A sick nursing home resident lies in bed
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Measles outbreaks have drawn headlines in recent weeks as the number of cases and outbreaks in more than a dozen US states is already the highest since 2019. The highly infectious disease poses multiple challenges to nursing homes that have become more pressing in recent years, according to Deborah Burdsall, PhD, board member at the Association for Professionals in Infection Control and Epidemiology.

“Twenty-five or 30 years ago, this wouldn’t have been such a big deal,” she told McKnight’s Long-Term Care News Thursday. “You would have had a majority of residents and most of the staff born before 1957 — so you would have a lot of acquired immunity through infection, because people had measles.”

Today, in contrast, many staff and even residents are entirely reliant on MMR vaccines for immunity, and many nursing homes are not checking for vaccination rates in their communities. While vaccination rates remain effective and generally widespread in the US, rising anti-vaccine sentiment has made it important to check immunization coverage in facilities, experts stress. 

In fact, raising awareness of facility vaccination rates should be a key focus for providers, Burdsall said — a task which would be made significantly easier by having a full-time, dedicated infection preventionist on hand at each facility. 

Measles is one of the most contagious diseases, according to the CDC. Even a single case of measles in a facility can pose a serious risk to community health and to daily care operations. A staff member exposed to measles should isolate from day 5 after their first exposure through day 21 after their last exposure, Burdsall told McKnight’s

“You could potentially have somebody off for a long time. And that’s why you don’t want it in your building in the first place,” she said — noting that this challenge is especially significant in today’s troubled nursing home staffing environment

Preparing for trouble

Beyond examining immunity rates in a facility and getting help from a dedicated infection preventionist, Burdsall stressed that it is vital to partner with local health officials in the event of an exposure, confirmed case or outbreak of measles.

She gave an example of a potential measles outbreak she was personally involved in preventing in 2015. 

“If you even have a suspicion, you do exactly what I did in 2015. The first thing I did… was call the local public health department,” Burdsall recalled. “Notify them and have them help you work through it. You’ve got to work closely with local public health.”

Another key is to ensure that clear lines of communication are open between different leadership groups in the facility — from administrators to infection preventionists to corporate leaders.

Burdsall drew parallels between a potential outbreak in a nursing home setting and the recent outbreak that hit a Chicago migrant shelter. That outbreak has made Illinois the state with the most measles cases in 2024 so far. 

“It’s the same situation. You have a lot of people — some potentially vulnerable — in close proximity, living and sharing the same air,” she explained. 

Measles is so contagious that should an outbreak occur, nursing homes should make use of an airborne infection isolation room when available, Burdsall said. If an AIIR is not available, providers should ensure residents are transferred to a healthcare facility that can provide those precautions.