HEALTH Connections

Update: Measles Outbreak in the U.S.
The United States is currently experiencing a large, multi-state outbreak of measles. Between January 1, 2015, and February 6, 2015, 121 cases from 17 states have been reported. One hundred three of these cases are linked to potential exposure at Disneyland Resort Theme Park in California. (more)
All Rhode Island healthcare providers should remain vigilant for possible measles cases. A single case of measles will trigger a full outbreak response.
For patients presenting with febrile rash illness suggestive of measles:
  • Think measles in any patient presenting with febrile rash illness and clinically compatible measles symptoms: prodrome of cough, coryza, and conjunctivitis for about 3-4 days followed by rash appearance. Measles rashes are red, blotchy, and maculopapular and typically start on the hairline and face and spread down to the rest of the body. Typically, fever abates once the rash appears. The infectious period for measles is four days before to four days after the onset of rash. The incubation period is 14 days (range 7-21 days). Ask patients about travel in the 21 days prior to symptom onset (to destinations within and outside the US where measles is circulating) and assess for exposure risks.
  • Report immediately any suspect or confirmed measles case to the Rhode Island Department of Health (HEALTH). Call 401-222-2577 (401-272-5952 after hours). HEALTH will support healthcare providers with recommendations for laboratory testing and management of cases and contacts.
  • Isolate the patient in a single room (negative pressure room if available). Non-immune providers should ideally wear a N-95 mask when examining the patient. There is no utility to putting a mask on the patient. If the patient wears a mask, it should be a surgical mask. Never put an N-95 mask on a patient. The room may not be used again for another patient for at least two hours and should be surface cleaned prior to use again.
  • Test. Specimens must be sent to the State Lab, not a commercial lab.
  • Collect a blood sample in a Serum Separator Tube, with, at minimum, 5 ml of whole blood for an adult and 2 ml of whole blood for pediatric patients. Blood should be centrifuged to separate serum from clot within two hours of collection.
  • Collect a swab sample (Polyester/Dacron tipped swap) in a vial containing 3 ml of Viral/Universal Transport Medium (VTM/UTM). The swab should be taken from the throat, nasal, or nasopharyngeal area.
  • Assist HEALTH, when asked, to provide HEALTH investigators with index case information, to identify contacts and their susceptibility status, to provide post exposure prophylaxis with MMR or IG as needed, and to recommend isolation and exclusion from congregate environments on a case-by-case basis with guidance from HEALTH.
Routine MMR vaccination for children
Healthcare providers should continue administering and advocating for MMR vaccination according to Advisory Committee on Immunization Practices (ACIP) and HEALTH immunization guidelines, which call for a first dose at 12 to 15 months of age, and a second dose at 4 to 6 years of age (ACIP’s full MMR recommendations).
Vaccination and immunity for healthcare workers
MMR vaccination is strongly recommended for all healthcare workers. Additionally, Rhode Island’s immunization regulations include MMR vaccination requirements for healthcare workers in certain facilities. These facilities include: adult day cares, CVS Minute Clinics, free-standing ambulatory care surgical centers, free-standing emergency care facilities, home care providers, home nursing care facilities, hospice facilities, hospitals, kidney treatment centers, nursing facilities, organized ambulatory care facilities, and physician ambulatory surgery centers. (more)
  • All newly-hired healthcare workers in these facilities must have received two doses of MMR, show laboratory evidence of immunity, or show laboratory confirmation of disease.
  • For current healthcare workers in these facilities born before 1957 who lack laboratory evidence of measles immunity or laboratory confirmation of disease, two doses of MMR vaccine are recommended. These individuals will be required to be vaccinated during outbreaks.
In the event of one or more measles cases in Rhode Island
  • HEALTH will initiate an outbreak response in consultation with the Centers for Disease Control and Prevention (CDC). This will include isolation of the index case, contact tracing to identify exposed susceptible individuals, recommendations for post-exposure prophylaxis, and exclusion measures (for unvaccinated individuals) from group settings and/or when vulnerable populations are at-risk of contracting severe disease.
  • HEALTH will provide clinicians with further guidance and clinical recommendations.
  • Visit and follow emailed HEALTH advisories for updates and guidance.
Clinical Resources

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Rhode Island Department of Health
Three Capitol Hill
Providence, Rhode Island 02908-5097

HEALTH Information Line: 401-222-5960 / RI Relay 711


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