Effective April 22, 2019
The Los Angeles County (LAC) Department of Public Health (DPH) has recently confirmed five (5) cases of measles. All of the cases were adults, the majority were unvaccinated and two had recently traveled internationally.
LAC DPH is currently investigating multiple exposures in adults and children related to these cases. This alert is to notify all healthcare providers about the outbreak and summarize immediate steps to take when evaluating a person with possible measles. Further recommendations related to the outbreak will be released through LAHAN soon.
Key Messages
- There is an outbreak of measles in Los Angeles County.
- Consider the diagnosis of measles among persons presenting with a febrile rash illness.
- Screen for rash with fever at the point of entry to a healthcare facility and immediately institute respiratory and airborne precautions to prevent health care associated exposures.
- Ask patients about recent or planned travel and review their measles immunization status.
- Report all patients with suspected measles immediately to the Health Department. Do not wait for laboratory confirmation.
Actions Requested of Providers
- Screen for acute rash illness with fever at entry to any clinic or healthcare facility.
- If you suspect measles:
- IMMEDIATELY institute respiratory and airborne precautions for all persons with a measles-like rash and fever.
- IMMEDIATELY report to LAC DPH. Do not wait for laboratory confirmation.
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- Reduce exposures. Schedule patients with fever and rash for end of the day and have them enter via a separate entrance, if possible. Suspect measles cases should be masked and placed immediately in an examination room with the door closed. Do not use the examination room for at least two hours after the patient has left.
- Do not send suspect measles cases to the Emergency Department (ED) unless they require hospitalization. Be sure to notify the ED first. Do not refer suspect measles patients to commercial laboratories or to other departments/facilities for testing or other services.
- Obtain specimens for confirmation of diagnosis: blood for serology, +/- urine and nasopharyngeal/throat swabs for PCR. If you cannot collect specimens on site, call LAC DPH for assistance. All specimens should be sent to the Public Health Laboratory after consultation with LAC DPH. Note: waiting for results from commercial laboratory tests may delay management of the investigation.
- Provide a list of exposed staff and patients (those exposed from 4 days before through 4 days after rash onset) to LAC DPH.
- Refer to the LAC DPH measles toolkit "Checklist for Measles" and "Measles Fact Sheet for Clinicians" for more information including details on specimen collection.
Reporting
Measles cases must be reported by telephone immediately to the local health department (Title 17, California Code of Regulations, § 2500).
Los Angeles County DPH Morbidity Central Reporting Unit:
- Call 1-888-397-3993 on weekdays from 8:30 a.m. to 5:00 p.m.
- For after-hours, call 1-213-974-1234 and ask for the physician on call.
Long Beach Health and Human Services:
- Call 1-562-570-4302 on weekdays from 8:00 a.m. to 5:00 p.m.
- For after-hours, call the Duty Officer at 1-562-500-5537.
Pasadena Public Health Department:
- Call 1-626-744-6089 on weekdays from 8:00 a.m. to 5:00 p.m. (note: closed every other Friday)
- For after-hours, call 1-626-744-6043.
Resources
- For technical assistance, call the LAC DPH Vaccine Preventable Disease Control Program Surveillance Unit at 1-213-351-7800
- For clinicians: View LAC DPH's Measles Fact Sheet and Toolkit
- For parents and patients: View information at LAC DPH's Measles Outbreak page.