Update on Measles in Virginia
September 14, 2021
Today, I am writing to provide specific information about recent measles cases in Virginia. Specifically, the following are addressed in this letter:
- Current Measles Situation in Virginia
- Management of Patients with Illness Clinically Compatible with Measles
- Measles Vaccination
Current Measles Situation in Virginia
Multiple cases of measles have been confirmed among individuals who have arrived in the United States from Afghanistan. VDH is working closely with federal partners who are in charge of the transport and housing of individuals from Afghanistan to identify any new cases of measles and perform case investigation, contact tracing, and administration of post-exposure prophylaxis (PEP).
Clinicians should maintain a high index of suspicion for measles in patients who present with a febrile rash illness and clinically compatible symptoms (cough, coryza, and/or conjunctivitis) or epidemiologic linkage to known measles cases and notify their local health department immediately upon knowledge of any suspect cases of measles so that testing can be arranged and public health actions can be initiated quickly.
Management of Patients with Illness Clinically Compatible with Measles
Measles is a highly infectious viral disease spread through coughing, sneezing, and contact with secretions from the nose, mouth, and throat of an infected person. Typically, it is characterized by fever >101°F, cough, coryza, and conjunctivitis. After 3-7 days of illness, this stage progresses to a maculopapular rash that begins on the face and generalizes to the rest of the body. Persons with measles are contagious from 4 days before rash onset through 4 days after rash onset.
If you suspect measles, the following actions are recommended:
- Immediately isolate and report suspected cases to your local health department (After hours call 866-531-3068).
- Use standard and airborne precautions.
- Do not allow such patients to remain in your waiting area.
- Immediately provide a surgical mask to the patient and place the masked person 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 a suspect measles patient leaves.
- Permit only healthcare workers with measles immunity to attend to the patient.
- For patients being transported by EMS, EMS and the receiving hospital should be notified before arrival so the masked patient may be directed immediately to an appropriate exam room.
- Collect serum, a nasopharyngeal swab, throat swab, and urine (if possible) and coordinate with the local health department for submitting specimens for laboratory confirmation.
- Patients who are asymptomatic may present to you because they believe they have been exposed or worried they may be susceptible. For those who are not immune, provide vaccination as appropriate.
- People who work in healthcare facilities in any capacity are at increased risk of exposure to measles. To ensure healthcare workers, from direct care to administrative staff, are immune to measles, they must have documentation of two doses of measles vaccine or laboratory evidence of immunity to measles. Recommendations from the Centers for Disease Control and Prevention regarding the vaccines recommended for healthcare workers can be found here.
- Susceptible personnel who have been exposed to measles should not have contact with patients or be in a healthcare facility from the 5th to the 21st day after exposure, regardless of whether they received vaccine or immune globulin after the exposure.
Vaccination is the best prevention for measles. VDH urges persons who are not vaccinated or whose children have not been vaccinated to receive the vaccine as soon as possible. A healthcare provider’s recommendation encouraging vaccine has been shown to be one of the most influential components of a parent’s decision making about vaccinating their children. Please continue to encourage routine vaccinations to your patients.
Measles vaccination recommendations include the following:
- Children should receive two doses of MMR vaccine – the first dose at 12 through 15 months of age and the second dose 4 through 6 years of age. Giving the second dose earlier is acceptable as long as it is at least 28 days after the first dose.
- Children 6 through 11 months of age who are traveling internationally should receive one dose of vaccine before departure. Upon return, the child should receive two additional doses of vaccine as above.
- Birth before 1957 is considered acceptable evidence of immunity for adults other than healthcare workers, college and other students, and international travelers, who should receive two appropriately spaced doses.
- Adults born after 1957 who are not in a high risk group described above need one dose.
- People who received two doses of MMR vaccine as children according to the U.S. vaccination schedule do not ever need a booster dose.
Please contact your local health department if you have any questions about this guidance.
M. Norman Oliver, MD, MA
State Health Commissioner