Measles Reporting and Infection Prevention and Control Recommendations
February 29, 2024
This message is being sent to local health officers, Tribal health directors, local and Tribal health department (LTHD) staff, infection preventionists, Wisconsin Vaccinators, Vaccines for Adults, and Vaccines for Children Program lists.
Measles is a highly contagious infectious disease that can be transmitted by direct contact with infectious droplets or by airborne spread when an infected person breathes, coughs, or sneezes.
Given recent measles activity in the U.S., the Wisconsin Department of Health Services (DHS) urges health care providers to consider measles in individuals who are unvaccinated and may have traveled recently, and to review infection prevention and control best practices related to measles. As of February 29, there have been no new measles cases reported in Wisconsin.
Vaccination
We urge health care providers to use every opportunity to assess patients and ensure they are up to date with the measles-mumps-rubella (MMR) vaccine. In recent years, the rates of MMR have dropped in school aged children, leaving pockets of our communities vulnerable to infection. Reports for reminder and recall efforts can be generated from the Wisconsin Immunization Registry (WIR) to indicate which patients are not vaccinated.
Infection prevention and control
Being prepared to care for a patient with measles helps reduce risk of transmission to others.
In preparation of receiving a suspected measles case
- Keep record of staff who have documented measles immunity. Only those with immunity should care for a suspected measles case.
- Assess supply of personal protective equipment (PPE) and alcohol-based hand sanitizer available to staff.
- Review policy and procedures regarding intake of a measles case. Educate staff on the process.
Upon arrival of a potential measles case
- Immediately mask the patient.
- Do not allow the patient to remain in the waiting room.
- Immediately isolate the patient to an airborne infection isolation room (AIIR). In clinic settings where an AIIR may not be available, a single exam room with the door closed and away from susceptible contacts should be used for patient evaluation. The exam room should remain closed for two hours after measles suspect patient leaves.
- Adhere to standard and airborne precautions. All health care workers entering the patient room should be wearing a fit-tested N95 respirator.
- Limit transport of the patient to essential care needs. The patient should remain masked during transport. If a patient is being transported to another health care facility or moved within a facility, staff should be notified ahead of time about suspected measles infection.
- Standard health care cleaning and disinfection procedures are adequate for measles virus environmental control. Clinic exam rooms (non-AIIRs) should remain closed for two hours post-appointment prior to cleaning.
- Consult facility infection prevention staff.
- Make note of the staff and other patients who were in the area during the time the suspect measles patient was in the facility for public health follow-up.
Assessment of a potential measles case
Assess for the clinical presentation of measles:
- Fever of 101°F (38.3°C) or higher
- Cough, coryza, or conjunctivitis
- A generalized, maculopapular rash lasting three days or more
- Koplik spots (tiny red spots with bluish-white centers inside mouth on the lining of the cheek) are diagnostic for measles.
- Assess recent travel history.
Contact the Wisconsin Healthcare-Associated Infections Prevention program or your regional infection preventionist with questions related to infection prevention and control.
Reporting
Measles is a Category I Reportable Disease (DHS 145.04). Health care providers are required to immediately report by telephone the suspected or confirmed case to the LTHD in which the patient resides. Detailed guidance regarding measles case investigation and reporting from DHS is also available.
Testing
Please contact your local and Tribal health department (LTHD), who will work with the DHS immunization program for approval and to arrange logistics for transportation of the specimens. Health care providers outside of the Milwaukee area are asked to send any laboratory specimens for patients suspected of having measles to the Wisconsin State Laboratory of Hygiene (WSLH) for testing. Providers in the Milwaukee area may send specimens to either the City of Milwaukee Health Department Laboratory (MHDL) or WSLH.
If testing is approved, it can be performed fee-exempt at the WSLH. The WSLH can perform real-time PCR for the detection of measles, real-time PCR to distinguish wild-type measles strain from vaccine-strain, and IgM and IgG serology. Specimen types for PCR at the WSLH include NP/OP swabs in VTM and urine.
Details about specimen collection, transport, and testing can be found at the WSLH website. For additional details on WSLH testing please call customer service at 1-800-862-1013.
For entities in the Milwaukee area, real time PCR for detection of measles at MHDL may be an option. This should be coordinated through the City of Milwaukee Health Department Communicable Disease Team, prior to specimen collection, at 414-286-6800. If testing is approved by the City of Milwaukee Health Department Communicable Disease Team, it can be performed fee-exempt at the MHDL. Specimen types for PCR at the MHDL include OP swabs.
Note: Serologic tests to determine immunity (for example, in non-symptomatic individuals) may be done at commercial laboratories.
The Wisconsin Immunization Program can be reached at 608-267-9959 or after hours at 608-258-0099.
Additional resources
For public health and health care staff:
For the general public:
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