^st day after exposure, regardless of whether they received vaccine or immune globulin after exposure.

Currently, measles outbreaks are occurring in every region of the world with health officials in many countries reporting large outbreaks (see Global Measles). Between December 1, 2023, and January 23, 2024, CDC was notified of 23 confirmed U.S. cases of measles, including seven direct importations of measles by international travelers and two outbreaks with more than five cases each.  

Additional information about measles and measles vaccination is available at the CDC website.