Measles Information for Healthcare Providers

Health Advisory: Measles Alert

Updated April 25, 2025

Situation Overview

For current measles updates, visit the Michigan Measles Dashboard. For other important information, see below.

Immediate Actions Required

1. Suspect & Identify

• Consider measles in patients with febrile rash illness, especially if:
  • Unvaccinated/unknown status OR recent travel to outbreak areas
  • Fever, respiratory symptoms (cough, coryza, conjunctivitis), followed by rash

2. Isolate

• Immediately mask patient with suspected measles; place in private room with door closed
• Airborne precautions; only immune staff with N95 respirators

3. Report to OCDPH Immediately (Do not wait for lab confirmation)

• Business hours: 616-396-5266 (ask for Communicable Disease Nurse)
• After hours/weekends: 616-994-7850 or 800-249-0911 (County Dispatch: ask for a supervisor)

4. Test

• Collect within 72 hours of rash onset: NP/OP swab (PCR) and blood (IgM)
• Whenever possible, collect specimens while patient is present in clinic. For questions about specimen
  submission, consult OCDPH, Infection Prevention, or laboratory facility.
• Do not send a patient with suspected measles to another location for testing without consulting OCDPH or
  Infection Prevention team

5. Limit Spread

• Keep exam rooms vacant 2+ hours after case departs
• Do not send patient to another location for testing without consulting OCDPH or Infection Prevention Team
• Confirmed cases must isolate through 4 days after rash onset

Clinical Information

• Incubation: 7-14 days (range: 7-21 days)
• Infectious period: 4 days before through 4 days after rash onset
• Signs: Fever (often up to >104°F), cough, runny nose, red eyes, Koplik spots (tiny white spots inside mouth),
  maculopapular rash spreading from hairline downward
• Vaccination/prevention:
  • MMR 97% effective with 2 doses
  • Exposed contacts: MMR within 72hrs or immune globulin within 6 days
  • Healthcare workers need documented immunity or 2 MMR doses

Addressing Patient Questions

Healthcare providers may assist patients who are sorting through contradictory health information. Current scientific and medical consensus indicates:

• MMR vaccine does NOT cause autism (extensive research confirms safety)
• “Natural immunity” is NOT safer than vaccination
• Vitamin A supplements may reduce severity but are NOT a substitute for medical care; warn patients about potential toxicity from self-medication
• Homeopathic or “natural” remedies do NOT prevent or treat measles
• Antibiotics do NOT treat measles virus but MAY be needed for secondary bacterial infections
• Measles is NOT a “mild” disease; complications include pneumonia, encephalitis, and death

Testing Information for Healthcare Providers

Things Everyone Needs to Do

1. Before the Patient Arrives

• Screen patients for measles symptoms (fever, rash, 3Cs: cough, coryza, conjunctivitis)
• Check exposure risk: travel history, vaccination status, known contact with measles cases
• Notify staff about potential measles case and ensure only immune staff with N95 masks will interact with patient
• Prepare isolation room: private room with door closed (negative pressure/AIIR if available)
• Have PPE ready: N95 respirators (not surgical masks), gowns, gloves, eye protection
• Assess resources: If staffing or PPE is limited, consider coordinating with health department for assistance

2. Patient Arrival

• Keep patient isolated: Have patient call from vehicle upon arrival; avoid waiting areas
• Mask immediately: Provide surgical mask to patient and accompanying family before entry
• Direct route: Escort directly to prepared isolation room, bypassing other patients
• Protect others: Consider temporary closure of adjacent rooms during specimen collection.

3. Specimen Collection Requirements

• Timing: Collect within 72 hours of rash onset if possible
• Required specimens:
  • Nasopharyngeal or oropharyngeal swab in viral transport medium for PCR
  • Blood/serum specimen for measles IgM antibody testing
• Documentation: Complete MDHHS Test Requisition Form MDHHS-6084 if sending to
  MDHHS state lab
• Labeling: Clearly mark “suspected measles” on all specimens

4. Required Notifications

• Ottawa County Department of Public Health:
  • 616-396-5266 (M-F 8 AM to 5 PM: ask to speak to a CD nurse)
  • 616-994-7850 (after hours: County Dispatch — ask to speak to a supervisor)
• Infection control team at your facility (if applicable)
• Receiving laboratory to ensure proper handling

5. After Patient Departure

• Room management: Keep room vacant for 2+ hours after patient leaves
• Cleaning: Follow facility cleaning protocol for isolation room
• Contact tracing: Record all potential contacts for health department follow-up
• Patient education: Provide home isolation instructions and follow-up guidance

Facility Specific Protocols

Outpatient Facility/Urgent Care — Not Hospital-Affiliated

Specimen Collection Workflow

1. Respiratory specimen:
   • Collect NP/OP swab in isolation room (or vehicle if patient seen outside)
   • Place in viral transport medium
2. Blood specimen:
   • Clinic staff draws blood if capabilities exist
   • Arrange mobile phlebotomy service if available
   • Contact health department for specimen collection support if needed
   • Coordinate with nearby hospital lab for direct admission to isolation room if required
3. Specimen handling:
   • Package according to facility protocol
   • Arrange courier pickup rather than staff transport if possible
   • Store specimens according to laboratory requirements until pickup
4. Patient management:
   • Provide home isolation instructions
   • Coordinate with health department for contact tracing
   • Ensure patient exits through route that avoids other patients

Outpatient Facility/Urgent Care — Hospital-Affiliated

Specimen Collection Workflow

1. Respiratory specimen:
   • Collect NP/OP swab in isolation room (or vehicle if patient seen outside)
   • Place in viral transport medium
2. Blood specimen:
   • Clinic staff draws blood if capabilities exist
   • Utilize affiliated hospital’s mobile phlebotomy service if available
   • Arrange direct admission to hospital lab isolation area if required
3. Specimen handling:
   • Use hospital system’s established laboratory transport processes
   • Follow existing protocols for suspected highly infectious diseases
   • Alert affiliated hospital laboratory before specimens arrive
4. Documentation and follow-up:
   • Document in EMR for hospital system awareness
   • Follow hospital notification protocols
   • Report to health department as required

Emergency Department

Specimen Collection Workflow

1. Patient isolation:
   • Use negative pressure room if available
   • If unavailable, use private room with door closed
2. Specimen collection:
   • Obtain both NP/OP swab and serum during single isolation episode
   • Minimize entries and exits from isolation room
3. Laboratory coordination:
   • ED: Alert hospital laboratory before specimens arrive
   • Lab:
     • Send PCR specimens to MDHHS Bureau of Laboratories if possible (use form MDHHS-6084)
     • Use hospital or commercial laboratories for IgM testing
4. Disposition planning:
   • Maintain airborne precautions if patient requires admission
   • Coordinate with health department for isolation instructions if discharge planned
   • Provide detailed home isolation guidance if discharged

Telehealth (Patient at Home)

Assessment and Coordination

1. Clinical assessment:
   • Document fever, rash pattern, respiratory symptoms via video
   • Determine severity and need for in-person evaluation
2. Health department notification:
   • Immediately contact health department for guidance
   • Provide patient demographics and contact information
3. Specimen collection planning:
   • Coordinate controlled facility visit during low-volume hours with direct entry to isolation if available
   • Request health department home visit for specimen collection if available
   • Ensure patient wears mask and avoids contact with others during any travel
4. Patient instructions:
   • Remain at home until test results are known
   • Separate from household members if possible
   • Wear mask when in shared spaces
   • Coordinate with health department for monitoring and further guidance