Suspected Measles Exposure or Infection Clinical Pathway — ED, Outpatient Specialty and Primary Care

Measles
Risk Assessment Guidance for Clinicians
- Measles Exposure in Unimmunized,
  Under-immunized or Immunocompromised
Transport/Referral Process
Primary Care and Outpatient Specialty Care
Process for Measles Exposed/Suspected Patient Referrals to the ED

Locations/Dates of
Possible Measles Exposure

Active Measles in the Community

Epic Travel, Exposure and Symptoms Screen

Measles Symptoms	Fever plus > 1 of the following: Bilateral conjunctivitis Rash on face, neck, trunk within 24 hrs of fever
Exposure	In shared space with infectious measles patient at the same time or In shared space vacated by infectious child within prior 2 hrs
Immunocompromise	Severe primary immunodeficiency History of bone marrow transplant, current chemotherapy, solid organ transplant HIV infection Daily steroid therapy > 2 wks

≥ 1 MMR
No immunocompromise

Age < 12 mos
Unimmunized
Unknown immunization
Immunocompromised

Exception:
- Healthy
- Measles symptoms
- Exposed
- 1 MMR

Exposed and/or
Measles Symptoms Present

Expedite to Room

Can return to Waiting Room
Standard Precautions

PPE	N95, child Masking/Tenting
PHL ED	AIIR preferred, ED Rms 4, 14,15, 27, 28, 45, 46, 47, door closed Non-AIIR ED Rm w/ door closed if no AIIR available
KOPH ED	ED Rm 26, followed by 25, 24
Documenting Isolation In Epic

Clinical-decision Making for Measles Testing

Testing

No Symptoms	No measles testing recommended Testing for proof of immunity only, if indicated
Symptoms	Measles Testing recommended NP for Measles PCR Urine Measles PCR Rapid QUAD and Respiratory Viral Panel PCR Requested
Call 5-SAFE prior to ordering tests If testing indicated ensure both studies sent, confirm receipt by lab prior to discharge

Measles Post Exposure Prophylaxis
Consult Medical Home as indicated
Consult ID for immunocompromised children
Vitamin A for Measles Infection, Supplementation
Administration Best Practice for Intramuscular Immune Globulin
Room Closure Requirements

Discharge

Admit

CDC MMRV Vaccine Information Sheet
Quarantine as indicated, 21-28 days
Monitor symptoms
Call PCP if symptoms develop
Safe Discharge for Measles Patient
CHOP measles quarantine guidance for:
- Measles Susceptible Patients Who Cannot Receive PEP
  English, Spanish
- Measles Susceptible Patients Who Have Received Immunoglobulin
  English, Spanish
- Measles Susceptible Patients Who Have Received the MMR Vaccine
  English, Spanish
- Those with Suspected Measles
  English, Spanish

As clinically indicated
AIIR or single room w/door closed
Airborne precautions

Posted: August 2023
Last Revised: April 3, 2025

Authors:
- K. Cohn, MD;
- S. Townsend MS–HQS;
- MK. Abbadessa, RN;
- J. Ercolani, RN;
- E. Hayes MD;
- J. Lavelle, MD

Editors: Clinical Pathways Team

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The clinical pathways are based upon publicly available medical evidence and/or a consensus of medical practitioners at The Children’s Hospital of Philadelphia (“CHOP”) and are current at the time of publication. These clinical pathways are intended to be a guide for practitioners and may need to be adapted for each specific patient based on the practitioner’s professional judgment, consideration of any unique circumstances, the needs of each patient and their family, and/or the availability of various resources at the health care institution where the patient is located.

Accordingly, these clinical pathways are not intended to constitute medical advice or treatment, or to create a doctor-patient relationship between/among The Children’s Hospital of Philadelphia (“CHOP”), its physicians and the individual patients in question. CHOP does not represent or warrant that the clinical pathways are in every respect accurate or complete, or that one or more of them apply to a particular patient or medical condition. CHOP is not responsible for any errors or omissions in the clinical pathways, or for any outcomes a patient might experience where a clinician consulted one or more such pathways in connection with providing care for that patient.

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