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Measles Briefing

Measles Briefing. June 5, 2019. Welcome and Thank You. * Please mute your lines. Roll Call for Hospitals BS MRMC BS Richmond Community BS St. Francis BS St. Mary’s Centra Southside CJW – Chipp CJW – JW HDH – Parham HDH- Forest John Randolph Retreat Sentara Halifax (S. Boston)

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Measles Briefing

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  1. Measles Briefing June 5, 2019

  2. Welcome and Thank You * Please mute your lines • Roll Call for Hospitals • BS MRMC • BS Richmond Community • BS St. Francis • BS St. Mary’s • Centra Southside • CJW – Chipp • CJW – JW • HDH – Parham • HDH- Forest • John Randolph • Retreat • Sentara Halifax (S. Boston) • Southern Virginia Regional Medical Center (Emporia) • Southside Regional Medical Center • VCU Health • VCU Community Memorial • The VA

  3. Purpose: • Overview of Measles • Current Outbreak Status • Clinical Care Guidance • Healthcare Provider Risks • Environmental Care • Recommended PPE • Discussion of regional signage

  4. Briefing Angela Myrick-West, MPH, CIC Virginia Department of Health Central Region Epidemiologist

  5. Measles CVHCC, June 5, 2019, Conference Call

  6. Clinical Picture • Incubation: Illness presents 7–21 days (average 10–12 days) after exposure • Prodromal Phase: lasts 1–7 days (average 2–4 days) • high fever (103°F–105°F) • 3 Cs: conjunctivitis, cough, coryza • malaise, and anorexia • Koplik spots (1–3 mm whitish/bluish lesions on an erythematous base) may be visible on the buccal mucosa 1–2 days before rash onset to 1–2 days after (but are not always present) • Rash: An initially blanching, erythematous maculopapular rash usually first appears at the hairline and/or face and then spreads to the trunk and extremities • initial lesions are generally discrete but may become confluent. • rash lasts 4–7 days and may darken and finely desquamate • fades in the same order that it appeared. • Contagious Period: 4 days before to 4 days after rash appears

  7. Clinical Picture https://www.medscape.com/viewarticle/828508?src=par_cdc_stm_mscpedt&faf=1#vp_1

  8. National Picture

  9. Virginia • We have not had any confirmed cases of measles this year… • In Central Region, we experienced a measles outbreak in 2010 with 4 cases. ¾ were unvaccinated and 1 was an exposed HCW • VDH has investigated several imported cases of measles • Overall, due to a lack of philosophical exemption, MMR rates are high • Consider pockets of unvaccinated though who are not captured through public school records—children < 5, home schooled, medically fragile, Amish, communes

  10. Healthcare: Presentation & Specimens • Triage quickly: place a mask on the patient (and any accompanying family) • Use standard and airborne precautions. • HCW should use an N95 mask or equivalent • Isolation--The preferred placement for patients who require airborne precautions is in a single-patient airborne infection isolation room (AIIR). • Notify infection Control and your local health department asap. Call the District Epidemiologist, or if after normal business hours call 866-531-3068 • Coordinate with the local health department to collect specimens for confirmatory testing (np swab in VTM, op swab in VTM, serum, urine)

  11. Healthcare: Cleaning • Short survival time. Virus remains viable for up to 2 hours in the air or on objects/surfaces. Close any room for at least 2 hours and then clean • Hand washing and ABHS • Measles virus is rapidly inactivated by heat, sunlight, acidic pH, ether, and trypsin • Disinfectants (enveloped virus) • follow manufacturer recommendations • Ensure appropriate kill time • If utilizing wipes, ensure an adequate # of wipes for the surface area

  12. Ensuring vaccinated/immune workforce • Employee Health and Exposure Management • Contract employees? • All HCW should have evidence of immunity, regardless of age. • If a HCW without evidence of immunity is exposed to measles, MMR vaccine should be given within 72 hours, or IG should be given within 6 days when available. Exclude healthcare personnel without evidence of immunity from duty • Do not administer MMR vaccine and IG simultaneously, as this practice invalidates the vaccine. • HCW receiving PEP will STILL be furloughed from day 5 after first exposure to day 21 after last exposure, regardless of post-exposure vaccine. • https://www.cdc.gov/measles/hcp/index.html • http://www.cdc.gov/vaccines/adults/rec-vac/hcw.html

  13. Healthcare: Other Considerations • EMS Exposures? • If exposure occurs in your facility, how will notifications be handled? • IG Clinics?

  14. Signage for preventing spread Johns Hopkins example

  15. Signage for visitor restrictions: Example from measles outbreak in Clark County, Washington Difficult to enforce

  16. Discussion of Regional Signage • Historically Provided during Influenza 2016 • Created collaboratively • VDH funded / CVHC Distributed • All major health system logos present • Requested for Measles • Recommended by CVHC and VDH per CDC Guidance

  17. Resources • www.Central-region.org • RESOURCES Page • Click “Measles” • Here you will find this presentation, CDC website links/ guidance, workforce education, contacts for VDH should you have a suspected case

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