Measles (child care and school)
What is Measles?
Measles is a highly contagious and acute viral disease caused by the measles virus. Humans are the only natural host for the measles virus.
Outbreaks occur when unprotected people become infected and infect others who are not protected (either through vaccination or immunity from past disease). Measles is rare in the United States but can result in serious complications, such as hearing loss, pneumonia, seizures, brain damage, and death.
Signs and symptoms
- Fever, cough, runny nose, and red, watery eyes
- Appearance of rash at hairline spreading downward over body
- Koplik’s spots (tiny white spots with bluish-white centers found inside the mouth)
- Diarrhea, pneumonia, or ear infections
Incubation period
Usually 8-14 days (range of 7-21 days) from exposure to onset of symptoms. In rare circumstances, a person who is immunocompromised may have a longer incubation period.
Contagious period and spread
- Contagious period: From four days before the rash appears until four days after the appearance of the rash.
- Spread through airborne route: Breathing small particles containing virus floating in the air. These particles travel along air currents and can infect people in another room.
- In a closed setting, measles virus can be transmitted in the air for up to two hours after an infected individual occupied the area.
- Even brief exposure or shared airflow poses a high risk of infection for people who have not had the disease before, have not been protected by the measles vaccine, or who have a problem with their immune system.
Public health reporting requirements
Report any suspected or confirmed measles to the state or local public health agency immediately by phone. A single case of measles anywhere in the U.S. is considered to be a reportable outbreak.
Control of spread
- If a child attends a school or child care facility while infectious, public health will work with the facility to provide recommendations on disease control activities and possible exclusion of un- or under-immunized students and staff.
- Measles is a vaccine-preventable infection. Immunize according to current recommendations. Review immunization status of all children and staff members.
- Use good hand-hygiene techniques at all times and routine infection control measures.
- Do not transfer children to other facilities.
Vaccination
Routine child/adolescent recommendations:
- Measles, mumps, rubella (MMR) vaccine is routinely given to children at 12-15 months of age, with a second dose at 4-6 years of age.
- Unvaccinated children and adolescents should receive two doses, at least four weeks apart.
Colorado school-required vaccines:
- Child care/preschool: One dose of MMR for children who are 16 months of age and older and two doses prior to kindergarten entry.
- School (K-12): Two doses of MMR are required.
- College/university: Two doses of MMR are required for students born on or after Jan. 1, 1957.
- A complete school-required vaccine exemption provided to the child/adolescent/adult’s school may be accepted in place of documentation of an age-appropriate MMR vaccination series.
- Laboratory confirmation of positive titers to measles, mumps, and rubella is an acceptable alternative to age-appropriate vaccination.
Routine adult/other recommendations:
- Adults with no evidence of immunity for measles should receive at least one dose of MMR vaccine.
- Evidence of immunity includes people born before 1957 (except for health care personnel), documentation of receipt of MMR vaccine, or laboratory evidence of immunity or disease.
- Certain adults may need 2 doses. Adults who are going to be in a setting that poses a high risk for measles or mumps transmission should make sure they have had two dose separated by at least 28 days. These adults include students at post-high school education institutions, health care personnel, and international travelers.
Treatment
There is no specific treatment for measles. People without immunity who have a known exposure to measles can receive post-exposure prophylaxis to reduce the severity of disease.
Exclusion
- Exclude children with measles until four days after the rash starts when they are no longer contagious. Measles is a highly contagious infection; children suspected of having measles should be sent home immediately.
- Exclude exposed children and staff who are not immunized (or who are incompletely immunized for their age) until they become immunized. If they are not immunized because of an exemption, exclude them until the local health department determines it is safe for them to return.
- Readmit when the following criteria have been met:
- Four days after the beginning of the rash.
- When the child is able to participate and staff members determine they can care for the child without compromising their ability to care for the health and safety of the other children in the group.
Role of teachers, caregivers, and family
- Encourage routine vaccination. Review and ensure all children have received MMR vaccine according to current immunization recommendations.
- Immediately report the infection to the local or state health department. If the health professional who makes the diagnosis does not inform the local health department that the infected child is a participant in a child care program or school, this could delay controlling the spread.
- Report the infection to the staff member designated by the child care program or school for decision-making and action related to the care of ill children. That person, in turn, alerts possibly exposed family and staff members and parents/guardians of unimmunized children to watch for symptoms and notifies the health consultant.
- Ensure staff members who have had fewer than two doses of vaccine are properly immunized unless documented to have had the disease or were born before 1957. Individuals born before 1957 are presumed to be immune because measles was widespread before the vaccine became available, although being in this group is not a guarantee of immunity. A laboratory test is available for testing immunity.
- During investigation of a suspect case, exposed children with weakened immune systems or who have not received MMR vaccine routinely may be excluded from the facility. In an outbreak, if public health makes a recommendation, infants aged 6-11 months can be immunized and then re-immunized at the age-appropriate time. Immunization at 12 months is still necessary because the child’s immunity from the previous dose of vaccine may be blocked by the birthing parent’s measles antibodies which cross the placenta during pregnancy.