Measles: The Daily PANCE Blueprint
A 26-year-old woman calls the clinic because a coworker she sat beside in a long meeting 2 days ago was just diagnosed with measles. She feels well. She is not pregnant and not immunocompromised, and she has no allergies. She cannot find any record of measles vaccination and does not recall ever having measles. Which is the most appropriate next step?
A. Reassure her and advise her to call only if a rash develops
B. Give 1 dose of the MMR vaccine today
C. Draw a measles IgG titer and vaccinate only if it is negative
D. Advise home quarantine and vaccinate after 21 days
E. Start oral ribavirin
Answer and topic summary
The answer is B. Give 1 dose of the MMR vaccine today
She has no evidence of measles immunity (no documented vaccination, no lab proof, no prior disease, and born after 1957) and a significant exposure 2 days ago. Measles is one of the most contagious infections known, and the virus can stay in the air of a room for up to 2 hours. Postexposure MMR vaccine given within 72 hours can prevent or soften the illness, and it also counts as her first documented dose. ACIP recommends it for exposed people without immunity who are 6 months or older and can receive a live vaccine. Immune globulin within 6 days is the option for those who cannot receive a live vaccine: infants younger than 6 months, pregnant people without immunity, and severely immunocompromised patients. Waiting on a titer can burn through the 72-hour window, reassurance alone wastes the chance to protect her, and ribavirin is not a prevention strategy. She should watch for symptoms for 21 days, and if fever, cough, runny nose, red eyes, or a rash appear, she should call ahead before coming in so staff can place her in an airborne infection isolation room.
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