<div dir="ltr"><div class="gmail_default" style="font-family:tahoma,sans-serif;font-size:small">FYI </div><div class="gmail_default" style="font-family:tahoma,sans-serif;font-size:small"><br></div><div><div dir="ltr" class="gmail_signature" data-smartmail="gmail_signature"><div dir="ltr"><div dir="ltr"><div dir="ltr"><div dir="ltr"><div dir="ltr"><div dir="ltr"><div dir="ltr"><div dir="ltr"><div dir="ltr"><div dir="ltr"><div dir="ltr"><div>Stacie</div><div><br></div><div><b>Stacie Leap</b><br></div><div><a href="mailto:stacie.leap@gmail.com" target="_blank">stacie.leap@gmail.com</a> | 215.776.6741</div></div></div></div></div></div></div></div></div></div></div></div></div></div><br><br><div class="gmail_quote"><div dir="ltr" class="gmail_attr">---------- Forwarded message ---------<br>From: <strong class="gmail_sendername" dir="auto">PDPH</strong> <span dir="auto"><<a href="mailto:health.notifications@phila.gov">health.notifications@phila.gov</a>></span><br>Date: Tue, Jan 9, 2024 at 4:06 PM<br>Subject: PDPH Advisory - Measles Infection Control, Testing, and Vaccination Guidance<br>To: <a href="mailto:stacie.leap@gmail.com">stacie.leap@gmail.com</a> <<a href="mailto:stacie.leap@gmail.com">stacie.leap@gmail.com</a>><br></div><br><br> <u></u>
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<p> </p><p>The Philadelphia Department of Public Health has released a Health Advisory regarding measles infection control, testing, and vaccination guidance. It is available from <a href="https://hip.phila.gov" target="_blank">https://hip.phila.gov</a>, is appended to this email and is attached as a PDF document. To read this attachment, you will need the Adobe Reader software, which can be downloaded at no cost from <a href="http://tinyurl.com/6ip" target="_blank">http://tinyurl.com/6ip</a>.</p>
<p>If you have any questions or problems, please contact the Philadelphia Department of Public Health at <span class="gmail_default" style="font-family:tahoma,sans-serif;font-size:small"></span><span class="gmail_default" style="font-family:tahoma,sans-serif;font-size:small"></span><a href="mailto:publichealthpreparedness@phila.gov" target="_blank">publichealthpreparedness@phila.gov</a>.</p>
<p>To report a disease or condition to the Philadelphia Department of Public Health, call 215-685-6748 during business hours (8:30AM to 5:00PM Monday-Friday). If the disease or condition requires immediate notification and it is after normal business hours, call 215-686-4514 and ask to speak with the contact for the Division of Disease Control.</p>
<p>To update your contact information for the Health Alert Network or to register to receive health alerts and newsletters from PDPH, reply directly to this email or complete a registration form at <a href="https://hip.phila.gov/health-alerts-subscriber-signup/" rel="noopener" target="_blank">https://hip.phila.gov/health-alerts-subscriber-signup/</a>.</p>
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<p><span style="font-family:'times new roman',times;font-size:12pt">Philadelphia Department of Public Health</span><br><span style="font-family:'times new roman',times;font-size:12pt"><strong>Health Advisory</strong></span><br><span style="font-family:'times new roman',times;font-size:12pt">Measles Infection Control, Testing, and Vaccination Guidance</span><br><span style="font-family:'times new roman',times;font-size:12pt"><strong>January 9, 2024</strong></span></p>
<p><span style="font-family:'times new roman',times;font-size:12pt"><strong>Summary Points:</strong></span></p>
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<li><span style="font-family:'times new roman',times;font-size:12pt">Three secondary cases and 4 tertiary cases of measles have occurred locally in Philadelphia in the past month after exposure to an individual with an infection acquired internationally. All cases have been unvaccinated.</span></li>
<li><span style="font-family:'times new roman',times;font-size:12pt">Have a high suspicion for measles in unvaccinated individuals with fever, congestion, and cough, even before the appearance of rash, especially if they have been notified that they are or a contact of theirs was exposed to measles. </span></li>
<li><span style="font-family:'times new roman',times;font-size:12pt">Primary care providers should reach out to all individuals who are 12 months and older and who are not up to date on vaccination to schedule MMR vaccination as soon as possible.</span></li>
</ul>
<p style="line-height:110%"><span style="font-size:12pt;line-height:110%;font-family:'times new roman',times">Three secondary cases of measles have occurred locally in Philadelphia in the past month after exposure to an individual with an infection acquired internationally. Four tertiary cases have occurred after exposure to one of the secondary cases at daycare. Cases did not have previous immunity.</span></p>
<p style="margin:0in;line-height:107%"><span style="font-family:'times new roman',times;font-size:12pt"><span style="line-height:107%;color:black;background:white">There have been multiple measles exposures at healthcare facilities in and around Philadelphia as well as a daycare in Philadelphia. For a complete updated listing visit this </span><a href="https://www.phila.gov/2024-01-04-health-department-cautions-philadelphians-about-recent-measles-cases/" target="_blank"><span style="line-height:107%;background:white">blog post.</span></a><span style="line-height:107%;color:black;background:white"> </span></span></p>
<p style="margin:0in;line-height:107%"><span style="font-size:12pt;line-height:107%;color:black;background:white;font-family:'times new roman',times"></span><br></p>
