Measles Exposure throughout a University Hospital Medical Center

ISSUE: With universal childhood measles immunization, measles virus infections are very rare in the United States and are due to importation from other countries. Due to the unfamiliarity of frontline clinicians with the clinical presentation of measles, the identification of the disease may be challenging and lead to delays in the institution of isolation precautions. We highlight the impact of exposure to a case of measles at a tertiary care facility.

PROJECT: Within 5 days of returning from China, a 24 year old Caucasian male developed a fever and was evaluated in a medical clinic. Two days later he developed a rash, pharyngitis and cough and was referred to the Infectious Disease clinic. A diagnostic evaluation was begun; however, the patient's symptoms worsened prompting evaluation in the Emergency Department. At this time the patient was admitted to acute care and while the diagnosis of measles was considered, the patient was placed on droplet instead of airborne precautions. This was corrected when Infection Control became aware of the situation. The diagnosis of measles was confirmed by serology and investigation revealed an incomplete vaccination history. Infection Control staff met to assess the situation and identify exposures to staff and patients.

RESULTS: Isolation precautions were nonexistent or improper in 6 clinical areas. A total of 65 employees were exposed to the patient, 15 of whom were placed on provisional furlough until a measles IgG was obtained; 12 of these employees were subsequently seropositive and returned to duty. The remaining 3 were seronegative and furloughed from days 5 through 21 post exposure and were offered vaccination. There were 154 patients exposed mainly from waiting areas. Of these, 104 were contacted by phone. The remaining 50 were unreachable. Measles information was sent to the medical center faculty while the state health department sent information to the surrounding counties. No secondary cases of measles occurred.

LESSONS LEARNED: Measles is not endemic to the United States and presentations of symptoms are not readily recognized. Identified areas of concern include: education of clinic and hospital staff regarding presentation of patients with fever and rash having recent travel outside of the United States; initiation of appropriate isolation precautions; a multi-bed exam room in the Emergency Department utilized for patients with fever and rash; and assurance of all employees' immune status against measles.