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Guidance for Child Day Care Programs Regarding Measles

(Updated June 19, 2019)

Measles is a highly contagious viral disease that can be very serious or even fatal.

What do OCFS regulations say?

According to OCFS regulations pertaining to health and infection control, child care programs must immediately notify the parent and OCFS upon learning of a communicable illness. Measles is a communicable illness that must be reported both to OCFS and local health departments.

The program must keep documentation of immunizations the child has received to date, in accordance with New York State Public Health Law.

Any child not yet immunized may be admitted provided the child’’s immunizations are in process, in accordance with the requirements of New York State Public Health Law, and the parent gives the program specific appointment dates for required immunizations.

Any child who is missing one or more of the required immunizations may be admitted if a physician licensed to practice medicine furnishes the program with a written statement that such immunizations may be detrimental to the child’’s health.

With the exception of children meeting the criteria of sections 418-1.11(a)(5) or (6) children enrolled in the child day care must remain current with their immunizations in accordance with the current schedule for required immunizations established in the New York State Public Health Law.

Should children with measles be excluded from the child care program?

Yes. Measles is a highly communicable illness. Unimmunized people who have been exempted from measles immunization, if not immunized within 72 hours of exposure, should be excluded from the group care setting until at least two weeks after the onset of rash in the last case of measles.

When can I readmit the children with measles to the program?

Four days after the beginning of the rash and when the child is able to participate and staff members determine that they can care for the child without compromising their ability to care for the health and safety of the other children in the group.

Who gets the measles?

Although measles is usually considered a childhood disease, it can be contracted at any age by a person who never had the disease or been vaccinated. Unvaccinated individuals are 22 times more likely to get measles than are who those who have two measles vaccines, usually given as measles, mumps and rubella vaccine (MMR).

How is measles spread?

The measles virus lives in the mucus in the nose and throat of infected people. When they sneeze, cough or talk, droplets spray into the air and the droplets remain active and contagious on infected surfaces for up to two hours.

What are the symptoms of measles?

Symptoms usually appear in ten to 12 days, although they may occur as early as seven or as late as 18 days after exposure. Measles symptoms generally appear in two stages. In the first stage, which last two to four days, the individual may have:

  • runny nose,
  • cough, and/or
  • slight fever.

The eyes may become reddened and sensitive to light while the fever gradually rises each day, often peaking as high as 103° to 105°F. Koplik spots (small, bluish white spots surrounded by a reddish area) may also appear on the gums and inside of the cheeks. The second stage begins on the third to seventh day and consists of the following:

  • A red, blotchy rash lasting five to six days. The rash usually begins on the face and then spreads downward and outward, reaching the hands and feet. The rash fades in the same order that it appeared, from head to extremities.
  • Weight loss
  • Diarrhea
  • Enlarged lymph glands throughout the body

An individual is able to transmit measles from four days prior to and four days after rash onset.

What are the complications associated with measles?

Complications occur in up to 30 percent of all cases and are more common in those younger than five and older than 20 years of age. Pneumonia occurs in up to six percent of reported cases. Encephalitis (inflammation of the brain) may also occur. Other complications include middle ear infection, diarrhea and seizures. Infection of the mother during pregnancy has been associated with an increase in low birthweight, premature labor, miscarriage and birth defects.

What can be done to prevent the spread of measles?

Maintaining high levels of measles immunization in the community is critical to controlling the spread of measles. Infected individuals should be excluded from work or school during their infectious period. Measles-containing vaccine should be provided to susceptible contacts within 72 hours of exposure. Immune Globulin (IG) can be given to susceptible persons within six days of exposure.

For more information about measles, visit the New York State Department of Health website.

Child care programs and schools can find communicable disease reporting requirements, forms, and instructions for reporting measles to local health departments on this NYS DOH informational sheet.