Table 3.

General guidance for measles outbreak control in healthcare settings in three elimination settings.

Strategy	United States	Canada	Australia
Exposure	• Closed settings	• Room or enclosed space	• Shared defined air-space
	• ≤2 hours after infectious case left	• ≤2 hours after infectious case left	• ≤30 minutes after infectious case left
Isolation of case-patients while in hospital	• Airborne precautions	• Airborne precautions	• Airborne precautions
	• Through 4 days after rash onset	• Onset of symptoms to ≤4 days after rash onset	• Through 4 days after rash onset
Caring for isolated case-patient	• Only staff who are immune	• Only staff who are immune	• Only staff who are immune
	• N95 respirator even if immune	• No additional precautions (respirators) needed
Transporting infectious case-patient	• Should wear a mask	• NS	• Should wear a mask
Isolation (quarantine) of exposed susceptible patients while in hospital	• Airborne precautions	• Airborne precautions	• Airborne precautions
	• Through 21 days after exposure	• ≥5 days to ≤21 days after last exposure,	• Through 18 days after last exposure
Exclusion of case-staff from facility	• Through 4 days after rash onset	• Through 4 days after rash onset	• Through 4 days after rash onset
Exclusion of exposed susceptible staff from facility and patient contact	• ≥5 days to ≤21 days after exposure	• ≥5 days to ≤21 days after last exposure,	• Through 18 days after last exposure
Post-exposure prophylaxis (PEP) of susceptible contacts
-Vaccine	•  ≤72 hours of first exposure	• ≤72 hours of first exposure (implied)	• ≤72 hours of first exposure
-Immunoglobulin (IG)	• ≤6 days of exposure	• ≤6 days of exposure (implied)	• ≤6 days of exposure
Return of isolated patients to floor after timely PEP	• Allowed in hospital settings (implied)	• Not allowed in hospital settings	• Allowed in hospital settings (implied)
Return of excluded staff to work after timely PEP	• Not allowed in hospital settings	• Not allowed in hospital settings	• Allowed in hospital settings (implied)

Note: NS = Not specified; Information comes from References 1–3, 93–94.

^aE.g., waiting area, assessment room, ward.

^bNegative-pressure room; if unavailable, a single room with the door closed and away from susceptible contacts.

^cRegardless of whether they received post-exposure prophylaxis (vaccine or immunoglobulin).

^dIn Canada, healthcare workers and patients with no documented doses of a measles-containing vaccine, no other evidence of immunity, or with 1 documented dose, are recommended to be tested for measles IgG antibody, receive one dose of MMR vaccine, and excluded from work (staff) or isolated (patients) pending results. If IgG results are positive, healthcare workers and patients are allowed to return; if negative, healthcare workers and patients should be vaccinated with a second dose (28 days after the first dose), and excluded (staff) or isolated (patients) regardless of whether they received post-exposure prophylaxis.

^eDid not receive vaccine within 72 hours or immunoglobulin within 6 days.