Measles
Measles is highly infectious & can be severe in immunosuppressed patients and young infants. Measles in pregnancy increases the risk of miscarriage, stillbirth, or preterm delivery.
The incubation period is typically around 10 to 12 days but can vary from 7 to 21 days. Patients are infectious four days before & after the onset of rash. R rate for measles is 15-20 (15 to 20 individuals infected from a single case in a totally susceptible population).
All staff working in primary care should have two documented MMR vaccinations or be IgG positive for measles. Staff who do not have immunity/ pregnant/ immunocompromised should not be involved in the assessment or management of patients with suspected measles.All children presenting to primary care with fever and coryzal symptoms should be triaged before being seen f2f. They should not be waiting in reception areas. Please do have hot and cold pathways if practically feasible within your surgeries. If this is not possible, children should be triaged and seen with minimal waiting times within the surgery. Think about seeing the patient at the end of a session in a designated room where fallow time and cleaning can be undertaken.
Ask about, and look for symptoms of measles:
- Fever of 39ºC or more without taking paracetamol or ibuprofen, a rash which goes away with pressure and at least one of the following: cough, runny nose, and conjunctivitis.
- A measles-like rash - red spots non-itchy, sometimes raised and joined together to form blotchy patches. The rash starts three to four days after the initial symptoms behind the ears, then the face, trunk of body and limbs.
- Small white spots inside the cheeks and on the inner part of the lips – Koplik spots.
Think about differential diagnosis -
Scarlet fever/streptococcal infection,
Kawasaki disease,
early meningococcal disease,
parvovirus B19,
rubella,
infectious mononucleosis (glandular fever),
herpes virus type 6 (roseola infantum) and safety net the patients appropriately.
Wear appropriate personal protective equipment (PPE). FFP3 is recommended by NHSE. FFP3 Fit testing has been arranged through mutual aid at various acute providers in NWL. Please see below for further details.
Seek immediate advice from secondary care services if the patient has a measles-like rash and is in one of the following high-risk groups:
- Younger than one year of age
- Immunocompromised (regardless of immunisation status)
- Pregnant
Immediately notify the local
Health Protection Team (HPT): They will advise on public health measures including contact tracing and surveillance testing.
The HPT will also advise on post-exposure prophylaxis. Healthy immunised patients deemed as low risk will need warn and inform letter from the surgery or A&E.
Post exposure prophylaxis is recommended for immunocompromised, younger than one year of age and pregnant patients.
For immunocompromised patients, HPT will arrange administration of intravenous immunoglobulin through secondary care.
For pregnant women and infants under nine months of age, HNIG (Human Normal Immunoglobulin) is recommended. HPT will liaise obstetric team for pregnant patients & local paediatric team for infants under nine months. Infants between 6-9 months of age who did not have a household exposure and infants over nine months, will need MMR (to be done at the surgery).
Patients with measles need to exclude themselves from nursery/educational settings and work until four days after the onset of rash. Please do safety net patients regarding complications – Pneumonia, otitis media, diarrhoea, encephalitis (rare), subacute sclerosing panencephalitis and other secondary bacterial infections.
Unimmunised household contacts might be advised to exclude themselves from school/work settings up to 20 days’ post exposure. Local public health teams and HPT will advise the patients themselves.
Please continue to invite unvaccinated children and adults for their MMR vaccination.
Additional information and links:1.
Timeline of the symptoms 2.
National measles guidelines 3.
Measles guidance for primary, community care, emergency departments and hospital 4. PPE: Refer to the
National infection prevention and control manual (NIPCM) sections 1.4, 2.4 and appendices 5b and 6 for further information of the use of PPE.
NHS England’s Infection Prevention and Control guidance on PPE is available online.5. Please note details of the trusts who are able to help with FFP3 fit testing across NWL. Some are able to offer train the trainer sessions:
London North West University Hospitals
Ryan Bautista
Call 0208 869 3745, the line is manned from 8:30 to 12:00,13:00 to 16:00
Imperial College Healthcare
Niina Bell -
niina.bell@nhs.netAlice O’Brien -
alice.obrien1@nhs.netChelsea and Westminster links to book fit testing
Chelsea Site Fit Test Bookings 2024West Middlesex Site Fit Test Bookings 2024Hillingdon Hospital
James Brind -
james.brind@nhs.net