Measles, Mumps, and Rubella - Centers for Disease Control and ...

42 MMWR May 22, 1998who cannot provide documentation of two doses of measles-containing vaccine separatedby at least 28 days with the first dose administered on or after the first birthday,or who do not have other evidence of measles immunity (Table 1), should receive adose of MMR vaccine. If indicated, health-care workers born during or after 1957should receive a second dose of MMR vaccine at least 28 days after the previous dose(see Documentation of Immunity). Some health-care workers born before 1957 haveacquired measles in health-care facilities and have transmitted the disease to patientsor coworkers (see Health-care Facilities). Therefore, during outbreaks, health-care facilitiesalso should strongly consider recommending a dose of MMR vaccine tounvaccinated health-care workers born before 1957 who do not have serologic evidenceof immunity or a history of measles disease.Serologic testing of health-care workers before vaccination is not generally recommendedduring an outbreak because arresting measles transmission requires rapidvaccination of susceptible health-care workers. The need to screen, wait for results,and then contact and vaccinate susceptible persons can impede the rapid vaccinationneeded to curb the outbreak.Susceptible health-care workers (Table 1) exposed to measles should receive adose of MMR vaccine and should be removed from all patient contact and excludedfrom the facility from the fifth to the 21st day after the exposure. They may return towork on the 22nd day after exposure. However, susceptible health-care workers whoare not vaccinated after exposure should be removed from all patient contact andexcluded from the facility from the fifth day after their first exposure to the 21st dayafter the last exposure, even if they receive postexposure IG. Personnel who becomeill with prodromal symptoms or rash should be removed from all patient contact andexcluded immediately from the facility until 4 days after the onset of their rash.Use of QuarantineImposing quarantine measures for outbreak control is usually both difficult and disruptiveto schools and other organizations. Under special circumstances (i.e., duringoutbreaks in schools attended by large numbers of persons who refuse vaccination),restriction of an event or other quarantine measures might be warranted (226). However,such action is not recommended as a routine measure for control of mostoutbreaks.Rubella Case Investigation and Outbreak ControlCase DefinitionA suspected rubella case is any generalized rash illness of acute onset. A clinicalcase of rubella is defined as an illness characterized by all of the following clinicalfeatures:• acute onset of generalized maculopapular rash; and• a temperature of >37.2 C (>99 F), if measured; and• arthralgia/arthritis, or lymphadenopathy, or conjunctivitis.