May 3, 2009

Charlotte Carneiro RN,MS,COHN-S,CIC 

Occupational Health Nurses should be alert to workers who have either been exposed to or are actively ill with measles.  As of April 22, 2009 at least six cases had been reported in the region. These cases, reported by the region's health departments, show that unimmunized children and adults are vulnerable to the disease and can transmit the virus four days prior to and four days after the appearance of the rash. The virus is transmitted by droplet from person to person and can live on surfaces for at least two hours. Transmission occurs in and has been recently attributed to emergency rooms and physician offices exposures. Early identification is critical in infectious disease containment and control. Therefore, it may be well to post signs in the occupational health clinics/units asking workers when presenting for care, "If you have been exposed to measles, please put on a surgical mask and advise the clinic staff."

Measles vaccine has been a part of U.S .public health immunization programs since 1963. Measles was declared eliminated in the U.S .in 2000.  However, a mean number of 62 cases per year from 2000-2007 have been reported. This number nearly doubled in 2008 as reported by the Centers for Disease Control and Prevention. A most notable cluster of 11 cases was reported in San Diego, California Jan-February 2008. My professional experience with measles is that in 1989, a cluster of children with measles presented to Childrens Hospital National Medical Center in Washington, D.C., when I worked there in infection control. The rash was remarkable for the confluence of the macular rash without pustules. Some children had Koplik spots , small bluish-white nodules in the inside cheeks of the mouth, but many did not have these. The children also were quite sick and miserable with conjunctivitis and runny noses.  

Many practitioners have not seen a measles rash and it can be confused with medicinal and allergic dermatitis.  CDC has some photographs of the measles rash but www.dermnet.com has one good measles photograph that can be enlarged for better magnification.

Hand hygiene and using tissues to contain secretions remain important infection control practices.  Wiping surfaces with a phenol compound such as Lysol or hospital grade disinfectant available in the clinical setting help to reduce the spread of the virus after a patient has been in the room.  Using paper sheeting, and gowns minimizes the need to launder sheets.  Plastic beds and pillows, and exam tables can be wiped down with the phenol wipes. Droplets fall to the floor so airing out a room may be unnecessary. A practical suggestion may be to leave the room empty of other patients until it has been terminally cleaned. Stethoscopes, BP devices, otoscopes and other screening equipment should be wiped down according to the clinic procedures.

For more information for local D.C. area individuals D.C. Department of Health:  http://newsroom.dc.gov/show.aspx/agency/doh/section/2/release/16804

General measles information from the D.C. Department of Health:  http://dchealth.dc.gov/doh/cwp/view,A,1370,Q,604285.asp

CDC Measles webpage:  http://www.cdc.gov/ncidod/Diseases/submenus/sub_measles.htm