Suspected Measles Exposure or Infection Clinical Pathway — ED, Outpatient Specialty and Primary Care

Clinical-Decision Making for Measles Testing

Patient Presenting for Possible Testing
 
 
 
 
Exposed
No Known Exposure
 
 
 
 
 
 
Isolate Immediately
No Active Community Transmission
Active Community Transmission*
 
 
 
 
 
 
 
 
 
 
 
 
No Symptoms
Symptoms
Present
Symptoms
Present
No Symptoms
Symptoms Present
No Symptoms
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  • Call 5-SAFE
  • Measles unlikely
  • No testing
  • Call 5-SAFE
  • Measles testing recommended
  • Measles unlikely
  • No Testing
  • Recommended
Non-immune
  • 1 MMR, given at least 2-3 wks prior to presentation
2 MMRs
 
 
 
 
 
 
  • Call 5-SAFE
  • Strongly consider measles testing
  • Measles unlikely
  • If very high suspicion, may call 5-SAFE
    to discuss
  • Measles unlikely
  • No testing recommended
  • Symptoms Compatible with Measles
  • Presence of any of the following:
    1. Fever > 101°F + Rash*
    2. Fever > 101°F + Persistent + Bilateral conjunctivitis (injection of sclera/white portion of eye)
    3. Rash* + Cough/Rhinorrhea/Conjunctivitis
  • *Rash with onset in the past 4 days on the face/torso.
    Not rash limited to only extremities or only diaper area, not rash
    that is only petechiae.
  • Persistent meaning symptoms should remain present.
    If conjunctivitis has resolved on exam, this does not meet criteria.
  • Measles rash may appear less typical in:
    1. Young infants in young infants with partial immunity due to maternal immunity
    2. Immunocompromised patients
  • Definition of Active Community Transmission of Measles:
    • Measles is being spread locally without a clear epidemiologic link to a known case.