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Why Primary Care Clinics Must Prepare for a Measles Outbreak

Measles, once declared eliminated in the U.S. in 2000, is resurging due to declining vaccination rates. Primary and urgent care clinics are the first point of contact for most patients. Without proper preparation, these facilities could become sources of measles transmission given how easily measles spreads through aerosols.

The U.S. Measles Resurgence: Risk, Impact, and Urgency

A recent study published in JAMA suggests the U.S. could see over 850,000 measles cases over the next 25 years at current vaccination levels. A 10% drop in vaccine coverage could lead to over 11 million cases and 30,000 deaths.

The study confirmed what many of us in primary care and public health began fearing after childhood vaccine rates declined and the anti-vaccine movement grew stronger during the COVID-19 pandemic: measles is poised to return to endemic levels in the United States.

Why Primary and Urgent Care Clinics Are Critical in Measles Detection and Response

Clinics will be required to identify, isolate, and report cases rapidly, as well as assist with contact tracing. I reviewed existing recommendations from CDC and state public health agencies, then adapted them into a guide for measles preparedness in primary and urgent facilities.

This guide offers concrete recommendations to enhance readiness, improve patient outcomes, and, ideally, reduce measles airborne transmission in clinics.

I realize that these recommendations may be challenging. Many require investing time and money, both of which are in short supply in American healthcare facilities. Some may feel impractical, such as screening for respiratory symptoms and masking patients during allergy season, when many patients are coughing.

Nevertheless, it is important for all clinicians, clinic managers, and anyone involved in healthcare infection control to consider these issues given the extreme contagiousness of measles and its respiratory, neurological, and immune consequences.

Clinic Measles Preparedness Checklist: Infection Prevention and Emergency Readiness

Use this checklist to assess and improve your facility’s readiness for a measles outbreak.

A. Measles Immunity and Staff Readiness

• Confirm presumptive immunity for all staff. This includes 2 MMR doses, laboratory evidence of measles immunity, or birth before 1957.
• Store documentation of immunity status in an accessible format.
• Offer MMR vaccine to non-immune staff.

B. Measles Training, Drills, and Respiratory Protection

• Train all staff on measles recognition and response protocols.
• Fit-test staff for N95 respirator use.
• Conduct quarterly measles simulation drills.

C. Facility Supplies, PPE, and Airborne Isolation

• Ensure sufficient supply of Dacron- or Nylon-tipped swabs for collecting samples
• Ensure sufficient N95s, surgical masks, gowns, gloves, and hand sanitizer.
• Install portable HEPA filters in all exam rooms or upgrade HVAC system with MERV-13 filters.
• Designate isolation space with clear signage and workflow.
• Stock immune globulin or develop referral and access plan.

D. Measles Triage and Airborne Precaution Protocols

• Screen for rash and fever during appointment scheduling.
• Display signage at entrances for symptomatic patients.
• Mask and isolate suspected patients immediately.
• Vacate room for 2 hours or per air exchange rate after exposure. e.g., a room with 12 air changes per hour only needs to be vacant for ~35 minutes.

E. Testing, Reporting, and Post-Exposure Management

• Know which labs perform measles RT-PCR and serology testing.
• List local/state health department contacts visibly at triage.
• Maintain census for all staff, patients, and visitors in facility at all times.

F. Communication, Media, and Vaccine Policy

• Create and disseminate policy for managing patient vaccine refusal.
• Assign a clinic spokesperson and prepare media messaging.
• Use educational materials developed by your state health department for patient communication.
• Establish protocol for notifying exposed patients and staff.

Downloadable Resources and Measles Response Tools

Download a PDF of the checklist to use in your clinic.

Below are essential resources to support your clinic’s measles preparedness efforts:

• Healthbeat Article on Measles Resurgence
• CDC Measles Toolkit for Providers
• Project Firstline Infection Control Resources
• Measles Skin Assessment Guidance (Johns Hopkins Center for Outbreak Response Innovation)
• Measles Assessment Checklist for Providers (Washington State Health Department)
• “Should I Test for Measles?” (California Health Department algorithm)

Frequently Asked Questions (FAQ)

What makes measles so contagious?

Measles spreads through aerosolized particles that can linger in the air for up to two hours. Just being in the same room with an infected person can result in transmission if you’re not immune.

How can clinics prevent measles transmission?

Prevention involves multiple layers: verifying staff immunity, isolating suspected cases immediately, maintaining proper ventilation, using personal protective equipment, and following airborne precautions.

What should we do if a patient with measles visited our clinic?

Report the case to your local health department immediately, notify potentially exposed patients and staff, and follow post-exposure prophylaxis protocols. Vacate affected rooms according to air exchange rate guidance.