The Measles Test: How CMOs Should Prepare Their Organizations for High-Risk Infectious Disease Outbreaks

As measles cases rise across the United States, clinical leaders must ensure their organizations have the clinical protocols, workforce training, and infection-control infrastructure needed to rapidly identify, isolate, and contain highly contagious diseases.

For many clinicians practicing today, measles is largely theoretical. The disease was declared eliminated in the United States in 2000, and most physicians have never treated a case.

That reality is now changing, and it is creating a new preparedness challenge for health system leadership. As measles cases reappear across the country, CMOs must ensure their organizations can recognize the disease quickly, isolate infected patients, and prevent outbreaks from spreading within hospitals and clinics.

The strategic concern for CMOs is not simply the rise in measles cases. It is whether their clinical teams, infection-prevention protocols, and vaccination programs are ready to respond to a disease that is both unfamiliar to many clinicians and one of the most contagious pathogens in medicine.

Effective preparedness requires coordinated leadership across infectious disease teams, emergency departments, laboratories, and public health partners to ensure that a single case does not escalate into a systemwide outbreak.

There are three primary concerns about the resurgence measles cases, beginning with the health of children, according to Erik Summers, MD, CMO for the Division of Hospital Medicine at Medical University of South Carolina Health. Summers is a member of the CMO Exchange.

"Measles is not a benign disease," Summers says. "Some individuals with measles will develop severe neurological involvement, such as seizures, subacute sclerosing panencephalitis, or brain damage. This can result in clinical devastation to a child, which can result in long-term care needs."

Second, health system and hospital CMOs must be concerned about the ability of their facilities to address a measles outbreak, Summer explains.

"Measles is a highly contagious disease, and statistics show that one in five unvaccinated patients who get measles will be hospitalized," Summers says. "We need to identify space to separate these patients from other patients as soon as possible."

Third, the resurgence of measles raises concern for what lies ahead, according to Summers.

"As childhood vaccination rates decline, will we see diphtheria and polio outbreaks in the future?" Summers says. "It all speaks to the importance of measles vaccination. Two doses of the measles vaccine lower an exposed person's risk of contracting measles from 90% to 3%."

Erik Summers, MD, is CMO at Medical University of South Carolina Health. Photo courtesy of MUSC Health.

Addressing Measles Outbreaks and Promoting Vaccination

There are several steps that health systems, hospitals, and physician practices can take to be prepared for measles outbreaks, according to Cassandra Salgado, MD, MS, the director of the Division of Infectious Diseases at MUSC Health, which operates 18 hospitals in The Palmetto State.

The first step is for CMOs and other clinical leaders to make sure clinical staff understand the epidemiology of the measles outbreaks in the United States, Salgado says.

"Hospitals and physician practices should be aware of the hot spots, the affected populations, how patients are presenting with the disease, and whether there are cases in their state or region," Salgado says.

High-risk populations for measles infection include people who have not been vaccinated, people who have not been fully vaccinated, and people with compromised immune systems such as cancer patients.

"These populations are not only at higher risk for acquiring measles but also for having more serious cases of the disease that require a high level of care," Salgado says.

For CMOs and other clinical leaders, Salgado says there are six essential elements of measles preparedness at health systems, hospitals, and physician practices:

1. Patient populations should be educated about the disease including measures to prevent exposure to the virus.
    
2. Hospitals and physician practices should have the capability to notify people if they may have been exposed to measles.
    
3. It is important to engage teams that can collaborate when there is a measle outbreak such as public health teams, infectious disease teams, pharmacy teams, and the senior leadership of hospitals and physician practices.
    
4. There should be development and implementation of policies, including requirements for vaccination of clinical staff and infection prevention measures such as isolating patients who present for measles assessment.
    
5. Hospitals and physician practices should make sure that measles vaccine is available for any patients who want to receive it.
    
6. Hospitals and physician practices need to be ready to evaluate patients such as developing diagnostic algorithms and ensuring that laboratories know how to order measles diagnostics for patients.
    

To prevent measles outbreaks, CMOs and other clinical leaders should make sure that their health system, hospital, or physician practice has a robust measles vaccination program, Salgado explains.

"Vaccination is the cornerstone for measles prevention," Salgado says. "The need for vaccination should be stressed for at-risk patient populations."

Health systems can promote measles vaccination by utilizing their subject matter experts to educate their patient populations, according to Salgado.

"This education should focus on the safety of the vaccine and the effectiveness of the vaccine," Salgado says. "Health systems also should encourage their primary care providers to have informed conversations with patients who may be hesitant to get the vaccine."

Being Ready to Treat Measles Cases

In general, the treatment of measles patients is supportive in nature, Salgado explains.

"You need to make sure you get patients fluids and get them medication to reduce fever," Salgado says. "The biggest treatment challenge occurs when patients need a high level of care such as assessment in an emergency department or hospitalization. In those cases, you need to have infection prevention measures in place to avoid infection of other patients, employees, or visitors in a hospital."

A recent KFF Health News story found that one of the challenges of treating measles patients is that few doctors have experience in providing measles care.

CMOs and other clinical leaders need to equip their clinicians to rise to this challenge, according to Salgado, who says educating clinicians on how to recognize measles and to treat the disease is paramount.

"Clinical leaders should use subject matter experts to talk about how measles presents clinically," Salgado says. "Doctors should be encouraged to follow public health news briefings that explain how measles patients are presenting in their state or region. Clinicians should be pointed to trusted sources of information such as the World Health Organization, the Centers for Disease Control and Prevention, and the Infectious Diseases Society of America."

Readiness to Contain Measles Outbreaks

CMOs and other clinical leaders not only need to ensure their facilities are prepared to treat measles patients but also must focus on containing an outbreak.

Measles, which is transmitted through the air, is one of the most infectious diseases.

"Whenever an infected individual breathes, talks, coughs, or sneezes, measles viral particles become suspended in the air and can remain in the air for upto two hours," Salgado says. "For people who are not vaccinated for measles, if they come into contact with an infected person or enter a space within two hours where an infected person was located, they have a 90% chance of being infected."

To contain measles outbreaks, CMOs and other clinical leaders should take a holistic approach to infection prevention, according to Salgado.

If someone has been exposed to measles and there is concern that they may be infected, they should be educated about quarantining at home until a healthcare provider can be sure they don't have measles.

If a patient has measles but does not require a high level of care, the patient should isolate themselves from friends, family, and the community until the infection runs its course.

If a measles patient requires assessment in a clinic or emergency department, or if they require hospitalization, CMOs and other clinical leaders should ensure that they are doing everything they can to prevent the illness from spreading to other people in their facilities.

"This includes having infected people don masks before coming into a facility, escorting infected patients to an airborne isolation room as soon as possible, and equipping clinical staff who work with an infected patient with N95 masks," Salgado says.

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