Potential Measles Exposures in DC Region, March 2025

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PUBLIC HEALTH INVESTIGATING POTENTIAL EXPOSURES FROM A MEASLES CASE IN THE DC REGION

March 11, 2025

Dear Colleague:

As you may know, both Maryland and Virginia health officials are investigating potential measles exposures in Northern Virginia and Howard County, Maryland. Persons may have been exposed to the measles virus if they were at the following locations at the specified dates and times:

Washington Dulles International Airport (IAD) on March 5th, 4:00 pm - 9:00 pm at the following locations:
- Terminal A
- Aerotrain public transport from Terminal A Gates to the Main Terminal
- Baggage Claim area
Johns Hopkins Howard County Medical Center Pediatric Emergency Department on March 7th, 3:30 pm - 7:30 pm

***Maintain a high index of suspicion for measles in patients with exposures in the specific locations at the dates and times noted above. ***

This case is not related to the recent larger measles outbreaks occurring in Texas and New Mexico.

Given the recent increases in measles cases and exposures, this is an important reminder to you and your staff to review the following guidance to identify a suspected measles case and how to prepare your practice to protect patients and staff from possible measles exposures, including keeping patients and staff up to date on measles/mumps/rubella (MMR) vaccine schedules.

Please review the following sections with all staff:

WHAT TO DO IF YOU SUSPECT MEASLES IN A PATIENT ALREADY IN YOUR OFFICE
HOW TO PROTECT YOUR PATIENTS AND STAFF FROM POSSIBLE FUTURE MEASLES EXPOSURES

WHAT TO DO IF YOU SUSPECT MEASLES IN A PATIENT ALREADY IN YOUR OFFICE:

Do not allow such patients to remain in your waiting area. Immediately provide a surgical mask to the patient. Place the masked person in a private room with negative pressure if available, or a room with a closed door.
NOTE: Any shared airspace (including the exam room and waiting area) that has been occupied by the patient should not be used for the next 2 hours.
Use standard and airborne precautions and only allow staff with documented evidence of measles immunity to work with the patient.
Call Arlington County Public Health Division (ACPHD) staff immediately to report your suspicion and for guidance on appropriate testing and control measures. You can reach ACPHD staff 24/7 to report suspect cases of measles and/or to discuss these recommendations and other questions you may have about measles:
- Monday to Friday, from 8 AM to 4:30 PM, call 703-228-5200, option #1.
- Nights and weekends, call 703-558-2222 and ask for the Public Health Duty Officer.
NOTE: You may be asked to collect up to three specimens to confirm measles: 1) serum, 2) nasopharyngeal swab, and 3) oropharyngeal swab.

For patients needing transport by EMS from your office to the hospital:

Notify EMS that you suspect measles, so EMS personnel can take appropriate precautions before arriving at your office to protect themselves from exposure during transport.
Notify the receiving hospital that you suspect measles, so hospital personnel can take appropriate precautions to protect themselves when they receive the patient from EMS and protect the other patients from exposure by directing the masked patient to an appropriate exam room.

HOW TO PROTECT YOUR PATIENTS AND STAFF FROM POSSIBLE FUTURE MEASLES EXPOSURES

The most effective protection against measles infection is getting adequately vaccinated.

MMR VACCINATION GUIDANCE FOR:

Infants

Children

Students, Travelers, Healthcare Personnel

All Other Adults

If traveling internationally, infants 6 through 11 months old should receive 1 dose of MMR vaccine before departure.
Infants who receive a dose of MMR vaccine before their first birthday should receive 2 more doses of MMR vaccine at the recommended ages and at least 28 days apart.

Children should receive 2 doses of MMR vaccine–the first dose at 12 through 15 months of age and the second dose 4 through 6 years of age.
Giving the second dose of the vaccine earlier is allowed if it is at least 28 days after the first dose.

Unless they have evidence of measles immunity, college and other students, health care personnel, and international travelers need 2 MMR doses that have been given on or after age 1 and at least 28 days apart.

All other adults born in or after 1957 should have documentation of at least 1 dose of MMR or other evidence of measles immunity.

Ensure all eligible patients are adequately vaccinated against measles (see vaccination table above)
Ensure all office staff, from direct care to administrative staff, have evidence of immunity to measles:
1) documentation of two doses of measles vaccine or

2) documentation of laboratory evidence of immunity.
Proactively ask your patients NOT to walk in unannounced when they have fever and rash. Advise patients to report fever and rash symptoms when they contact you to request an appointment.
Instruct staff to ask patients about fever and rash symptoms when they request an appointment.
Schedule appointments for patients with suspected measles at the end of the day or when other patients are not present and will not arrive within 2 hours of the scheduled visit for the suspected measles patient.