Leadership Insights: The Measles – What Leaders Need to Know

April 24, 2025

Insights from Calvin Reynek, RN, IP-BC, AS-BC, CDP, CADDCT, QAPI-BC
Clinical Nurse Consultant, Pathway Health

The World Health Organization (WHO) states that measles is a highly contagious disease caused by a virus. It spreads easily when an infected person breathes, coughs, or sneezes. Measles can cause severe disease, complications, and even death. While anyone can be affected, measles is most common in children.

According to the National Foundation for Infectious Diseases, measles is so contagious that, per the CDC, 90% of individuals who come into close contact with an infected person will develop the disease if they are not protected.

Know the Facts About Measles:

Measles Symptoms and Timeline.
The initial symptoms typically appear 7 to 14 days after exposure to the measles virus and include:

  • High fever
  • Cough
  • Runny nose (coryza)
  • Red and watery eyes (conjunctivitis)

Within 2–3 days of symptom onset, tiny white spots known as Koplik spots may appear inside the mouth. By day 3–5, the measles rash usually appears, starting as flat red spots at the hairline and progressing downward to the face, neck, trunk, arms, legs, and feet. There is currently no specific antiviral treatment for measles. Supportive care is essential, along with early identification and management of any complications associated with this viral respiratory illness.

Why Is Measles a Concern in Post-Acute and Long-Term Care Facilities?
The MMR vaccine (measles, mumps, rubella) was introduced in the U.S. during the 1960s. However, not all residents—or even staff members—may be fully vaccinated. This may be due to age, incomplete vaccination records, or personal circumstances. Per CDC guidelines:

  • Two doses of the MMR vaccine are required to be considered fully vaccinated against measles.
  • Older children, adolescents, and adults without evidence of immunity may require 1 or 2 doses, spaced 28 days apart.
  • Healthcare staff are among those specifically recommended to receive the MMR vaccine due to increased occupational risk and the nature of working in congregate care settings.

Facility Infection Control Risk.
Most health care settings—including ILFs, ALFs, ICFs, rehab centers and SNFs—are not equipped to manage confirmed cases of measles. Strict Droplet and Airborne Precautions are required for the duration of the illness, beginning four days before and after the appearance of the rash.

Given the incubation period of 11–12 days, individuals exposed to measles may unknowingly spread the virus before symptoms develop. In a facility setting, this poses a serious risk of rapid transmission—especially among vulnerable populations—potentially leading to serious health complications, outbreaks, and facility-wide exposure.

Leadership Considerations: What Can We Do to Prevent Measles Transmission?

Leaders in post-acute and long-term care settings play a critical role in protecting residents, staff, and visitors from measles transmission. While complete elimination of risk is not always possible, there are several key strategies to help prevent or mitigate the spread of measles within your community:

1. Promote Vaccination

  • Ensure staff, residents, and frequent visitors are informed about the importance of MMR vaccination.
  • Encourage those who have not been previously vaccinated to receive 1 or 2 doses of the MMR vaccine, per CDC guidance.
  • If your facility identifies a low vaccination rate, collaborate with your medical director and pharmacy partners to provide onsite or facilitated access to the MMR vaccine.

2. Encourage Symptom Awareness and Reporting

  • Reinforce the importance of staying home when ill, even as traditional respiratory viral season winds down.
  • Viral respiratory illnesses—including measles—can still circulate year-round.
  • Educate staff, residents, and visitors to monitor for and report early symptoms, such as fever, cough, runny nose, and conjunctivitis.

3. Implement Early Identification and Response Protocols

  • Respond quickly when a staff member or resident exhibits signs or symptoms of measles.
  • Interventions may include:
  • Immediate isolation of suspected cases
  • Contact tracing
  • Clinical surveillance of exposed individuals (staff and residents)
  • Notification to state and local public health authorities
  • Activation of your facility’s Respiratory Protection Program

4. Foster Public Health Collaboration

  • Work proactively with local public health departments and infection prevention specialists at the first sign of possible exposure.
  • Use current data and evidence-based guidance from reputable sources such as the CDC, WHO, and other public health organizations to inform your prevention and response strategies.

By fostering a culture of preparedness, education, and collaboration, leadership can significantly reduce the risk of measles transmission and protect the health and safety of everyone within your care setting.

Helpful Resources:

Complimentary Resource: Interim Policy & Procedure for Measles

Download this complimentary resource to support the implementation of effective infection prevention and control measures to mitigate the risk of introduction and spread of measles.

Download

We provide infection prevention solutions and professionals to support your team and compliance strategies.

Contact us to learn more.

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