🚨 URGENT HEALTH ALERT: Measles Exposure in Maricopa County

MARICOPA & PIMA COUNTY HEALTH ALERT NOTICE

Public Health Measles Health Alert for Physicians & Healthcare Clinicians

🏢 Public Exposure Locations

MCDPH has identified 2 public locations where people may have been exposed to measles. Individuals who were at the following locations at the listed dates and times may have been exposed and should watch for symptoms for the 21 days following their exposure:

🩺 Recommendations for Maricopa County Healthcare Providers

1. Consider measles in the differential of individuals who present with fever and a rash. Adults who received only 1 MMR vaccine as a child are considered fully vaccinated but may have waning immunity, and measles should not be excluded.
2. Minimize exposures of patients and staff by utilizing the infection control guidance below. Signage and masks should be posted at the entrance to encourage prompt masking and isolation of
   

  3. Make sure that all patients and clinical staff are adequately vaccinated.

  4. Immediately report suspect cases of measles to Maricopa County Department of Public Health by

🔬 Measles Laboratory Testing

For suspect measles cases, call

to coordinate with MCDPH for confirmatory testing through Arizona State Public Health Laboratory (ASPHL).

Specimen Collection

Collect the following two specimens for polymerase chain reaction (PCR) testing through ASPHL:

• Urine collection
• Nasopharyngeal swab

⏰ Optimal Testing Window

Detection of measles RNA is most successful when specimens are collected on the first day of rash through the 3 days following onset of rash. Detection of measles RNA by rRT–PCR may be successful as late as 10-14 days after rash onset.

🩹 Clinical Presentation of Measles

Measles typically presents in adults and children as an acute viral illness characterized by a prodrome with high fever (>101 °F), cough, coryza, and conjunctivitis followed several days later by a generalized maculopapular rash.

Rash Characteristics

• Usually starts on the face (starting at the hairline)
• Proceeds down the body and may include the palms and soles
• Appears discrete but may become confluent
• Lasts several days
• Fades in the same order that it appears
• Koplik spots are occasionally seen
• 
  

Symptom Timeline

Signs and symptoms typically appear 7 to 21 days after exposure. Symptoms may be mild, absent, or atypical in persons who had some degree of immunity to measles virus before infection (e.g., in previously vaccinated persons who had waning immunity or children aged > 1 year who passively acquired maternal antibodies).

🦠 Transmission

Measles is highly contagious. Approximately 90% of persons lacking immunity who are exposed to measles virus will develop the disease.

How Measles Spreads

• Transmitted by airborne particles or direct contact with respiratory secretions of an infected person
• Can live for up to 2 hours in an airspace where an infected person has coughed or sneezed
• Individuals with measles are infectious from 4 days before rash onset through 4 days after rash onset (9 days total)
• A person with measles can spread the virus to others before symptoms begin

🏥 Infection Control at Health Care Facilities

The following steps are recommended to prevent measles transmission in health care facilities:

Facility Preparation

• Signage and masks should be posted at all entrances to encourage prompt masking and isolation of symptomatic individuals.

• Do not allow suspect measles patients to remain in the waiting area or other common areas

Patient Isolation

• Immediately isolate them in an airborne isolation, negative pressure room – if available – otherwise, utilize a private room with a closed door
• If a potential measles patient is evaluated in a room that is not a negative pressure room, do not use that room for the next 2 hours
• Immediately place a surgical mask on the patient

Arrival Procedures

• When possible, ask the suspect measles patient or their guardian to call the facility when they arrive outside, so staff can meet them before they enter the facility
• When possible, have the suspect measles patient use an alternative entrance into the facility, like a back door, that will minimize exposure to other patients

💉 Evidence of Immunity for Healthcare Providers

✅ Ensure Your Healthcare Staff is Fully Immunized

Review immunity to measles for all healthcare workers, including ancillary staff such as office staff, dietary staff, housekeeping, maintenance, etc. – anyone that shares airspace in your facility with a patient.