Control and Prevention

During an outbreak or local community transmission, any workers who are unvaccinated or partially vaccinated (one dose) can become ill if exposed to measles.

According to the CDC, people born before 1957 and those who developed measles in the absence of a vaccine are presumed to have lifelong natural immunity. Conversely, the CDC recommends that people who were vaccinated between 1963 and 1968 and do not know the type of vaccine they received should consult their healthcare provider about receiving the MMR vaccine. This is because a “killed” version of the vaccine was found to be less effective in 1967 and withdrawn.

Workers in certain professions are more likely to be exposed to the measles virus during an outbreak due to their work environment, while others are at greater risk for serious illness and complications from measles if exposed.

General Recommendations for Employers

Employers may encourage workers at risk of exposure to get the measles, mumps, and rubella (MMR) vaccine. The CDC recommends that the best way to prevent measles is through vaccination of those who have not already been vaccinated or had measles. Workers may be more likely to get the vaccine if it is available to them at no cost.

Ensure all workers have access to hand-washing facilities equipped with adequate hand-washing supplies in accordance with 29 CFR 1910.141.

Conduct a hazard analysis to identify workers at risk of exposure to the measles virus during an outbreak. When performing a hazard analysis, specific work operations and tasks should be considered before implementing a hazard control plan.

Select appropriate controls. Based on the results of the hazard analysis, including engineering controls, administrative controls, safe work practices, and personal protective equipment (PPE). Some controls may be required by OSHA standards.

Follow applicable OSHA Standards. As described on the Standards page, OSHA's Personal Protective Equipment (PPE) standards (in general industry, 29 CFR 1910 Subpart I, and in construction, 29 CFR 1926 Subpart E) require gloves, eye and face protection, and respiratory protection to help prevent worker exposure to the measles virus. OSHA’s Bloodborne Pathogens (BBP) standard (29 CFR 1910.1030) also applies to workers who have occupational exposure to human blood, saliva in dental procedures, and other potentially infectious materials (OPIM) as defined in the standard. When the BBP standard applies, employers must implement universal precautions and other infection prevention measures, such as a written exposure control plan, engineering and work practice controls, PPE, and worker training as described in Healthcare Workers (HCW).

Develop specific work instructions to ensure procedures are followed consistently.

Train workers to use PPE appropriately. OSHA requires training on when to use PPE; what PPE is necessary; how to properly put on, use, and take off PPE; how to properly dispose of or disinfect, inspect for damage, and maintain PPE; and the limitations of PPE. Applicable standards to protect workers from measles in 29 CFR 1910 Subpart I include those for personal protective equipment (29 CFR 1910.132) and respiratory protection (29 CFR 1910.134). OSHA offers a variety of training videos on respiratory protection.

Workers exposed to human blood or other potentially infectious materials must receive training required by the Bloodborne Pathogens (BBP) standard (29 CFR 1910.1030), including recognition of hazardous tasks and controls that reduce the likelihood of exposure. More information on OSHA's BBP training regulations and policies is available for employers and workers on the OSHA Bloodborne Pathogens and Needlestick Prevention Safety and Health Topics page.

Cleaning and Disinfecting

Choose disinfectants effective against measles from the Environmental Protection Agency (EPA) List S since measles is an enveloped virus like HIV and Hepatitis.

Protect workers from chemical exposures when cleaning and disinfecting areas, surfaces, and equipment potentially contaminated with the measles virus. For hazardous chemical exposures, train workers on the hazards of the chemicals, and provide appropriate PPE and training based on the results of the hazard analysis. Where respiratory protection is worn, respirators must be used as part of a comprehensive respiratory protection program that includes medical evaluations, fit testing, training, and meets the requirements of OSHA's Respiratory Protection standard (29 CFR 1910.134). OSHA standards for PPE (29 CFR 1910 Subpart I) and Hazard Communication (29 CFR 1910.1200) require employers to protect workers from chemical hazards. See the Standards section for more detailed information.

Employers must also follow requirements in mandatory OSHA standards for Hazard Communication, 29 CFR 1910.1200, and PPE, 29 CFR 1910.132, .133, .134, and .138, when these chemicals are used.

If a worker contracts measles on the job, contact your local health department for guidance. Visit the Standards section for information about OSHA recordkeeping and reporting requirements that may apply in this situation.

Centers for Disease Control and Prevention
(CDC)/Judy Schmidt

The Centers for Disease Control and Prevention (CDC) recommends vaccination to protect against measles, mumps, and rubella (MMR). Adults who do not have evidence of immunity should get at least one dose of the MMR vaccine. According to the CDC, workers traveling outside of the United States need two doses spaced at least 28 days apart.

