Letter to Child Care Providers re: Measles From the Pennsylvania Department of Health

Dear Child Care Provider,

As measles cases rise across Pennsylvania, your leadership is essential in protecting children, staff, and families. With more than 570  confirmed cases statewide and several counties experiencing concentrated outbreaks, child care facilities play a critical role in reducing further spread. By strengthening prevention efforts, maintaining high vaccination awareness, and ensuring rapid response procedures are up to date you can help to safeguard your child care facility and community.

What You Should Know:

Measles is a highly contagious viral illness that spreads through the air, often when an infected person coughs or sneezes. The virus lingers on surfaces and in the air for up to two hours after an infected person leaves the area. In addition to a rash, symptoms of measles include fever, cough, runny nose, and red, watery eyes. Some people may suffer severe complications, such as pneumonia (infection of the lungs) and encephalitis (swelling of the brain), and some may be hospitalized or die.

Individuals are contagious from four days before to four days after the rash appears. Symptoms usually appear 7–14 days after exposure but can take up to 21 days.

Vaccines provide the best protection against getting sick from measles, specifically two doses of the measles, mumps, and rubella (MMR) vaccine. Two doses of MMR vaccine provide approximately 97% protection; one dose offers 93% protection. Most people who are fully vaccinated with MMR will be protected for life. 

PA Code § 27.77. Immunization requirements for children in child care group settings.

A licensed child care facility requires all children aged 2 months and older to have an immunization record on file. The record should be provided by the parent from an acceptable medical professional: a physician, physician’s assistant, CRNP, the Department of Health or a local health department. The record must contain the dates the child received all age-appropriate vaccinations.  Newly enrolled families have up to 60 days to provide a child’s complete and updated record.  If a child has not received their vaccinations, acceptable documented exemptions must be on file, since there are limited exemptions, reasons accepted in child care.  For an exemption due to a medical concern, documentation must be provided by an acceptable medical professional.  For an exemption due to religious, or philosophical reasons, a signed and dated written statement from the parent must be on file. Children who are considered to have received all age-appropriate vaccines should have one dose of the MMR vaccine between 12-15 months of age.

Some children 6-11 months of age may receive a dose early because they have been exposed to someone with measles or traveled to or live within an area that has sustained community transmission of measles. The Pennsylvania Department of Health (DOH) has an online dashboard that shows measles case counts by county and indicates which counties have sustained community transmission of measles. Although doses that are administered before 12 months of age do not count towards the requirement of one dose between 12-15 months of age, it does confer some protection against measles during an outbreak. Also, during an outbreak, children can get their second MMR dose (typically given at age 4 to 6 years) early but no sooner than 28 days after their 12–15-month dose.

People who are not immune by either vaccination or documented prior infection have a 90% chance of developing measles after being exposed.

The guidance below includes simple steps you can take to help prepare and protect your child care facility before a case occurs. 

Recommended Policy Measures for Child Care

Review the immunization status for all children AND talk to staff members/volunteers about their immunization status. Proof of immunity includes:

• Documentation of one or more doses of MMR vaccine;
• Laboratory evidence of immunity (blood test) or laboratory confirmation of measles disease; and
• Birth before 1957. Adults born before 1957 are more likely to have had measles as children and are generally, but not always, considered immune.

Develop an Exposure Response Plan to quickly identify who is susceptible (no proof of immunity) to ensure timely action.  Quarantine or post-exposure prophylaxis may be required by the Department of Health.

Develop a communications strategy for disseminating information about cases occurring in the child care facility setting to the parents, staff, and to the public.

• Remind families and staff about MMR vaccination, including where it can be accessed, such as primary care providers, urgent care, pharmacies, federally funded health centers, state health centers, and your local health department.

Promote infection control practices, such as respiratory hygiene and cough etiquette, frequent handwashing, and disinfect high-touch surfaces. Strongly encourage staff and children to stay home when ill.

Review the signs and symptoms of measles and have procedures in place for handling suspected cases.

• Be watchful for children who may develop a fever and other signs and symptoms of measles.
  • Measles starts with symptoms that are common with other diseases: a high fever, runny nose, cough, red/watery eyes, and sore throat.
• Isolate symptomatic individuals in a designated area until they can be picked up.
• Instruct families of ill children to call ahead to their health care provider or urgent care center before arrival.

Exclude individuals confirmed with measles until four days after rash onset. Inform families of unvaccinated children and unvaccinated staff of the exposure and that they may need to stay home for up to 21 days after their last exposure to someone who has had measles. If a child care attendee is exposed to measles and receives a dose of MMR vaccine within 72 hours after their initial exposure, the child may return to child care and other activities.

Actions If a Measles Case Occurs:

Notify authorities immediately. Contact your local health department or the PA Department of Health at 877-PA-HEALTH (877-724-3258).

Follow Health Department guidance. Work with public health officials to identify potentially exposed individuals via attendance records, including names, contact info, birth dates, immunity/vaccination status, and potential exposure locations. Share required data promptly to aid in public health outreach, vaccination, and quarantine efforts.

Exposure locations may include:  

• The same room(s) as an infectious individual;
• Lunchrooms/other shared spaces;
• A shared bus with the infectious individual; and
• Shared extracurricular activities.

Typically, outdoor areas are NOT considered an exposure location.

Share required data promptly to aid in public health outreach, vaccination, and quarantine efforts.

Contact health officials before deciding to close. Child care facility closure is generally not recommended and should only be considered in consultation with public health officials and your district medical staff.

Additional Resources:

• PADOH Measles Information Page and Dashboard
• Measles What You Need to Know
• PADOH Measles School and Child Care Settings Guidance
• CDC Be Ready for Measles Toolkit

By adopting these proactive measures and working in partnership with the Pennsylvania Departments of Health, Education and Human Services and your local health department, your child care facility will be well-prepared to prevent, identify, and respond effectively to any measles case.

If you have any questions about measles, please contact 877-PA-HEALTH or your local health department.

Thank you,

Debra L. Bogen, MD, FAAP
Secretary
Department of Health | Office of the Secretary 
625 Forster Street, 8^th floor | Harrisburg, PA 17120

Valerie A. Arkoosh, MD, MPH (she/her)
Secretary
Department of Human Services
625 Forster Street, Harrisburg, PA 17120

Shante’ A. Brown, Ed.S
Deputy Secretary
Office of Child Development and Early Learning
Pennsylvania Departments of Human Services and Education