• ciprofloxacin-resistant strains of N. meningitidis detected

• ciprofloxacin no longer recommended for PEP

• alternative recommendations

  • • rifampin (90–95% efficacy)

• <1 month: 5 mg/kg PO q12h x 2d; consult expert for infants <1 months

• children ≥1 month: 10 mg/kg PO q12h x 2d (max 600 mg)

  • • can interfere with efficacy of OCP & some seizure and anticoagulant medications

    • can stain soft contact lenses

• adult: 600 mg PO q12h x 2d

• • • ceftriaxone (90–95% efficacy)

• children <15 years: 125 mg IM x1

• ≥15 years – adult: 250 mg IM x1

• • • azithromycin (90% efficacy)

• children: 10 mg/kg PO x1 (max 500 mg)

• adult: 500 mg PO x1

• no changes in empiric treatment of IMD recommended

• counties affected: Imperial, Kern, Long Beach, Los Angeles, Orange, Pasadena, Riverside, San Bernardino, San Diego, San Luis Obispo, Santa Barbara, and Ventura

When evaluating patients

• gather detailed information on symptoms and any epidemiological risk factors (exposure in past 21 days) such as: 

  • • Contact with known measles case or someone with fever and a rash 

    • International travel or exposure to international visitors 

    • Travel through international airports or to popular US venues 

    • Residence in or visitation of a community with measles cases 

Recognizing Symptoms

• Measles symptoms include: 

  • • Fever 

    • Descending maculopapular rash 

    • At least one of the "3 C's" (cough, coryza, and conjunctivitis) 

Note: Any patient showing these symptoms, regardless of vaccination status, should be evaluated for measles. 

Immediate Actions

• If measles is suspected: 

  • • Mask and isolate the patient. Follow infection control guidelines. 

    • Alert Infection Control (03184 or Epic chat: Infection Control group)

    • Notify local health department

      • • 800-722-4794 during business hours (Monday-Friday, 8 a.m.-5 p.m.)

        • 800-472-2376 after hours, holidays, or weekends

Infection Control Measures for Suspected Measles

• Mask the patient as soon as measles is suspected, place a surgical mask on the patient. 

• Limit Exposure: Do not allow the patient to remain in the waiting area. Immediately move them to a negative pressure room, closing the door behind them. 

• Room Protocols: If no negative pressure room is available: 

  • • Place the patient in a single exam room with a closed door or evaluate them outside if necessary

    • Visitors and Staff: Only essential visitors and staff should enter the room. All staff, regardless of immunity status, must use N95 respirators or PAPR and Standard Precautions. 

• Staff not known to be immune should not enter room

• Maintain a log to track potential exposures to staff

• Room Cleaning: After patient leaves, ensure exam room is left vacant for at least one hour before entering without N95; follow standard cleaning/disinfection procedures. 

Testing Guidelines

1. Throat (Oropharyngeal) or NP Swab 

• • • Collect within 2 weeks of rash onset 

    • Use sterile synthetic swab (e.g. Dacron)

    • Throat swab is preferred respiratory specimen. Vigorously swab tonsillar areas with Dacron swab

    • Nasopharyngeal swab: firmly rub posterior nasopharynx with sterile Dacron swab. 

    • Place the swab in Universal Viral Transport Media (UVT) and send to lab immediately. 

2. Urine 

• Collect 10-50 ml urine in a sterile container, within 2 weeks of rash onset

• Collect from first part of urine stream. The first morning void is ideal. 

• Send specimen to lab immediately. 

Epic Order Instructions

• Enter "Measles PCR"

• Choose "swab"" or "urine" for specimen type

• Choose "throat", "nasopharynx", or "urine" for specimen 

source

For lab questions, please call 909-580-0015

How do I test for Mpox?

• Use the same swabs as for COVID testing

• Current recommendation: test two different lesions using one swab each

• In EPIC, use “Miscellaneous Test” and specify that it is for Mpox. Code is 12084. Indicate the anatomic location the specimen is obtained in the "Test Info" section.

What is the isolation and screening protocol for suspected cases?

• Place patient in a private room

• Negative pressure not necessary

• Similar protocol as suspected varicella (chickenpox) cases

• Not as contagious or wide spread as COVID-19

What PPE is required of me when I examine the patient?

• Current CDC recommendation for HCW - full protective gear:

  • • gloves

    • eye protection

• Not thought to be aerosolized easily

Do we have vaccines available here at ARMC and who should get vaccinated?

• ARMC has a very limited supply of JYNNEOS

• Supposed to be a 2 dose vaccine given 28 days apart

• Current guideline: divide single dose into 5 smaller doses (and given to 5 individuals)

• May provide sufficient protection to prevent severe illness 

• Indications include recent close contact exposure (within 14 days) to known or highly suspected case, and as pre-exposure prophylaxis to:

  • • men having sex with men

    • pts on PrEP

    • known immunocompromised status

    • recent STI

    • plan to engage in or attend a high risk activity

    • 18 yrs or older

Do we have any treatment available?

• ARMC has a very limited supply of ticovirimat (TPOXX)

• Should only be offered to “high risk” pts only

• Please speak to ID and Pharmacy to dispense this medication

• It requires a lengthy informed consent process before dispensing it

• It is a two week course, given BID either PO or IV

From the CDC

From CDPH

From CAPTC