Primary Care

Measles is extremely infectious. One person with measles can infect 15 to 20 unimmunised people. 15 minutes in direct contact with someone infected with measles is sufficient to transmit virus.

Measles is spread through coughing and sneezing, close personal contact or direct contact with infected nasal or throat secretions.

Measles is infectious from 4 days before rash onset until 4 full days after the rash appears.

Prevent transmission

In health care settings, suspected measles cases should be triaged and isolated immediately to protect other patients.

Ensure Infection Prevention and Control measures are in place.

  • Fever > 39°C in the absence of antipyretics
  • Conjunctivitis
  • Cough and/or coryza
  • Generally very unwell
  • Koplik spots (small red spots with bluish-white centres) inside the mouth

  • Generalised maculopapular rash – appears after prodromal phase usually on the face and upper neck and spreads to the rest of the body

Risk factors for measles

To inform clinical diagnosis consider:

  • Age of the case
  • Vaccination (two doses measles mumps rubella (MMR) vaccine = fully immunised)
  • Travel within and outside the UK
  • Member of an under-vaccinated population group
  • Link with a confirmed case of measles

Diagnostic testing

Clinicians should take an urgent diagnostic PCR test (unless confirmed measles is endemic - widely circulating within the region). This supports management of cases, and minimises impact on close contacts, the community and health care services.

How to take a sample for measles PCR:

  • A mouth swab (ideally in viral transport medium; usually available from your local laboratory) OR
  • A dry swab can be used to swab the inside of the mouth, use the swab from a charcoal transport medium pack but DO NOT place in the charcoal transport medium. Please use a plain sterile container such a universal container used for urine samples OR
  • Where mouth swabs or dry swabs are not available, a urine sample; please use a plain sterile urine container without preservative.

Please send these samples urgently to the UKHSA Virology lab at MFT via your local laboratory. Results will generally be available within 48 hours of sample receipt in the lab.

If urgent PCR samples are dispatched in hours inform the duty virologist by both phone T: 0161 276 8836 and email duty.virologist@mft.nhs.uk. If out of hours call via MRI Hospital switchboard T: 0161 276 1234 and email duty.virologist@mft.nhs.uk. Do not include patient identifying information.

To obtain urgent results please contact the Virology Results line on: 0161 276 8854 Monday - Friday 8.30am-5pm and Saturday 8.30am -12.00pm

Notification

Measles is a notifiable disease and clinicians must inform local UKHSA health protection teams of suspected cases to facilitate timely public health action and urgent risk assessment of any vulnerable contacts.

Contact UKHSA North West

Health Protection on: 0344 225 0562 - 9am to 5pm
- Cheshire and Merseyside Option 1
- Cumbria and Lancashire Option 2
- Greater Manchester Option 3

0151 434 4819 - 5pm to 9am

All suspected cases will be sent an Oral Fluid Test by UKHSA (via HPT), regardless of what local diagnostic testing is undertaken.
The Oral Fluid Test is a non-urgent test and used for surveillance not rapid diagnosis.

Exclusion

  • Suspected cases should be excluded from school, nursery or work for 4 days after the onset of rash.
  • Avoid contact with unvaccinated young children, susceptible pregnant women and immunocompromised persons during the infectious period.

Complications

The most common complications of measles infection are:

  • Ear infections (otitis media)
  • Pneumonia
  • Severe diarrhoea and related dehydration.

Less common complications include:

  • Convulsions and encephalitis
  • Serious consequences are more common in immunocompromised individuals.

MMR Vaccination

Measles is vaccine preventable. Children receive two doses of the MMR vaccine as part of the routine childhood immunisation programme.

Continue to identify children and adults who are not fully immunised and advise them to contact their GP to arrange vaccination.

Guidance

Downloads

A number of laboratory tests are available for Measles. There is a reported lack of awareness amongst clinicians around the availability of these tests and there purpose. There is uncertainty around NHS laboratory capacity for measles serology testing, and a likely imminent increase in demand from health care workers with uncertain MMR history/immunity getting their immunity checked either pre-exposure (to guide Occupational Health decision re MMR vaccination) or post-exposure (to potentially minimise impact of the 21 day exclusion from work requirement). 

Other groups requiring 21 day exclusion post -exposure would also benefit from having their immunity assessed by serological testing, e.g. household contacts in education. 

Different tests for the North West

National recommendations are included in section 1.5 of the UKHSA national measles guidelines: National measles guidelines - GOV.UK (www.gov.uk)

Frequently asked questions

FFP3 masks for probable cases of measles

Primary care staff are being encouraged to order FFP3 masks from the PPE portal here: https://www.ppe-portal.nhs.uk/customer/account/login/. They are free of charge to order. The FFP3 masks will need Fit testing and we are looking at how to support this but practices should order a range of sizes in anticipation of being Fit tested.

All clinicians, including general practice should use FFP3 masks, especially when encountering an undifferentiated presentation or probable/confirmed cases of measles. Those who have had two MMR doses are considered protected. Those who have had no doses and are immunosuppressed are most vulnerable and should be prioritised for FFP3 fit testing or, better, deployed away from risk of communicable disease. Pregnant healthcare workers are being advised to avoid suspected cases altogether.

We anticipate further updates re infection prevention control guidance.

Will there be enough vaccine supply?

There are no stock supply issues. MMRVaxPRO continues to be available to order unrestricted. Priorix (does not contain pork gelatine) has initially been restricted to a max of 15 vials per order. Practices who need to order more Priorix (as they serve communities that do not accept vaccines containing porcine gelatine) can have this cap removed and order more stock.

A team requiring to do so, just need to log into their ImmForm account and place an order for 15 vials; then contact the ImmForm Helpdesk at helpdesk@immform.org.uk or on 0207 183 8580 providing the order reference number and the extra quantity required.

Will GP practices be paid to vaccinate?

Yes, all MMR vaccines will be paid at the usual Item of Service (IoS) fee no matter the age of the patient.

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