Reduce Measles Exposure in Outpatient Facilities: Here's How

Veronica Hackethal, MD

September 13, 2019

Researchers with the Centers for Disease Control and Prevention (CDC) and the New York City Department of Health and Mental Hygiene have outlined strategies to decrease measles exposure in New York City outpatient facilities that lack negative-pressure isolation rooms.

The article was published online yesterday in the Morbidity and Mortality Weekly Report.

Measles, a highly contagious airborne virus, was declared eliminated in the US in 2000. Since then, the infection has made a comeback, largely through cases brought into the United States by international travelers and failure to vaccinate children. NYC has experienced the largest outbreak in the US since 1992, with 654 confirmed cases as of September 3.

To prevent transmission within healthcare facilities, patients with measles are usually isolated in negative pressure rooms. But not all facilities have these specialized rooms.

Therefore, researchers surveyed infection control staff at 17 outpatient facilities in NYC to learn how clinics lacking negative pressure rooms were preventing spread. They included facilities that had at least one verified or suspected case of measles between September 30 and December 10 of last year. These facilities included seven group practices, four single-provider practices, four federally qualified health centers, and two urgent care clinics.

Among contacted facilities, 15 participated in the study. Infection control procedures at these facilities included posting signs about measles symptoms and screening patients for fever or rash (all 15); telephone screening when scheduling appointments (13); screening at check-in (12); and screening during scheduling and check-in (10).

In addition, 14 facilities examined patients with possible measles in a separate room, and made that room off-limits for 2 hours after the examination.

Thirteen facilities used other methods to isolate patients with possible measles, including examining patients outdoors (10 facilities); using separate entrances or examination spaces for patients with suspected measles (6); evaluating patients after normal business hours (4), and visiting patients at home (4).

The authors acknowledge they did not evaluate the effectiveness of these strategies. Rather, their intent was to share methods currently in use for decreasing measles exposure in healthcare facilities that lack negative-pressure isolation rooms.

"The essential common element in the implemented strategies is early awareness that a patient might have measles, optimally before that patient enters the health care facility," write author Karen Alroy, DVM, from the Epidemic Intelligence Service, CDC, and the New York City Department of Health and Mental Hygiene, and colleagues.

"This underscores the importance of maintaining a high index of suspicion during an outbreak, performing measles screening, and rapidly identifying patients with suspected measles," they conclude.

The authors have disclosed no relevant financial relationships.

MMWR. Published online September 12, 2019. Full text

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