Measles Infection

Reviewed on : 8 Mar 2024

Expires : 8 Mar 2026

CWICB Update November 2023

UKHSA (United Kingdom Health Security Agency) and NHSE have recently circulated briefing notes to highlight the concerns of a measles resurgence in England

Measles is highly infectious and remains a dangerous illness with high mortality and morbidity

It can lead to serious health complications, particularly in immunosuppressed individuals and young infants. It is also more severe in pregnancy, and increases the risk of miscarriage, stillbirth, or preterm delivery

Measles exposures in health care settings pose a significant risk of transmission of infection

Confirmed cases have been reported across the UK, within the West Midlands and our locality of Coventry & Warwickshire.

Measles is a notifiable disease to UKHSA. Notifications of infectious diseases (NOIDs) – GOV.UK (www.gov.uk)

Please have a high index of suspicion for measles

If Measles is Suspected

Isolate the patient in a separate room and close the door ideally with a hand hygiene sink. NB: –any patient reporting a rash of unknown origin to reception staff should be triaged immediately and isolated
Only allow known-immune, non-pregnant staff to care for the patient
Take a comprehensive history, including asking the patient if they have had MMR vaccines. Ask about contact with known cases, travel, or attendance at large social e.g., parties, gatherings, festivals etc.
Contact the clinical virology team at UHCW or out of hours Microbiology for further advice and potential actions
If applicable make a list of patient and staff contacts.
Report to the local Health Protection Unit (Tel: 0344 225 3560 Option 2).
See guidance for care of suspected measles cases in the National Infection Prevention & Control Manual PRN00908-national-infection-prevention-and-control-manual-for-england-v2.7.pdf
Once the patient has left the clinical room (including any other areas of the surgery used by the patient e.g., waiting room, toilet etc) ensure the area has a terminal/deep clean e.g., 2 step clean with detergent followed by 1,000ppm of available chlorine

Typical Measles Presentation

Those most at risk are unvaccinated individuals, or those that have received only one dose of measles containing vaccine
Risk factors include travel, specific unvaccinated communities and those who have been exposed to a case of measles
Before the rash appears, there is typically prodromal phase of high fever, conjunctivitis, coryza and cough
Characteristic Koplik spots (clustered, white lesions on the buccal mucosa, opposite the lower 1st & 2nd molars)
A red blotchy rash appears after 3-7 days, starting on the face, becoming generalized and lasting for 4-7 days.
The infectious period is from just before the prodrome starts to 4 days after onset of rash

Advice for Staff (taken from NHSE correspondence)

Unvaccinated Healthcare Workers (HCWs) also pose a serious infection risk to vulnerable patients in whom measles infection can have life-threatening consequences

In addition to the risk to individuals, outbreak management in health care settings is resource intensive, including implications for service delivery as non-immune HCWs who are exposed to measles infection must be excluded from the workplace to protect patients and colleagues (incubation period 7-21 days)

All HCWs (including receptionists, phlebotomists etc.) should have satisfactory evidence of protection against measles to protect both themselves and their patients. Satisfactory evidence of protection includes documentation of having received two or more doses of a measles containing vaccine and/or a positive measles IgG antibody test