1. M EASLES (R UBEOLA ) February, 2015Safety Training

2. G ENERAL I NFORMATION ON M EASLES Measles (Rubeola) is a highly contagious respiratory disease caused by a virus. It spreads through the air through coughing and sneezing. If other people breathe the contaminated air or touch the infected surfaces, then touch their eyes, noses, or mouths, they can become infected. Infected people can spread Measles to others from four days before to four days after the rash appears.* *Sometimes immunocompromised patients do not develop the rash.

3. G ENERAL I NFORMATION ON M EASLES Measles is transmitted by contact with an infected person through coughing and sneezing; infected people are contagious from 4 days before their rash starts through 4 days afterwards. After an infected person leaves a location, the virus remains viable for up to 2 hours on surfaces and in the air. Measles can be serious in all age groups, however complications are more common in adults older than 20 years of age, children younger than age 5, pregnant women, and people with compromised immune systems, such as HIV infection and leukemia.

4. G ENERAL I NFORMATION ON M EASLES Measles typically begins with: High fever A high grade fever is greater that a temperature of 103 o F A fever starts at a temperature of 101 o F and goes up to 103 o F A low grade fever starts at a temperature of 99 o F and goes up to 101 o F Runny nose Cough Red, watery eyes Diarrhea Ear infection Rash

5. G ENERAL I NFORMATION ON M EASLES The symptoms of measles generally appear about 7 to 21 days after a person is infected (incubation period). A person infected with Measles can pass the virus to others before symptoms are noticed. About 3 out of 10 people who get measles will develop one or more complications including pneumonia, ear infections, or diarrhea. Two or three days after symptoms begin, tiny white spots (Koplik spots) may appear inside the mouth. Mouth of a patient with Koplik spots, an early sign of measles infection.

6. G ENERAL I NFORMATION ON M EASLES Three to five days after symptoms begin, a rash breaks out. It usually begins as flat red spots that appear on the face at the hairline and spread downward to the neck, trunk, arms, legs, and feet. Small raised bumps may also appear on top of the flat red spots. The spots may become joined together as they spread from the head to the rest of the body. When the rash appears, a person’s fever may spike to more than 104° Fahrenheit. After a few days, the fever subsides and the rash fades. Skin of a patient after measles infection

7. A M I P ROTECTED AGAINST M EASLES ? According to the CDC, you are considered protected from measles if you have written documentation (records) showing at least one of the following: You received two doses of measles-containing vaccine, and you are a(n)— school-aged child (grades K-12) adult who will be in a setting that poses a high risk for measles transmission, including students at post-high school education institutions, healthcare personnel, and international travelers. You received one dose of measles-containing vaccine, and you are a(n)— preschool-aged child adult who will not be in a high-risk setting for measles transmission. A laboratory confirmed that you had measles at some point in your life. A laboratory confirmed that you are immune to measles. You were born before 1957.

8. W HAT SHOULD I DO IF I’ M UNSURE WHETHER I’ M IMMUNE TO MEASLES ? If you’re unsure whether you’re immune to measles, CDC states you should first try to find your vaccination records or documentation of measles immunity. If you do not have written documentation of measles immunity, the CDC suggests you get vaccinated with measles- mumps-rubella (MMR) vaccine. Another option is to have a doctor test your blood to determine whether you’re immune, but this option is likely to cost more and will take two doctor’s visits. There is no harm in getting another dose of MMR vaccine if you may already be immune to measles (or mumps or rubella).

9. D O I HAVE TO BE VACCINATED ? No, there are many reasons why people choose not to get vaccinated. Every person in the United States has the right to choose whether or not they get vaccinated. For those under age 18, the legal parent or guardian has the right to choose if the child should be vaccinated. People exposed to Measles who cannot readily show or simply do not know if they have been vaccinated, can get the MMR vaccine as soon as they have been exposed (up to 6 days after exposure, the vaccine may provide some protection or modify the clinical course of the disease)

10. CDC V ACCINATION R ECOMMENDATIONS The Centers for Disease Control and Prevention (CDC) recommends: Routine childhood immunizations for MMR vaccine starting with the first dose at 12 through 15 months of age, and the second dose at age 4 through 6 years of age or at least 28 days following the first dose. Students are post-high school educational institutions without evidence of measles immunity need 2 doses of MMR vaccine, with the second dose administered no earlier than 28 days after the first dose. People who are born during or after 1957 who do not have evidence of immunity against Measles should get at least one dose of MMR vaccine

