Triage and Initial Action in Emergencies

Identification of Suspicious Case

In the current epidemiological context, any person who consults for: Fever + Rash (red, flat macules) + at least one respiratory symptom (cough, rhinitis or conjunctivitis).

  • Measles can present in a mild or atypical form (without conjunctivitis and with altered exanthematous progression) in previously vaccinated patients.

Immediate Action (Emergency Door)

  • Urgent Provide a surgical mask to the patient immediately.
  • Place the patient in a box or single room as soon as possible.
  • Strictly avoid staying in the waiting room to minimize infections.

Isolation Measures

  • Guy: Air insulation.
  • Location: Single room with the door closed.
  • PPE for Personnel: Mandatory use of FFP2 Mask to enter the room.
  • Duration: Maintain until 4 days after the appearance of the rash.

Diagnostic Tests

Samples to request from the laboratory

Three urgent determinations must be requested to confirm or rule out the case:

  • Serology: Measles IgG (CLIA) and Measles IgM (CLIA). Tube with 5ml separating gel (yellow cap).
  • Urine: Measles (PCR) in urine from spontaneous urination, medium stream. 10ml tube.
  • Pharyngeal/tonsillar exudate: Measles (PCR). Large red cap tube with liquid medium, leaving the swab inside.
Logistics note: Send the samples with a label that indicates "Urgent Xarampió" and notify the microbiologist on duty. Taking a double sample is not necessary.

Contact Management and Post-exposure Prophylaxis

Susceptible contact is considered to be those over 12 months of age without 2 doses of MMR (TV) or without positive IgG, and all children under 12 months of age.

Active Prophylaxis: Triple Viral Vaccine (TV)

Indicated in the first < 72 hours post-exposure.

Pediatric Age Group Indicated Action
Infants ≥ 6 months and < 12 months Administer 1 dose of TV. Warning: This dose will not replace the systematic 12-month regimen.
Children from 1 to 3-4 years (Not vaccinated) Administer 1st dose of TV. The 2nd dose will be administered according to the schedule.
Children 3-4 years old (With 1 previous dose) Advance the administration of the 2nd systematic dose.

Passive Prophylaxis: Nonspecific Immunoglobulins

Indicated up to 6 days post-contact, under epidemiological authorization (ASPB/SUVEC), in the following cases:

  • TV vaccine contraindication (severe immunosuppression, pregnancy).
  • Infants < 6 months (regardless of maternal immunity).
  • Infants between 6 and 12 months who come between 72 hours and 6 days from exposure.

Dose: 0.25 mL/kg (max. 15ml) via IM. In immunosuppressed patients: 0.5 mL/kg.

Vaccine Interference: After administering immunoglobulin, you should wait between 8 and 12 months to vaccinate with MMR.

Epidemiological and Discharge Notification

Urgent Declaration (< 24h)

The declaration must be made in response to clinical suspicion, without waiting for laboratory results.

  • Coding: ICD-10 episode "B05".
  • Working hours: Notify Preventive Medicine and Occupational Risks.
  • After hours: Notify SUVEC.

Hospital Discharge Criteria

  • Insulation check: Ensure that the patient can comply with home isolation in a single room with a closed door.
  • Duration: You must remain isolated until 4 days after the onset of the rash.
  • Precautions: Strictly avoid contact with vulnerable people, pregnant women and unvaccinated children.

Expert Module: Triple Viral Vaccine in Emergencies

Quick support guide for the pediatrician: Precise contraindications and addressing common doubts or vaccine reluctance in the box.

Contraindications

TV is a vaccine live attenuated viruses.

Absolute (DO NOT vaccinate)

  • Severe or secondary primary immunodeficiencies (HIV with CD4 <15%, active chemotherapy, high immunosuppressive treatment).
  • Previous severe anaphylactic reaction to vaccine components (neomycin, gelatin).
  • Pregnancy (theoretical risk).

False / Relative (YES vaccinate)

  • Egg allergy: YES you can get vaccinated. The viruses grow in chicken embryo fibroblasts, not egg white. No special protocol required.
  • Mild acute illness: (Ex: low fever, cold, mild diarrhea) It is NOT a contraindication.
  • Previous febrile seizures or family history.
  • Living with pregnant or immunocompromised women (the vaccine virus is not transmitted).

Addressing Myths (Reluctant Families)

Myth 1: "The vaccine causes Autism"

Argument for parents: "That myth was born from a fraudulent 1998 study whose author (Andrew Wakefield) lost his medical license. Since then, dozens of studies with millions of children have conclusively demonstrated that there is no relationship between MMR and autism."

Myth 2: "It is better that natural measles passes to get immunized"

Argument for parents: "Measles is not a benign disease. It can cause severe pneumonia, encephalitis (brain damage), and a fatal complication years later called SSPE. Additionally, the virus 'wipes' the child's immunological memory against other diseases (immunological amnesia). The vaccine offers safe immunity without these fatal risks."

Myth 3: "Vaccines have toxic components"

Argument for parents: "MMR does not contain mercury (thiomersal) or aluminum. Its stabilizing components are in minute quantities, much less than what a child is exposed to daily in their diet or natural environment."

Original Source of the Protocol

Official Document

This interactive clinical decision support tool for pediatric emergencies is based entirely on the "Protocol of action before the suspicion of a case of xarampió" of the Preventive Medicine and Epidemiology Service (Vall d'Hebron University Hospital).

Open Original PDF