Episode #303 Measles in the OR

When caring for patients with measles, the timing matters. Here are some important considerations:

Immunity Status – ask if the patient ever had measles or 2 doses of the measles vaccine. If so, then the patient is considered immune.

Recent exposure – during a regional outbreak, ask if the patient has been exposed in the last 12 days and delay elective surgery if there is a history of exposure.

When contagious – patients are contagious 4 days before rash onset until 4 days after.

Duration of symptoms – symptoms of cough, coryza, conjunctivitis, and airway reactivity can persist for days or weeks. Immune suppression can last for 2 days after infection.

Hello and welcome back to the Anesthesia Patient Safety Podcast. I’m your host, Alli Bechtel. Before we continue to talk about keep patients with measles safe during anesthesia care, we are going to check out a recent note from the APSF Newsletter Editors, Jennifer and Emily, to hear how the APSF is evolving. The APSF Newsletter has historically released three newsletters each year. This model worked well in the past, but it is now time to adapt to the pace of scientific discovery. Going forward, articles will be published online at apsf.org on a more regular cadence, 2-3 times per month. There will no longer be only the 3 newsletters each year. Our goal is to provide important safety information that is timely, relevant, and reflective of the dynamic nature of modern anaesthesiology practice. All articles will be easily accessible on our website and highlighted through social media channels and on this podcast. Consider subscribing at apsf.org/subscribe to make sure that all of the latest updates arrive in your inbox. Check out the show notes for more information. We look forward to the new stage of the APSF Newsletter and believe that this new approach will improve dissemination of perioperative safety knowledge and practice. We also welcome your feedback, and you can write to the editors at [email protected].

Before we dive further into the episode today, we’d like to recognize Fresenius Kabi, a major corporate supporter of APSF. Fresenius Kabi has generously provided unrestricted support to further our vision that “no one shall be harmed by anesthesia care”. Thank you, Fresenius Kabi – we wouldn’t be able to do all that we do without you!”

Our featured article is “Perioperative Management and Infection Control for Patients with Measles” by Brandan Wanta and colleagues on February 1, 2026. To follow along with us, head over to APSF.org and click on the Newsletter heading. The first one down is the APSF Newsletter Articles. Then, you can scroll down until you get to our featured article, and I will include a link in the show notes as well.

There has been a resurgence of measles in communities around the world. This is a very contagious disease, and perioperative teams need to be ready with the following action plan:

Early identification

Strict adherence to Airbourne precautions

Develop strategies for managing patients with suspected or confirmed measles.

Postpone elective procedures until the infectious period has passed to protect staff and other patients.

Now, let’s get into the article. Here is a quick review of measles or rubeola.

• It is a highly contagious viral illness caused by a paramyxovirus from the Morbillivirus
• Measles is spread by respiratory droplets, aerosols, or direct contact with bodily secretions. Individuals are contagious from 4 days before to 4 days after the rash onset.
• After exposure, symptoms develop within 7-14 days with an incubation period that lasts for about 11-12 days.
• Symptoms include fever, cough, coryza, and conjunctivitis at first followed by Koplik spots, tiny white spots inside the mouth and a maculopapular rash that spreads from the face down to the rest of the body. Check out Figure 2 in the article for a picture of Koplik spots.
• Complications from measles include otitis media, pneumonia, diarrhoea, stomatitis, keratoconjunctivitis, encephalitis, and subacute sclerosing panencephalitis.
• High risk patients include infants and patients who are pregnant, immunocompromised, or malnourished.
• Following measles infection, patients may develop prolonged immune suppression leading to increased risk for secondary infections and sepsis for months to years after the initial infection.
• The mortality rate from measles is as low as 0.1% in high-income countries but is increased to 1.3% in low or middle-income countries.
• Treatment includes supportive care since there are no anti-viral treatments available for measles. Options include hydration and antipyretics with careful monitoring for secondary bacterial infection. Administration of Vitamin A is recommended to help reduce the risk for ocular complications.
• Vaccines are available and effective to help prevent infection, but recent outbreaks are due to declining vaccination rates and increased travel to areas where measles is endemic. There were 16 measles outbreaks in 2024 in the United States, and this increased to 45 outbreaks with 1,753 confirmed measles cases by November 2025. There are well documented measles outbreaks dating back to the 1700s and before introduction of the vaccine, almost everyone was exposed to the virus at some point. Remember, it is highly contagious. The measles vaccine was introduced in 1963 and receiving 2 doses provides lifelong immunity, although some people may not maintain adequate antibody levels with aging. This was great news because it meant that you didn’t have to risk surviving measles to gain immunity. Anesthesia professionals are considered immune to measles either from a prior infection of completion go the recommended vaccination series.
• Many industrialized countries have implemented mandatory measles vaccination policies to reduce the burden from illness and complications…and these vaccination policies worked with the United States declaring measles eliminated in 2000, but with increased travel to areas where measles are endemic and declining vaccination rates, the virus continues to be reintroduced leading to new outbreaks.

