New cases of measles (rubeola) continue to make national headlines. In 2018 and into 2019, hundreds of cases were reported to the Centers for Disease Control and Prevention (CDC). Outbreaks occurred in many states, including Arizona, California, Colorado, Connecticut, Florida, Georgia, Illinois, Indiana, Kentucky, Maryland, Massachusetts, Michigan, Missouri, Nevada, New Hampshire, New Jersey, New York, Oregon, Texas, and Washington.1
The largest outbreaks occurred in Rockland County, New York, and New York City. Most of these cases resulted from the exposure of unvaccinated individuals. In 2018, 82 individuals brought measles into the United States when traveling here from other countries—the greatest number of imported cases for any year since the disease was declared to have been eliminated from the United States, according to the CDC.1
As more measles cases are diagnosed in 2019, physicians should implement effective screening protocols, infection control techniques, and patient education to reduce liability risks and promote patient safety.
Measles outbreaks most often occur in the United States when an unvaccinated traveler gets the disease while traveling in other countries and then spreads it to individuals who have not been vaccinated.2 In addition, the anti-vaccine movement has contributed to the recent spread of measles by creating pockets of unvaccinated people. Washington State and Oregon allow parents to opt out of vaccinations for their children, resulting in “hot spots” within those states. Given the disease was essentially eliminated from the United States, some physicians may not be familiar with the clinical manifestation of the disease and may not consider measles as a potential diagnosis. Since initial presenting symptoms of measles are similar to those of upper respiratory infections, measles may be misdiagnosed before a patient presents with the familiar red rash.
Exposure to measles in a medical office or facility is a serious patient safety issue because of the potential for complications from the disease, including death. The disease is airborne and extremely contagious; 90 percent of unimmunized individuals who are exposed to the disease could be infected.3 An infected individual is considered contagious from four days before to four days after the rash appears. The rash usually appears 14 days after a person is exposed; however, the incubation period ranges from 7 to 21 days.4 To protect staff and patients, medical offices should establish screening protocols that limit exposure risk from infected individuals.
Unlike hospitals, most medical offices are not equipped with negative pressure isolation units that offer better protection from airborne diseases. Your practice, however, can reduce liability risks and promote patient safety by:
Physicians who are not familiar with diagnosing measles should obtain additional training. It is essential to be knowledgeable about signs and symptoms, potential complications, diagnostic testing, and infection control recommendations from the CDC.
Follow these tips if you or your staff suspects a patient has measles symptoms:
The guidelines suggested here are not rules, do not constitute legal advice, and do not ensure a successful outcome. The ultimate decision regarding the appropriateness of any treatment must be made by each healthcare provider considering the circumstances of the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered.