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May 16, 2019
Overreaction to measles could end up in court

With the current measles outbreak making news daily across the country, employers are wondering what they can do to protect their workers. Can you require your employees to be vaccinated against measles? What should you do if you learn one of your employees has a case of measles?

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Mandatory vaccination. Outside of the healthcare sector, requiring vaccination could set your company up for legal problems. Immune-compromised or vaccine-allergic employees have rights under the Americans with Disabilities Act. Vaccine exemptions vary widely by state, county, or municipal jurisdiction. You should always seek advice from legal counsel before considering any mandatory vaccination policy.

Illness in the workplace. If you suspect an employee has measles or has exposed co-workers, you should send the worker home and call your local health department immediately. Measles cases are a public health issue. Health departments have quarantine and treatment authority that employers don’t have.

The health department can provide you with information you can share with employees about measles, immunity, risks for pregnant workers, and where to get vaccinations. You should follow your local health department’s instructions.

The Occupational Safety and Health Administration (OSHA) has no federal standard on infectious disease prevention. OSHA issued a request for information and completed a small-business impact review but has issued no proposed or final rulemaking. The agency has since moved its rulemaking to its list of long-term actions.

Post-exposure prophylaxis

Health department personnel may take one of two options to handle those who have been exposed to measles but lack proof of immunity:

  • Administering the measles-mumps-rubella (MMR) vaccine within 72 hours of initial measles exposure; or
  • Administering immunoglobulin within six days of exposure.

The health department would not administer both; immunoglobulin renders the MMR vaccine ineffective.

Surgical masks ineffective

Some employees may purchase and wear surgical masks in the mistaken belief they offer effective protection from infection. Surgical masks do not offer the same protection from airborne infections like influenza or measles that NIOSH-certified respirators, such as N95 filtering facepiece respirators, do:

  • Surgical masks are not designed to protect wearers from infection but rather they protect others from infections their wearer might carry;
  • Facepiece respirator effectiveness in protection can vary from manufacturer to manufacturer; surgical masks may be less than 10 percent effective; and
  • CDC recommends healthcare workers wear N95 respirators, regardless of immune status, when treating patients with measles.

Current measles outbreak

The federal Centers for Disease Control and Prevention (CDC) and city, county, and state health departments are tracking an ongoing series of outbreaks of measles related to unvaccinated international travelers.

Health departments have reported outbreaks to CDC in:

  • Butte, Los Angeles, and Sacramento Counties in California;
  • Georgia;
  • Maryland;
  • Michigan;
  • New York City and Rockland County, NY;
  • New Jersey; and
  • Pennsylvania.

CDC had confirmed 839 cases as of May 10.

Proof of immunity

In a confirmed or suspected outbreak, health department personnel will determine proof of immunity among those exposed. The CDC considers the following as proof of immunity:

  • Birth before 1957;
  • Laboratory confirmation of prior measles infection;
  • Laboratory evidence of immunity; or
  • Written documentation of adequate vaccination – one or more doses of a measles-containing vaccine administered on or after the first birthday for preschool-age children and adults not at high risk; or two doses of measles-containing vaccine for school-age children and adults at high risk.

“Teachable moment”

Unless you have a confirmed exposure in your workplace, communication and education may be your best options. Measles is highly contagious but the number of cases so far has been limited.

The CDC has resources on its website including articles that can be customized for company newsletters, as well as handouts and PowerPoint presentations about measles and vaccination that can be used in “brown bag” or other informational sessions.

Employees may have read or seen news stories about the ongoing outbreaks. Reliable information can help reduce anxiety and stem panic.

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