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For primary care settings, refer to Community HealthPathways.

Community HealthPathways (external link)

About measles

Measles is a serious and highly infectious vaccine-preventable viral illness. One person with measles can infect up to 18 susceptible (non-immune) individuals.

Complications from measles are common. In the 2019/2020 Aotearoa New Zealand measles outbreak, 1 in 3 cases required admission to hospital, with higher admission rates for children under 5 years, and Māori and Pacific peoples. Recovered cases experience immune amnesia and are at risk of developing other infectious illnesses for several years.

Measles symptoms

Early symptoms of measles include fever, cough, coryza and conjunctivitis. Koplik spots may also be visible. A rash develops a few days after the other symptoms and starts on the face before spreading to the rest of the body.

To meet the case definition fever must be present at rash onset.

Case definition — Measles, Communicable Disease Control Manual (external link)

Images of measles — Dermnet (external link)

Clinicians should be aware that immunosuppressed people and previously vaccinated people may not present with typical symptoms.

Preparing your facility

There is always the possibility that a person with measles may present at your healthcare setting. Preparing your facility for this possibility will help limit the spread of the virus.

  • Place appropriate signage at entrance to facility advising people of actions to take if they have symptoms of measles. A poster is available to download from HealthEd for use in healthcare setting entrances, when required.
    Measles is here — Could you have it? — HealthEd (external link)
  • Have alcohol-based hand sanitiser and medical masks available at waiting room entrances and/or reception desks.
  • Provide instructions for symptomatic patients who phone ahead to wear a medical mask and notify reception of measles risk immediately on arrival, so they can be promptly isolated.
  • Ask emergency services transporting suspected measles cases to call ahead to the receiving facility so that appropriate infection prevention and control (IPC) measures will be in place. Provide instructions on where to enter facility, masking and immediate isolation.

Isolate suspected and confirmed cases

  • Suspected or confirmed measles cases (including patients who develop measles-like symptoms during their admission) in healthcare settings should be immediately masked and placed in an airborne infection isolation room with the door closed.
  • Ensure all staff who enter the room are immune to measles and wearing a seal checked N95/P2 mask. Staff should follow standard and airborne precautions.
    Standard and airborne precautions
  • Once the patient has exited the room, it should be left vacant with the door closed for up to 2 hours or a timeframe based on risk assessment and directed by the local IPC team based on air handling. Refer to CDC air changes per hour and removal of airborne contaminants for guidance. The room should then be cleaned with a suitable disinfectant. Cleaning staff should be immune to measles and wear airborne PPE during this process.
    Appendix B. Air — CDC Infection Control (external link)

Notify public health

Notify all suspected cases to your local medical officer of health (MOoH) and infection prevention and control team as soon as possible. Do not wait for test results. For local notification processes see contacts for public health services.

Contact public health services

Advise the MOoH if the there is a high index of suspicion for measles. This will enable public health services to do a rapid risk assessment to determine if immediate public health action is required to prevent an outbreak.

A high index of suspicion for measles is for someone who:

Test all suspected measles cases

  • Test all suspected cases of measles using a nasopharyngeal or throat swab for PCR.
    • Discuss with the on-call clinical microbiologist if you are unsure how to take samples safely or need advice on testing.
    • Do not request serology for diagnosis of measles unless specifically advised by the MOoH or clinical microbiologist.
  • Mark samples as urgent and include relevant clinical details, travel history, date of rash onset and measles vaccination history if known on the laboratory request form.

Treat measles cases

Advice for suspected cases (if discharged/sent home)

  • For suspected cases of measles who are discharged/sent home from the hospital or healthcare setting, ensure that public health services have been notified/made aware of the case. For local notification processes see contacts for public health services.
    Contact public health services
  • Until their PCR test results are available, suspected cases should be advised to:
    • isolate at home — this includes not having any visitors to the household
    • stay away from family or other household members who have not had 2 measles vaccines (information on how to check for measles immunity is available on Health NZ) — if this is not possible, they should wear a disposable mask that covers the face and nose.
      How to check for measles immunity (external link)
    • ensure that any household members quarantine (stay at home) if they are not known to be immune to measles, until they are advised by the public health service team on next steps, or until the suspected case’s swab result is negative. If they develop symptoms, they should contact Healthline on 0800 611 116 for advice.
  • Inform suspected cases they will receive a phone call from the public health service team if their swab tests positive for measles.
  • Provide suspected cases and/or caregivers with the measles information sheet.
    Measles information sheet — HealthEd (external link)

Contact tracing and management of close contacts in hospital settings

Contact tracing

Contact tracing
  • Inform local public health service, IPC and occupational health teams immediately if a person with measles was present in the hospital setting without appropriate isolation and contact tracing is required.
  • Public health services will liaise with IPC and occupational health teams to confirm the contact tracing scope and agree roles and responsibilities for contact tracing of staff and patients and whānau or caregivers who accompanied the patient in the setting. In general, the public health service will manage visitors and accompanying whanau/caregivers.
  • Contact tracing response is time critical and may require escalation to a hospital outbreak response or incident management team to manage many contacts. This plan should be documented.
  • Guidance on identifying close contacts is available in the contact management section of the CD Manual.
    Contact management — Measles, Communicable Disease Manual