11. W HAT C AN I DO TO LESSEN THE SPREAD OF M EASLES ? As with any contagious illness, follow standard precautions which include the use of: Hand washing Soap and water is preferably, however an instant hand sanitizer is acceptable if there is no other option. Appropriate personal protective equipment such as gloves, masks, etc. Safe handling and proper cleaning of potentially contaminated equipment or surfaces. Respiratory hygiene/ cough etiquette Cover mouth/nose when coughing or sneezing Use and dispose of tissues Perform hand hygiene after hands have been in contact with respiratory secretions

12. I F YOU SHOW SIGNS OF M EASLES Stay home If you do not have any symptoms but may have been exposed to measles, stay home days 7 - 21 after measles exposure (the day of exposure is considered day 0). If you develop any measles symptoms, please contact your healthcare provider as soon as possible and the Public Health Services Department.

13. W HAT TO DO WHILE RECOVERING FROM A R ASH I LLNESS Remain in your own home or yard and do not interact with people outside the home. If you live in an apartment or other group housing setting, do not go to any common areas. DO NOT visit any public locations unless necessary to obtain medical care. Ask a friend or family member to run errands like grocery shopping and picking up medications while you stay home.

14. W HAT TO DO WHILE RECOVERING FROM A R ASH I LLNESS If you need medical care, call the facility ahead of time to let them know you may have been exposed or are possibly infected with measles. Your provider may arrange to see you outside of the facility, request that you visit after all other patients have left, or give you other directions. DO NOT remain in the waiting room with other patients DO NOT use public transportation such as the bus to go to your medical visit

15. W HAT TO DO WHILE RECOVERING FROM A R ASH I LLNESS DO NOT allow anyone who is not immune to measles to visit you in your home. People are considered immune to measles if they have two documented dose of measles vaccine (MMR) or can prove by a blood test that they are immune to measles. If you are having symptoms (e.g. a rash), CDC recommends you stay home for at least 5 days after the rash started (until you are no longer contagious).

16. H OW MANY MEASLES CASES ARE THERE IN THE U NITED S TATES EACH YEAR ? From 2001 to 2013, the number of measles cases reported in the United States ranged from 37 to 220. However, in some years like 2014, there have been more measles cases than usual. From January 1 to July 18, 2014, there have been 580 people in 20 states reported as having measles. The United States experienced a record number of measles cases during 2014, with 644 cases from 27 states reported to CDC's National Center for Immunization and Respiratory Diseases (NCIRD).

17. H OW MANY MEASLES CASES ARE THERE IN THE U NITED S TATES EACH YEAR ? From January 1 to January 30, 2015, 102 people from 14 states were reported to have measles. Most of these cases are part of a large, ongoing multi-state outbreak linked to an amusement park in California. The majority of the people who got the measles were unvaccinated.

18. H OW MANY MEASLES CASES ARE THERE IN THE U NITED S TATES EACH YEAR ?

19. L OCAL REPORTS OF M EASLES No reports have been made within Kings County as of February 3, 2015. One reported exposure occurred in Fresno County in January, 2015. No reports have been made within Tulare County as of February 3, 2015.

20. CDC’ S ROLE IN RESPONDING TO M EASLES CASES AND OUTBREAKS For more information on Measles, you can go to www.cdc.gov www.cdc.gov State and local health departments have the lead in investigating measles cases and outbreaks when they occur. CDC helps and supports health departments in their investigations by: Providing technical support for measles prevention and control Testing specimens from patients with suspected measles infection Providing rapid assistance on the ground during outbreak investigations, often through a formal request from the state health department.

21. O THER RESOURCES World Health Organization http://www.who.int/topics/measles/en/ California Department of Public Health http://www.cdph.ca.gov/Pages/NR15-008.aspx County of Kings Health Department http://www.countyofkings.com/departments/health- welfare/public-health http://www.countyofkings.com/departments/health- welfare/public-health EZIZ http://eziz.org/resources/measles/ LA Times – Many California child-care centers have low measles vaccination rates http://www.latimes.com/local/california/la-me- measles-preshool-20150204-story.html http://www.latimes.com/local/california/la-me- measles-preshool-20150204-story.html