<p style="margin:0in;line-height:107%"><span style="font-size:12pt;line-height:107%;color:black;background:white;font-family:'times new roman',times"></span><br></p>
<p style="margin:0in;line-height:107%"><span style="font-size:12pt;line-height:107%;color:black;background:white;font-family:'times new roman',times">Efforts have been made by health care institutions as well as PDPH and surrounding county and state health departments to contact individuals exposed. Since not all individuals are able to be reached or identified, it is possible that additional local transmission of measles may occur particularly among persons who lack measles immunity.</span></p>
<p style="margin:0in;vertical-align:baseline"><span style="font-family:'times new roman',times;font-size:12pt"><strong><span style="color:black;background:white"></span></strong></span><br></p>
<p style="margin:0in;vertical-align:baseline"><span style="font-family:'times new roman',times;font-size:12pt"><strong><span style="color:black;background:white"></span></strong></span><br></p>
<p style="margin:0in;vertical-align:baseline"><span style="font-family:'times new roman',times;font-size:12pt"><strong><span style="color:black;background:white">Infection Control</span></strong></span></p>
<ul>
<li><span style="font-size:12pt;color:black;background:white;font-family:'times new roman',times">Maintain a high suspicion for measles in individuals who are not immune and present with measles symptoms.</span></li>
<li><span style="font-size:12pt;color:black;font-family:'times new roman',times">Create triage policies to quickly identify patients who could have measles including questions about recent measles exposures and symptoms. If possible, consider preliminary triage at the door. </span></li>
<li><span style="font-size:12pt;color:black;background:white;font-family:'times new roman',times">Immediately place individuals who may have measles in airborne infection isolation rooms (AIIR). If an AIIR isn’t available, the patient should be placed in a single room and must mask until they can be placed in an AIIR. Measles spreads between rooms through shared airspace. All staff should don a respirator. </span></li>
<li><span style="font-size:12pt;color:black;background:white;font-family:'times new roman',times">Consult with engineering teams to determine the best locations to place patients if all AIIR are occupied.</span></li>
<li><span style="font-size:12pt;color:black;background:white;font-family:'times new roman',times">Outpatient providers should notify hospital emergency rooms (ER) prior to referring patients to present to the ER so that patients can be quickly isolated. Patients age 2 and over should be told to mask when presenting to the ER. Providers should also contact PDPH by calling 215-685-6741 for any suspect cases.</span></li>
</ul>
<p style="margin:0in;vertical-align:baseline"><span style="font-family:'times new roman',times;font-size:12pt"><strong><span style="color:black;background:white">Testing</span></strong></span></p>
<ul>
<li><span style="font-size:12pt;color:black;background:white;font-family:'times new roman',times">Contact PDPH by calling 215-685-6741 during regular business hours or 215-686-4514 after hours and on weekends if you suspect a measles case and to coordinate testing. Healthcare facilities that are located outside of Philadelphia should contact their local health departments to coordinate testing. Test concurrently for other respiratory viruses. </span></li>
<li><span style="font-size:12pt;color:black;background:white;font-family:'times new roman',times">Providers should collect an NP swab in viral or universal transport media and urine specimen in a sterile container (minimum 50 ml) for measles PCR. Refrigerate if specimens are not transported or shipped immediately. Ship on cold packs. PCR is sent through the state Bureau of Laboratories. While PCR testing is available commercially, results will not be received in a timely manner. </span></li>
<li><span style="font-size:12pt;color:black;background:white;font-family:'times new roman',times">Consider sending measles IgG serology through commercial labs for individuals who don’t have documentation of measles immune status and are potential contacts. This will help avoid a quarantine if positive but should be done in the first 5 days after exposure and before an individual would become potentially infectious. PDPH may be able to help coordinate a home blood draw after that time if necessary, so that healthcare exposures can be avoided.</span></li>
</ul>
<p><span style="font-family:'times new roman',times;font-size:12pt"><strong><span style="color:black">Vaccination</span></strong></span></p>
<ul>
<li><span style="font-size:12pt;color:black;font-family:'times new roman',times">Administer routine and catch-up vaccination with measles, mumps, and rubella (MMR) vaccine. </span></li>
<li><span style="font-size:12pt;font-family:'times new roman',times">Recall patients 12 months and older who are not up to date on MMR vaccination.</span></li>
<li><span style="font-size:12pt;font-family:'times new roman',times">Primary care offices could consider nurse only clinics or other strategies to bring children in quickly for their first MMR vaccine. </span></li>
<li><span style="font-size:12pt;font-family:'times new roman',times">Individuals who have received only 1 MMR greater than 28 days ago and are exposed should receive a 2<sup>nd</sup> dose within 72 hours of exposure. </span></li>
<li><span style="font-family:'times new roman',times;font-size:12pt">MMR is also recommended for infants 6-11 months of age <a href="https://www.cdc.gov/vaccines/vpd/mmr/public/index.html" target="_blank">before international travel.</a></span></li>
</ul><p></p>
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