General Recommendations for All Workers

All workers with potential exposure to measles viruses should take the following precautions:

Consider getting the measles (MMR) vaccine. Receiving two doses of the MMR vaccine has proven to be 97% effective in preventing measles.

Avoid unprotected contact with people who have measles. This includes physical contact as well as being in close physical proximity (shared air), since measles is spread through particles and tiny droplets in the air. In addition, all surfaces near someone who has measles should be considered contaminated.

Clean and disinfect contaminated areas. Use disinfectants registered with the U.S. Environmental Protection Agency (EPA) List S. Carefully follow the manufacturer’s directions on the label and wear appropriate PPE to handle and safely use the product and avoid harm to workers and the environment.

Practice good hand hygiene. Wash hands thoroughly and frequently for at least 15 seconds with soap and water. If soap and water are not available, use hand sanitizer containing at least 60 percent alcohol. Hand hygiene is especially important after contact with patients or with surfaces that may be contaminated with respiratory droplets, saliva, or other body fluids.

If you wear PPE, wash hands after removing PPE, and prior to eating, drinking, smoking, or bathroom use. The Centers for Disease Control and Prevention (CDC) provides additional information about effective hand hygiene practices. Shower at the end of each shift (or as soon as possible).

Measles Exposure on the Job

If you have been exposed to measles and are not immune, you may be eligible to receive Immunoglobulin G to protect you from serious disease. You should isolate yourself and monitor symptoms to protect others from contracting the disease. If you do have measles, 9 out of 10 close contacts who are not immune will also become infected.

• Practice good hand and respiratory hygiene. Wear a face covering, if available, especially if you are coughing or sneezing.
• Notify your employer immediately and go home.
• Notify your healthcare provider. Healthcare providers may be able to provide post-exposure care that protects against or lessens the effects of measles.
• Monitor your health. Early signs and symptoms of measles typically develop within 10-12 days. It may take up to 21 days following exposure for a rash to develop.
• If you become ill, see your healthcare provider. Alert the clinic or emergency room in advance about your possible exposure to measles so that arrangements can be made to prevent spreading it to others. You may be eligible for Post-Exposure Prophylaxispost-exposure prophylaxis if you know when your exposure occurred.
• When traveling to a healthcare provider, limit contact with other people. Wear a face covering and practice good hand and respiratory hygiene. Avoid all other travel. If you are working abroad, contact your employer for help with locating a healthcare provider. The U.S. embassy or consulate in the country where you are located can also provide names and addresses of local physicians.

Additional Measures for Specific Industries

The following sections provide additional guidance for workers who are more likely to be exposed to measles during an outbreak. These recommendations are provided in addition to the General Recommendations for All Workers.

As noted in the General Recommendations for Employers, employers of healthcare workers (HCWs) should implement measures for early identification and isolation of measles patients and may encourage workers to get the MMR vaccine if they are not immune to measles already (i.e., through previous vaccination or having had the virus).

Healthcare Workers

 

HCWs should follow recommendations provided in the General Recommendations for All Workers and the additional recommendations about personal protective equipment (PPE), standard precautions, and airborne precautions described here. This is because HCWs may have daily encounters with patients and perform work tasks that expose them to the measles virus. Activities that may increase the likelihood of exposure to measles include:

• Triaging or providing care to an infected patient—pediatric (i.e., child) or adult.
• Performing aerosol-generating procedures (AGPs) on an infected patient (e.g., intubation, airway suctioning). Although measles is already considered an airborne-transmissible disease, AGPs may increase transmission risk by adding to the concentration of the measles virus suspended in the air in the work environment.
• Working in environments where an infected patient or co-worker is or has been within the previous two hours (shared air).
• Cleaning or otherwise having contact with environmental surfaces contaminated with an infected person’s infectious body fluids (i.e., respiratory secretions, saliva).

Employers of HCWs should support the implementation of standard and airborne precautions whenever suspected or confirmed cases of measles are present in the healthcare workplace. All HCWs should routinely follow airborne and standard precautions when triaging and caring for patients with suspected or confirmed measles—even if HCWs have received the MMR vaccine. These precautions are necessary since, in very rare instances, the MMR vaccine may not completely protect workers against infection.

Standard Precautions

Healthcare workers routinely have exposure to potentially infectious body fluids. Following the provisions of OSHA’s BBP standard (29 CFR 1910.1030) and routinely following standard precautions, which expand universal precautions that the BBP standard requires, can help protect healthcare workers from potential sources of contact transmission.

