Practices should support all surgery staff to ensure they are ‘fully immunised’ against measles and those dealing with the public should have documented evidence of them being immune, NHS England guidelines have said as cases are rising.
Staff should wear appropriate PPE when assessing or managing patients with confirmed or suspected measles, including single use disposable gloves; a single use disposable apron; respiratory protective equipment and eye/face protection, such as goggles or a visor.
And a risk assessment should also be carried out for any team member at high risk of infection and/or complications from infection with measles.
NHS England issued the ‘Guidance for risk assessment and infection prevention and control measures for measles in healthcare settings’ last week as the UK Health Security Agency declared a national incident based on rising cases of measles and outbreaks in the West Midlands and Yorkshire.
The guidance warned that as primary care settings, including GP practices, are likely to be a first contact point for measles cases, reception staff should be aware of the symptoms.
‘Staff should know that any patients with fever and rash are potentially infectious and take appropriate action to stop onward transmission without delay, including PPE,’ it said.
And it advised GP teams that if patients with suspected measles require an in-person review, they should be separated from other patients and isolated on arrival at the practice.
In terms of managing staff exposure, the guidance said:
- Patient-facing staff, whether clinical or non-clinical, should have documented evidence of 2 doses of the MMR vaccine or have positive antibody tests for measles and rubella.
- A health care worker is considered to be ‘exposed’ and/or a contact if they have face-to-face contact of any length or spend more than 15 minutes in a small, confined area with a confirmed measles patient without wearing appropriate PPE. If PPE is worn, that person is not considered as being exposed.
- A health care worker exposed to a confirmed or suspected case but who doesn’t have satisfactory evidence of protection should be excluded from work from the 5th day after the first exposure to 21 days after the final exposure.
- If a health care worker is tested rapidly after exposure, they can continue to work if found to be measles IgG positive within 7 days of exposure
- Where an MMR vaccine is given post-exposure, it is unlikely to prevent the development of measles but, if the worker remains symptom-free for at least 14 days after the vaccine is given, they can return at that stage.
- Health care workers with satisfactory evidence of protection can continue to work normally but should monitor/report symptoms. Exposed health care workers that develop fever or rash should be excluded from all work until 4 full days after onset of the rash.
The guidance also includes a template to help practices undertake a local risk assessment for managing cases of suspected or diagnosed measles.
Meanwhile, today the NHS launched a national catch up campaign for missed MMR vaccines.
Parents and carers in England of children aged from six to 11 years are being urged to to see their GP to get the jab.
NHS figures show more than 3.4 million children under the age of 16 years are currently unprotected.
The campaign is particularly targetting areas with low uptake of the vaccine and where the risk of measles outbreaks is currently high by extending the age cohort receiving reminders . So, in London and some parts of the Midlands, children and young adults aged six to 25 years will be contacted and invited to make an appointment.
Last week’s primary care bulletin from NHS England said practices should ‘prepare to receive enquiries from their registered patients during February and March 2024 who have received a national MMR vaccination reminder, and should check immunisation records, book, and administer vaccination, if clinically appropriate’.
Dr Gayatri Amirthalingam, UKHSA consultant medical epidemiologist: ‘The continuing downward trend in the uptake of routine childhood vaccinations is a serious concern. We now have a very real risk of measles outbreaks across the country.
