UPDATED GUIDANCE FOR CHICAGO SCHOOLS

  • CDPH is starting to identify more spread of measles in the community. There have been several measles cases recently with no direct link to new arrivals or shelters. In the context of community measles transmission, schools and daycares should be aware of the new CDPH recommendation of an “accelerated” 2nd MMR dose to Chicago children.
    • For children over 1 year old, 2 doses of MMR vaccine:
      • Children can receive their 2nd dose 28 days after 1st dose.
      • This 2nd dose before 4 years of age meets IL school vaccine requirements.
  • Anyone who is exposed to measles and is vaccinated does not need to quarantine.
  • Public exposure locations are available on Chicago’s measles website: chicago.gov/measles

What is measles?

  • Measles is a very contagious disease caused by the Rubeola virus. It is so contagious that if one person has it, 9 out of 10 people close to him or her will also become infected if they are not immunized.
  • It spreads through the air when an infected person coughs or sneezes. In fact, the measles virus can stay in the air for up to 2 hours after an infectious individual was there. So you can get infected by simply being in a room where an infected person once was. Someone is contagious to others 4 days before to 4 days after the rash appears.
  • Measles symptoms appear 7 to 14 days after exposure, but may take as long as 21 days. It often starts with a fever, a cough, a runny nose, and red eyes. Then, a rash of flat red spots breaks out. The rash starts at the head and spreads to the rest of the body.
  • The best way to prevent measles is to be vaccinated.
    • The Centers for Disease Control and Prevention, American Academy of Family Physicians, and American Academy of Pediatrics strongly recommend children receive all vaccines according to the recommended vaccine schedule.
    • During periods of increased measles transmission, it is important to ensure everyone has evidence of adequate vaccination against measles in addition to all other recommended vaccines.  These vaccines are safe and effective and continue to be the best way to prevent infection.
      • CDPH recommends that children receive 2 doses of MMR, with 1st dose given at 12 months of age.
        • In the context of community measles transmission, Chicago families should ask their healthcare provider about an “accelerated” 2nd MMR dose for children >12 months of age, especially if attending schools or daycares.
      • A 2nd MMR dose can be administered as soon as 28 days after a 1st dose.
        • An “accelerated” 2nd dose given before 4 years of age is valid and effective according to ACIP. Children who receive two appropriately timed measles, mumps, and rubella (MMR) doses before 4 years of age should not need any additional doses in their lifetime.
      • This new recommendation does not change the requirement for school and daycare attendance but instead is an additional option available to families who want to increase their child’s protection to measles.

Is this a reportable illness?

  • This is a reportable illness to CDPH. Please work with your school nurse to gather the needed information and report as soon as possible but within 3 hours.
    • This is authorized by the IL Administrative Code Section 690.
    • Call the CDPH Disease Reporting Line at (312) 743-9000 immediately during normal working hours.
    • After hours, weekends, and holidays, call 311 and ask for the communicable disease physician on-call. If you are calling from outside the City of Chicago 311 can be reached at 312-744-5000

What do schools need to do next?

Everyone should encourage others to get the MMR vaccine, as it is the best protection against the spread of measles. 
  • Illinois requires 1 dose of MMR for daycare students aged ≥12 months and preschool aged students, and 2 doses of MMR vaccine for students in grades K through 12, unless they have other presumptive evidence of measles immunity, which includes laboratory evidence of immunity or laboratory confirmation of disease.
    • Schools shall maintain awareness of which students are not considered immune to vaccine-preventable diseases.
    • Follow up with families of students that are not compliant with childhood vaccination. Remind them that students who are not immunized against measles will be excluded from school for 21 days if they are exposed to measles.
  • Students who are not considered immune include those with incomplete vaccination records due to religious exemption, medical exemption, McKinney Vento exemptions, or noncompliance with childhood vaccination.
  • Remind your staff of the importance of being protected by making sure that they are up to date on recommended vaccines and are aware of whether they likely have immunity to measles. Adults who most likely do have immunity to measles include those who meet at least one of the following criteria:
    • Written documentation of two doses of measles-containing vaccine.
      • School and daycare settings are considered higher risk settings in the context of an outbreak and a history of two doses of vaccination provides the best protection against measles.
    • Laboratory evidence of immunity (i.e. a “titer” with a positive IgG result).
    • Laboratory confirmation of prior measles infection.
    • Birth before 1957.
  • If there is suspected measles case at school,  
    • If the student present during the school day, separate the suspected case from the other students to wait for pick up and escort them out as far away from the other students as possible, especially students that may be at higher risk.
      • Do not let other students into the room where the suspected case was isolated for at least two hours. Disinfect using normal protocols after suspected case leaves.
    • If there is a measles case, the school will send a letter to family and staff members notifying them of the potential exposure.  Schools must wait for CDPH to confirm the case before sending any letters.    
    • The school will also identify all students who were in school during the time the student with measles was in school and check if they were vaccinated against measles. The school may provide this list of students to the Chicago Department of Public Health (CDPH) for contact-tracing purposes.    
  • Sick Individuals 
    • Exclude for at least 4 days after start of rash.  
  • Close Contacts 
    • CDPH will provide a template letter with education around exposure, signs, and symptoms, and provide the school with guidance on any necessary exclusions.
      • Any exposed students who cannot prove immunity must be excluded from school for 21 days after exposure.

Links

Resources

Chicago Schools: This is a reportable disease to CDPH. 
  • Call the CDPH Disease Reporting Line at (312) 743-9000 immediately during normal working hours.  
  • After hours, weekends, and holidays, call 311 and ask for the communicable disease physician on-call. If you are calling from outside the City of Chicago 311 can be reached at 312-744-5000 
  • A draft parent letter is available through CDPH upon confirming a reported case. 

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