Dear Area Medical Providers, A Dallas County resident has been confirmed with measles today by a public health

laboratory. The case is recovering following hospitalization. The source of this adults infection is unknown, since the case did not have a history of recent international travel, and there is currently no known epidemiologic link to the 2 pediatric cases recently reported by Collin County in January. Healthcare providers are reminded to consider the diagnosis of measles in clinically compatible patients, particularly those who have traveled abroad, or come into contact with travelers or known measles cases. Because of the severity of measles, cases are likely to seek care in physicians offices or emergency departments, and pose a risk of transmission in healthcare settings. Please therefore continue to be aware of the following recommendations: ! Ensure written documentation of measles immunity for all healthcare personnel in all outpatient and inpatient setting locations, as per CDC guidelines.(www.cdc.gov/mmwr/pdf/rr/rr6007.pdf) Because of the greater opportunity for exposure, HCP are at higher risk for becoming infected with measles. Prior confirmation of immune status of all HCP enables rapid identification of susceptible HCP requiring furlough following measles exposures. (www.immunize.org/catg.d/p2017.pdf) Immediate airborne isolation precautions of suspected measles cases should occur in healthcare settings after quick triage. In outpatient settings, suspected cases should be placed in a private room with the door closed. Since the room should not be used for 2 hours after a suspected measles case, such patients should be scheduled at the end of the day, if feasible. (www.cdc.gov/hicpac/2007IP/2007isolationPrecautions.html) Testing for measles should be done in patients meeting clinical case definition, which includes: (1) a generalized rash lasting "3 days, and (2) fever "101F (38.3C), and (3) cough, coryza or conjunctivitis. A blood specimen for measles serology and throat swab for viral culture and measles PCR should be collected. (www.cdc.gov/vaccines/pubs/survmanual/chpt07-measles.html) Report immediately any suspected measles cases at the time of initial clinical suspicion to DCHHS at (214) 819-2004 or (877) 605-2660. Do not wait for laboratory confirmation to report. Prompt notification facilitates identification, vaccination and quarantine of susceptible contacts, and also facilitates early routing of clinical specimens to public health laboratories. (www.cdc.gov/mmwr/pdf/rr/rr6204.pdf)