Personal Protective Equipment

Healthcare workers should select and use PPE based on the results of the hazard analysis and as appropriate for their job tasks. In a healthcare setting, this may include, but is not limited to, the following:

• Disposable gloves (nitrile or powder-free latex)
• Disposable or washable gown or scrubs.
• Respiratory protection. HCWs should use NIOSH-approved, air-purifying respirators with a particulate filter that is rated N95 or higher.

Note that respirators must be used in conjunction with other airborne precautions as feasible and should be part of a comprehensive respiratory protection program that includes medical evaluations, fit testing, training, and meets the provisions of OSHA's Respiratory Protection Standard (29 CFR 1910.134).

For more information about appropriate selection of respiratory protection, see 2004 NIOSH Respirator Selection Logic for guidance on the protective capabilities of respirators. In addition, you may visit OSHA's Personal Protective Equipment and Respiratory Protection pages for more information on PPE and respirator selection and use.

When performing procedures that may result in contact with body fluids or splashes of infectious body fluids or materials (AGP), additional measures should be taken to protect the face. HCWs may consider wearing the following as an additional control to prevent exposure:

• Properly fitted, unvented, or indirectly vented safety goggles.
• Full face shield.
• Disposable head or hair cover, and if needed, beard cover.
• Disposable, fluid impermeable gown.

Practice good hand and respiratory hygiene as described in General Recommendations for All Workers. Do not eat, drink, or smoke, while wearing PPE. Remove gloves promptly after use and change them if torn, punctured, or otherwise damaged. Remove all PPE at work to avoid taking contaminated items home. Sanitize surfaces frequently to help prevent exposure to measles.

CDC/Debora Cartagena

Properly fit-tested, NIOSH-approved N95 filtering facepiece respirators, as shown in the photo, can protect workers from the measles virus in the air. When job tasks result in aerosols, workers may need more protective respirators, such as a powered air-purifying respirator (PAPR) equipped with high-efficiency particulate arrest (HEPA) filters.

Airborne Precautions

In addition to barrier precautions for contact transmission (i.e., as mentioned above and described in the BBP standard (29 CFR 1910.1030) and respiratory protection), HCW employers should implement other airborne precautions to protect workers.

Airborne Precautions prevent transmission of infectious agents that remain infectious over long distances when suspended in the air. Successful implementation involves patient isolation in a specially designed airborne infection isolation room (AIIR). An AIIR is equipped with special air handling and ventilation capacity that meet the American Institute of Architects/Facility Guidelines Institute (AIA/FGI) standards.

For more information about patient isolation using AIIRs, see NIOSH: Expedient Patient Isolation Rooms

Post-Exposure Prophylaxis

If you are exposed to measles in the healthcare setting, follow Measles Exposure on the Job and you may request post-exposure prophylaxis depending on the circumstances and timeline. There are two types of post-exposure prophylaxis for measles:

• MMR vaccine (administered within 72 hours of exposure)
• Immunoglobulin (IG) (administered within 6 days of exposure)

Healthcare providers should consult CDC recommendations for post-exposure prophylaxis, including guidelines for ministering the MMR vaccine or IG, but not both.

 

Laboratory Workers

 

Laboratory workers should follow General Recommendations for All Workers. However, additional controls are needed for workers in clinical and research laboratories since they are more likely to be exposed to infectious materials containing the measles virus.

Clinical laboratory workers’ exposure risks are increased during outbreaks when they are most likely to encounter respiratory and blood samples from infectious patients. Research laboratory workers are most at risk of occupational exposure whenever their work involves materials containing the virus. These hazards are amplified when work tasks involve propagating or growing the measles virus in cells.

In clinical laboratories, employers should implement procedures for careful accessioning of potentially infectious samples/specimens/materials. As noted in the General Recommendations for Employers section, employers may encourage workers to get the MMR vaccine if they are not immune to measles already (i.e., through previous vaccination or having had the virus) and offer the MMR vaccine to workers who are at risk of exposure).

In research laboratories where the work involves Morbillivirus hominis, a biological risk assessment should be performed as described in Biosafety in Microbiological and Biomedical Laboratories, 6th Edition (BMBL6) to determine what controls may be needed to prevent exposure.

In general, workers handling samples containing Morbillivirus hominis should work in a properly maintained Class II biosafety cabinet (BSC) with HEPA-filtered exhaust air whenever aerosol-generating procedures (AGPs) are being performed or when high volumes of pathogen are handled. Laboratory workers should be diligent in following appropriate hand hygiene practices.

Tasks that present aerosol exposure hazards that are not completely controlled by working in a BSC may require employers to provide respirators for workers. Laboratory workers should follow recommendations for PPE, including respirators, as described for Healthcare Workers. Consult Section IV of the BMBL6 manual for more details on appropriate biosafety practices.