Next up, let’s talk about anaesthetic considerations when caring for a patient with an active measles infection. First, since measles is highly contagious, you must consider the safety of the operating room team as well as the patient. Contact and airborne precautions are recommended with an N95 or powered air purifying respirator, eye protection, gown, gloves, and hat. But wait, anesthesia professionals are considered immune (from either vaccination or prior infection) so why all the precautions? Well, immunized health care workers who have not used full personal protective equipment have developed measles. Following the procedure, it is important to disinfect the area to prevent further measles transmission. Measles is an enveloped virus, so decontamination may be accomplished with alcohol, chlorine, hydrogen peroxide, and ammonium-based cleaners. Heat or ultraviolet light may also be effective.

For team members who are exposed to measles and have an uncertain immunity status, there are options for postexposure prophylaxis given the long incubation period. Postexposure vaccination and antibody administration are options for preventing or mitigating the infection. Recommendations include the following:

For unvaccinated or under vaccinated persons, measles vaccine within 72 hours of the exposure

For persons with contraindications to the vaccine including pregnant or immunocompromised patients or infants less than 6 months old, human immune globulin within 6 days of the exposure.

Timing of surgery is important for patients with measles. Elective surgery should be delayed until at least 4 days after the start of the rash when they are no longer infectious and once they have recovered from the illness.

For emergency surgery, the perioperative team will need to use strict contact and airborne precautions with N95 mask and if possible, a negative-pressure room before surgery and during recovery. It is important to limit staff to those with confirmed immune status if possible. The anesthesia team will need to be prepared for difficult airway management with swollen and friable airway tissues. During the preoperative phase, it is important to screen the patient for any measles complications and verify immunity of the operating room staff. Don’t forget about postexposure prophylaxis with measles vaccination or immune globulin for any exposed, nonimmune contacts.

We talked about one of the complications from measles infection is a period of immune suppression. Even after recovering from measles, patients are at risk for secondary infection and delayed wound healing and careful monitoring is recommended. There are no guidelines for surgery deferral beyond the initial measles infection at this time.

Here are the big takeaways for keeping patients with measles and healthcare professionals safe during surgery and anesthesia care.

Identification of measles infection followed by supportive treatment

Consideration of patient immune status and appropriate surgical timing

Timely postexposure prophylaxis when indicated.

And before we go, let’s review Table 1 in the article. This provides a summary of considerations for perioperative measles. I will include it in the show notes as well. Here we go:

Epidemiology: Sporadic cases and outbreaks of measles are increasing in the United States.

Transmission and Risk: Measles is highly contagious and spreads via secretions, droplets, and aerosols, which can linger in the air for hours. High risk for anesthesia professionals caring for infected patients.

Reporting Requirements: Many governments require immediate reporting of suspected or confirmed measles cases, regardless of day or hour.

Infectious Period: Measles is transmissible from 4 days before to 4 days after rash onset. Complications may last longer and increase perioperative risk.

Elective Procedures: Defer elective procedures until after the infectious period and symptom resolution.

Urgent and Emergent Procedures: May proceed with caution. Anticipate airway difficulties from mucosal swelling and implement strict infection control measures.

Prevention and Post-Exposure Actions: Measles vaccine is effective. Postexposure prophylaxis with vaccine or immune globulin is also effective.

If you have any questions or comments from today’s show, please email us at [email protected]. Please keep in mind that the information in this show is provided for informational purposes only and does not constitute medical or legal advice. We hope that you will visit APSF.org for detailed information and check out the show notes for links to all the topics we discussed today.

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Until next time, stay vigilant so that no one shall be harmed by anesthesia care.

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