Ask patients about any fever or rash to stop measles, says NHSE

ask patients about any fever or rash to stop measles, says new guidance

Patients should be asked about any fever or rash in a bid to stop the spread of measles, new guidance from NHS England (NHSE) says.

All staff must also know that non-immunised individuals with these symptoms should be isolated on arrival in the building under the advice which notes that ‘measles is highly infectious and correct triage is essential’.

Assessment of patients must be done in an isolated room with appropriate PPE.

If there is any suspicion of measles infection, the local health protection team must be notified by phone immediately so they can advise on contact tracing, the recommendations add.

And all staff working in proximity to patients should have two documented MMR vaccinations or be IgG positive for measles. Staff without immunity should not be involved in the assessment of management of patients suspected to have the infection.

In children under the age of one, immunocompromised or pregnant patients, immediate advice on management should be sought from local paediatric services.

This should also happen through locally agreed rapid access routes if the patient has symptoms of serious complication including pneumonia or neurological problems.

But healthcare professionals should also be alert to other causes of rash especially in those who have been fully immunised including scarlet fever, Kawasaki disease, early meningococcal disease and rubella, the advice says.

Adults and children with measles should stay away from nursery, school, or work for at least four days after the initial development of the rash.

It comes as cases of measles in England continue to rise despite signs that a large outbreak in the West Midlands is now starting to decline after officials declared a national incident in January.

In the past week a further 59 cases have been confirmed by laboratory testing bringing the total to 789 since October.

Increased case numbers have largely been driven by outbreaks in Birmingham but this is now on a downward trend, the UK Health Security Agency (UKHSA) said.

Small clusters of cases are being seen in other areas with 43 cases in London in the past month, 15 in the East Midlands and 11 in the North West.

Almost two thirds of all cases have been in children under the age of 10 with 30% in young people and adults over the age of 15.

Almost one million adults aged 19 to 25 in England have been invited to book an MMR vaccination appointment because they did not have it when they were children.

It is part of the NHS catch-up campaign specifically targeted in the West Midlands, Greater Manchester and London, where young adults are ‘more at risk’ from measles.

UKHSA said despite falling cases in the West Midlands we cannot be ‘complacent’ as it only takes one case in a community with low vaccination rates for measles to spread rapidly.

NHSE previously warned that community pharmacies were among the ‘most likely’ places to encounter measles, with staff instructed to ‘take appropriate action’ and wear PPE.

And after the Pharmacists' Defence Association (PDA) raised pharmacists' concerns about seeing patients with shingles as part of the Pharmacy First service, particularly when the staff member might be pregnant, reporting that adequate PPE was not always available.

NHSE confirmed that ‘pharmacy contractors are responsible for the health and safety of staff providing pharmaceutical services’.

The PDA then highlighted the need for pharmacy contractors to provide adequate PPE to pharmacists and their teams to guard against Covid-19, shingles and other viruses.

A version of this article first appeared on our sister publication Pulse.

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