Laboratory workers who are exposed should follow recommendations for All Workers and in Post-Exposure Prophylaxis.

 

Workers in Congregate and High-Density Settings

Congregate settings are facilities where unrelated people meet or gather in the same space for an extended period of time. People in congregate settings may share classrooms, kitchens, bathrooms, and sleeping quarters. Congregate settings may include, but are not limited to:

• Schools and daycares
• Assisted living facilities
• Dormitories
• Correctional Facilities

Similarly, settings where work tasks are performed in close proximity to other workers are considered high-density environments. These are often food processing and factory assembly lines but can be offices and other workplaces where many work in a relatively small space.

When people share spaces with many others, there is an increased risk of exposure to measles and all other infectious diseases. When community transmission of measles is ongoing, it is important for workers in congregate settings and high-density workplaces to identify people who are ill and inform the appropriate authorities so that measures can be taken to prevent further spread of disease. When possible, isolate the sick person from others until a medical examination or other appropriate actions can take place.

Workers in congregate settings that are often exposed to body fluids (i.e., daycares, assisted living facilities, etc.) should wear appropriate PPE prior to contact with these fluids or surfaces that may be contaminated. Workers in high-density environments are more likely to be exposed to aerosols and droplets resulting from coworkers’ coughs and sneezes.

In these settings, it is also important to ensure that common surfaces and high-touch items (phones, door knobs, elevator buttons, etc.) are cleaned regularly and decontaminated using EPA-registered disinfects from List S (at a minimum) and according to manufacturer instructions. Some facilities use EPA-registered disinfectants intended for organisms that are harder to kill than measles, i.e., non-enveloped viruses.

Workers Susceptible to Severe Disease

Measles can be especially hazardous for workers who are or may become pregnant and those with weakened immune systems.

Pregnant Women

Pregnant women who get measles may experience more frequent or severe complications from the virus, including pneumonia and death, compared to non-pregnant women. Measles infection during pregnancy also may cause expectant mothers to have miscarriages, give birth prematurely, or deliver low-birth-weight babies. A pregnant woman who gets measles can transmit the infection to her fetus if she has the virus within approximately 10 days of delivery. In addition to premature birth and low birth weight, measles can lead to other complications and death among infants born with the virus or infected shortly after birth, and may be especially severe among such infants.

Because of the risk of adverse health effects associated with measles infection during pregnancy, the Centers for Disease Control and Prevention (CDC) recommends that anyone without immunity get the MMR vaccine at least one month before becoming pregnant. Workers at risk of exposure can be tested before becoming pregnant, but there is no consensus on the utility of these tests. The MMR vaccine may cause complications if administered during pregnancy.

Workers who are pregnant or may become pregnant should talk to a healthcare provider about whether to request reassignment to work in an environment where they are less likely to be exposed to measles (i.e., away from non-immunized children, inbound international travelers, members of the public in outbreak-affected areas).

The Pregnancy Discrimination Act protects women who are pregnant or are planning to become pregnant from adverse employer actions that may result from notifying their employer of pregnancy plans or requesting reassignment due to pregnancy concerns.

Workers with Weak Immune Systems

Many conditions can weaken the immune system, including older age, chronic illness (especially those that affect the immune system, such as HIV and leukemia), and taking certain medications.

Workers with weak immune systems are more susceptible to most infectious diseases, including measles. These workers also have an increased risk of serious complications from measles and should take extra precautions, such as diligent adherence to hand and respiratory hygiene and using a mask or face covering during community transmission.

 

Workers Who Travel Abroad

According to the CDC, anyone who travels outside the United States is at increased risk of exposure to measles. Measles is endemic (i.e., routinely spreading) or associated with epidemics (i.e., spreading currently, but not always circulating) in many countries throughout the world, including many areas of Europe, Asia, the Pacific, and Africa.¹

American workers who travel to countries with endemic or epidemic measles may be exposed to the virus. Not only are international travelers at risk of getting measles abroad, but they may also bring the disease back to the United States if they return before they develop measles or during the infectious period. Most U.S. measles cases result from international travel.

Before any international travel, the CDC recommends that adults who do not have evidence of immunity against measles receive two doses of MMR vaccine, separated by at least 28 days.

Employers may consider allowing flexibility in required travel, including delaying travel to areas with ongoing measles outbreaks, especially for workers who are concerned about measles exposure. This includes workers who are not vaccinated (including those with health conditions that preclude vaccination), who are or may become pregnant, or whose sexual partners or household contacts are or may become pregnant. CDC guidance for travel to measles-affected areas may also help employers and workers in travel-related operations, such as airline crewmembers and cruise line workers, take appropriate precautions.