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
Present
Symptoms
Present
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:
- Fever > 101°F + Rash*
- Fever > 101°F + Persistent† + Bilateral conjunctivitis (injection of sclera/white portion of eye)
- 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:
- Young infants in young infants with partial immunity due to maternal immunity
- Immunocompromised patients
- Definition of Active Community Transmission of Measles:
- Measles is being spread locally without a clear epidemiologic link to a known case.