SHEA Weighs in on Addressing Measles Outbreaks

By Matt Phillion

With notable measles outbreaks occurring in different regions in the U.S., the Society for Healthcare Epidemiology of America (SHEA) is raising awareness about what health systems can do to prevent infections. Early recognition, isolation of suspected and confirmed cases, the use of PPE, ventilation controls, and more are essential to limiting outbreaks and infections. There’s also a growing discussion on what healthcare workers can do, including MMR vaccination, to keep themselves and their patients safe.

“We’re coming at this through the lens of healthcare to make sure we don’t have the spread of cases in our healthcare facilities. We’ve been dealing with community pockets of measles for the last 15 years in correlation with reduced vaccination,” says Dr. Tom Talbot, MD, MPH, president of SHEA and chief hospital epidemiologist with Vanderbilt University Health Center. “More folks have been declining vaccination for kids, and now we’re seeing that all it takes is the introduction of a single case that can be the kindling and create the spark for an outbreak.”

With these growing concerns, Talbot notes, comes a need to truly consider how clinicians react when someone shows up in a healthcare setting who may have a case of measles. The challenge, for many, is that measles has been so rare in the U.S. for so long that many clinicians haven’t had reason to encounter it in their own practices.

“Many clinicians grew up not seeing it much: the clinical recognition of a case is not as familiar, but it’s important to raise the attentiveness of clinicians to have a low threshold to suspect measles,” says Talbot. “When that light bulb goes off, they need to start taking the right measures to keep everyone safe.”

While situations like this are not ideal, they do offer a chance to take a step back and look at the basics of epidemiology and make sure organizations are prepared.

“It’s unfortunate that we need these reminders, but clinicians are inundated, they’re extremely busy,” says Talbot. “Cases are rare, but not nearly as rare as they had been, and so we need to make sure we’re alert.”

Getting back to the basics can be as straightforward as educational images and tools to help with measles identification.

“We had some cases around Memphis some years ago, and knowing that you might see a case, we made sure there were resources that were easy to access and built into the workflow. Clinicians might be busy in the moment, but when that light bulb goes off and they think they might see a case, they don’t have to go searching for those materials,” says Talbot.

Always be on the lookout

While there is not as much institutional knowledge about measles as there once was due to its rarity for so long, a lesson about overall preparedness can be a powerful takeaway from these current outbreaks.

“I tell people when I teach trainees to always have in your mindset: does this patient have a contagious condition?” says Talbot. “Nobody’s going to be mad at you if you isolate a patient if you have a suspicion. Maybe you’re wearing a gown, gloves, and so on, but it’s not that big a burden, and if you don’t think about it from this mindset, you suddenly find you’ve had a case of measles in your shared spaces, and that’s where you have that never event you don’t want to have.”

Use precautions, isolate, and call for assistance, Talbot says.

“Isolation is not a punishment,” he says. “Patients don’t like it and it scares them,” but erring on the side of caution can be beneficial.

This proactive preparedness doesn’t just stop with elevated awareness on the part of clinicians. Organizations can offer proper placement in isolation, rooms with better ventilation—something Talbot notes has seen a push throughout the industry recently—and ensuring that those who are most likely to encounter people throughout a facility are taking precautions so they are not the person who brings a case into the building.

On the upside, we have witnessed a general rise in awareness about infectious illnesses overall, Talbot notes.

“It’s anecdotal, but there’s a general awareness of how infections may spread, particularly if you are sick,” he says. “It’s better than it was five years ago. Some people are now more likely to say: I was going to get my hair cut today but I don’t feel so good, so I’ll go another time.”

There’s a balancing act that organizations must overcome when discussing preventive measures, as industry burnout is dangerously high.

“We need to be very thoughtful and careful,” says Talbot. “Preventive measures need to be carefully and pragmatically implemented so that the rationale and impact are clear. We need to make sure we’re communicating and are appropriately measured to avoid fueling that burnout.”

The other essential factor in stemming healthcare outbreaks of measles: ensuring healthcare professionals are properly immunized.

“It’s such an infectious virus and can cause some very harmful post-infection issues and complications,” says Talbot. “If you can get immunized, this immunization has such a good track record you don’t have to think about it.”

Be proactive

Now is also the time for healthcare facility leaders to take a proactive stance to help drive how their organizations react to, and prepare for, an outbreak like measles.

“The biggest thing is that leaders actively support infection control programs and interventions,” says Talbot. “Whether there’s an outbreak or not, you want to have those teams and experts as foundational to your organization. It’s also important to prioritize and strengthen expectations for healthcare personnel to be up to date with all recommended vaccines, including measles. Some facilities, as recommended by SHEA, require all healthcare personnel to have proof of immunity to measles if they work in healthcare as a core safety practice.

While this isn’t going to be another COVID-level outbreak because many people are already immune, we can’t discount the dangers to people who are at risk of severe complications from measles exposure.

“We’ve had the luxury of not seeing this infection widespread because of the great success of the measles vaccines,” says Talbot. “We don’t have to see the devastation this has caused.”

It’s easy to accidentally give sentience or ill intent to a virus during an outbreak, but the better way to look at it, Talbot says, is that when there’s an opening, when we’ve made it easier for a virus to cause trouble, it will.

“It seems foolish to make it easier for the virus to harm others,” he says.

Confusion in getting the right message and information out to communities and professionals alike.

“Some of the messaging, particularly around vaccination, has been counter to traditional, evidence-base public health messaging,” says Talbot. “It is concerning how very confidently stressed messaging that is counter to the science can be.”

The message that needs to get out there is that this can be a devastating infection if not handled correctly especially through vaccination, and appropriate messaging needs to drown out information that confuses public understanding of what’s right.

Public education in the right spaces can go a long way.

“Everybody can be a part of this,” says Talbot. “In some of our clinics when someone comes into the building there’s a note: if you have a fever, a rash, a red eye, the classic signs of an infection, that patient shouldn’t sit in the waiting room with others.”

This is sound advice for any number of highly contagious illnesses, Talbot notes.

“We’re talking specifically about measles here, but the same could be said about acute diarrhea, pink eye, does the patient have a new cough,” he says. “All of those things have symptoms that don’t necessarily require a doctor to diagnose—so if we think you might have something contagious, let’s get you somewhere safe to protect others.”

This comes full circle, back to the idea of using extra caution when dealing with very contagious conditions.

“The most effective programs are those that don’t wait for someone to see the physician. They look for signs, signals, and flags to take precautions,” says Talbot.

This can be challenging depending on the environment: not all clinics have enough spaces for effective isolation, for example, but those extra precautions can be game changing.

“We can start identifying those patients when they first come in, put those precautions into place, rather than just waiting until someone’s been sitting in a public space for hours,” says Talbot.

Matt Phillion is a freelance writer covering healthcare, cybersecurity, and more. He can be reached at