Guidance on measles for the summer travel season

Actions requested

• Ensure all patients without evidence of measles immunity, especially those planning international travel, are up to date on MMR vaccine and other recommended vaccines before their international travel.
• Assess immunization status of patients at every visit and strongly recommend vaccination based on recommended schedule, and other risk factors.
• Under-vaccinated individuals may be at risk for measles infection due to outbreaks that occur in the U.S. or anywhere else in the world.   
• CDC recommends that all U.S. residents older than age 6 months who will travel internationally, without evidence of immunity, receive MMR vaccine prior to departure. Travelers should be fully vaccinated according to age at least 2 weeks before departure.
• Be vigilant in clinical settings for possible measles cases. Consider measles infection in patients with recent international travel, especially in countries with ongoing outbreaks (e.g., India, Somalia, and Yemen) or suspected measles exposure and compatible symptoms, including:
• Prodrome of fever, cough, coryza and conjunctivitis for 2-4 days
• Generalized maculopapular rash that usually begins on the face at the hairline and then spreads to the neck, trunk, and extremities
• Koplik spots may appear on buccal mucosa 1-2 days prior to rash
• Be prepared for the possibility of patients with measles at your facility:
• Suspected patients should wear a mask covering the nose and mouth
• In urgent/emergency healthcare settings:
• Suspected patients should be triaged immediately away from waiting rooms
• Room patient in airborne isolation if available
• In outpatient clinic settings:
• Schedule suspected patients to be seen at end of day, if possible, and keep them out of waiting rooms
• Use standard and airborne infection control precautions
• Only staff with documented immunity to measles should enter patient's room.
• After patient is discharged, do not use or have staff enter the room for 2 hours.
• Collect specimens on patients with suspected measles for diagnostic testing:
• For PCR and virus isolation:
• Nasopharyngeal swab placed in viral transport media (VTM)
• Urine, minimum 20mL, in sterile leak proof container
• For measles IgM serology:
• Serum, minimum 1mL, in red top or red-grey top tube
• Route specimens through Public Health to expedite testing (do not use commercial laboratory).