Management of hospital in-patients who are close contacts

Management of hospital in-patients who are close contacts
  • Determine the immune status of the contact. Serology testing is recommended for contacts who have received one MMR, or where immune status is unknown or cannot be confirmed.
  • Offer MMR to unvaccinated or partially vaccinated contacts if within 72 hours of exposure.
  • Determine if the close contact is eligible to receive post exposure immunoglobulin (refer to post-exposure prophylaxis section of CD manual for guidance). Liaise with public health services as required.
    Post-exposure prophylaxis — Measles, Communicable Disease Manual
  • Non-immune or partially vaccinated contacts should be cared for in airborne precautions for the full incubation period for measles as follows:
    • If no immunoglobulin was administered: from day 7 after first exposure to the case until the end of day 21 after last exposure to the case.
    • If immunoglobulin was administered within 6 days of exposure: from day 7 after first exposure until the end of day 25 after last exposure to the case.
  • Guidance on managing close contacts is available in the contact management section of the CD Manual.
    Contact management — Measles, Communicable Disease Manual

Management of healthcare workers who are close contacts

Management of healthcare workers who are close contacts

Healthcare workers include all workers regardless of their employment status such as administrative staff, cleaners, doctors, nurses, students, contractors and volunteers. These workers have contact (not necessarily physical) through their roles that could allow the acquisition or transmission of measles via respiratory spread.

Close contact management differs according to the immune status of the healthcare worker contact. Refer to Table 1: Healthcare worker immunity assessment and close contact management and the contact management section of the CD Manual for more detail.

  • Determine the immune status of the healthcare worker contact. Evidence of immune status may be obtained for healthcare workers via:
  • Serology testing is recommended for healthcare worker contacts who have received one MMR, or where immune status is unknown or cannot be confirmed. Healthcare worker contacts should be managed as non-immune while awaiting evidence of immunity to measles; this includes non-immune healthcare worker contacts who have received MMR vaccine as post-exposure prophylaxis.
  • Offer MMR to unvaccinated or partially vaccinated healthcare worker contacts if within 72 hours of exposure. Note that receipt of post-exposure MMR vaccine will not change quarantine or restriction requirements for healthcare worker contacts.
    • Non-immune healthcare worker contacts may be excluded from work beyond their quarantine period. This is due to the vulnerability of patients in healthcare environments, and the impact of a measles outbreak on health services.
    • Contacts should not be referred for MMR vaccination during their quarantine or restriction period, as this would put others at risk of exposure to measles. 
  • Determine if the healthcare worker contact is eligible to receive post exposure immunoglobulin (refer to post-exposure prophylaxis section of CD manual for guidance). Liaise with public health services as required.
    Post-exposure prophylaxis — Measles, Communicable Disease Manual
  • Note: Healthcare workers with known or potential immunosuppression or who are pregnant need to be individually assessed and a plan put in place to minimise risk.

Table 1: Healthcare worker immunity assessment and close contact management

Immune  
Definition Management

Any of the following:

  • born or living in NZ before 1 January 1969
  • 2 documented doses of measles-containing vaccine (for example, MMR), given at least 4 weeks apart after 12 months of age, and at least 4 weeks prior to exposure to a measles case
  • serology results confirming they are immune (positive IgG)
  • evidence of a previous measles infection confirmed through PCR testing.

Quarantine: not required.

Work exclusions: not required.

Monitor: for symptoms for 21 days after last exposure. 

  • If symptoms develop, stay home and seek advice from occupational health/IPC or public health services — call ahead before attending any healthcare services.
Susceptible - partially vaccinated
Definition Management

Does not meet the definition of an immune contact and

  • has one documented dose of a measles-containing vaccine given after 12 months of age, and at least 4 weeks prior to exposure to a measles case.

Serology testing is recommended to confirm immune status. Contact should then be managed as immune or susceptible-non-immune according to their serology result. 

In the absence of serology results, the following management is recommended:

Quarantine: not required.

Restrictions: exclude from visiting high risk settings (including healthcare facilities) and avoid contact with people at higher risk of severe illness from day 7 after first exposure to day 14 after last exposure.

High risk settings

Work exclusions: exclude from working in a healthcare facility as early as 5 days after first exposure until 21 days after last exposure (7 days after the end of restrictions).

Monitor: for symptoms for 21 days after last exposure.

  • If symptoms develop, stay home and seek advice from occupational health/IPC team or public health services. Call ahead before attending any healthcare services.
Susceptible - non-immune  
Definition Management

Does not meet the definition for immune or partially vaccinated contacts and:

  • has not received any measles containing vaccine (for example, MMR)
  • has received one or more measles vaccines, before 12 months of age or less than 4 weeks prior to exposure to a measles case
  • serology results are negative or equivocal
  • unsure or unable to provide evidence of previous measles vaccinations.

Quarantine: from day 7 after first exposure to day 14 after last exposure.

Work exclusions: exclude from working in a healthcare facility as early as 5 days after first exposure until 21 days after last exposure (7 days after the end of quarantine).

Monitor: for symptoms for 21 days after last exposure.

  • If symptoms develop, stay home and seek advice from occupational health/IPC team or public health services. Call ahead before attending any healthcare services.

General immunisation advice

For healthcare worker measles immunisation advise, contact you occupational health team.

For public immunisation advice:

Resources for health professionals

Health NZ has developed printable and shareable resources for primary care, after-hours clinics and emergency departments, businesses and community groups. These include an information sheet, posters, and social media tiles. These are available from HealthEd. 

Measles — HealthEd (external link)

Translated versions of these resources are under development and will be available soon.

Feedback

For feedback or updates to this page contact ipc@tewhatuora.govt.nz or protection.clinical@tewhatuora.govt.nz