Provider News Urgent Update: Measles Post-Exposure Prophylaxis (PEP) Information and Referral Instructions

Key Information: It is vital that Seattle Children’s is made aware of patients being directed to the hospital in advance of their arrival. Providers should screen patients for exposure risk, and call Mission Control (206-987-8899) to notify us that they are directing a patient to Seattle Children’s for PEP or suspected measles testing.

As communicated yesterday, there is a patient currently being treated at Seattle Children’s for measles. Public Health – Seattle & King County has reported multiple potential sites of community exposure, pictured below. We want to provide our community with some important information on post-exposure prophylaxis in general, and specific procedures for patients who need to be directed to Seattle Children’s for treatment. Additionally, we are seeking your help in screening concerned patients and only directing those with actual exposure risk who need testing or Immune Globulin to Seattle Children’s. We are directing patients and families with questions to contact their PCP for guidance and appreciate your support in addressing their concerns and referring them to Seattle Children’s only when necessary.

Post-Exposure Prophylaxis Information

Measles post-exposure prophylaxis (PEP) for pediatric patients is a strategy used to prevent or reduce the severity of measles in some children who have been exposed to the virus. The need for post-exposure prophylaxis for measles is dependent on the timing of exposure as well as a patient’s age, health status, and prior immunization status. There are two main options for PEP in children, outlined below. Patients eligible for the MMR vaccine should have that administered by their PCP. For patients who need Immune Globulin, please see details below on instructions for directing those patients to Seattle Children’s.

1. Measles, Mumps, and Rubella (MMR) Vaccine
   • Who: Given to children ≥6 months old who are not fully vaccinated and were exposed to measles within the past 72 hours.
   • Considerations:
     • If given before 12 months of age, the child will still need the routine MMR doses at 12–15 months and 4–6 years.
     • Not recommended for immunocompromised children.
2. Immune Globulin (forms include Intramuscular [referred to as both IMIG and IGIM] and Intravenous [IVIG])
   • Who:
     • Exposed infants <6 months old (who cannot receive MMR).
     • Exposed infants 6 through 11 months old who did not receive MMR within 72 hours after exposure
     • Exposed severely immunocompromised children (e.g., those with cancer, primary immunodeficiencies).
     • Exposed pregnant people who are nonimmune to measles
   • Timing: Must be given within 6 days of exposure.
   • Considerations:
     • The specific form of immune globulin used will depend on patient age and product availability.
     • PEP should be given as soon as possible after exposure.
     • Close contacts (e.g., household members, healthcare providers) should also be evaluated for PEP if unvaccinated.
     • Before getting an MMR vaccine, wait at least 6 months for those who receive IMIG, and at least 8 months for those who receive IVIG

Post-Exposure Prophylaxis and Suspected Measles Testing Procedures at Seattle Children’s

It is vital that Seattle Children’s is made aware of patients being directed to the hospital in advance of their arrival. Providers should call Mission Control (206-987-8899) to notify us that they are directing a patient to Seattle Children’s for PEP or suspected measles testing. Mission Control will work with our teams to facilitate evaluation while reducing exposure. Please note that Mission Control is for provider-to-provider use only and families should not be directed to call this number.

Reminder: Patients eligible for the MMR vaccine as PEP should have that administered by their PCP.

Measles is a highly contagious disease, but it is preventable with vaccines. A patient with measles can expose a large number of people within healthcare settings, so identifying potential cases early is crucial.

Measles symptoms include:

• Fever of more than 100.0° F (37.8° C).
• Cough
• Eye redness
• Runny nose
• Rash