1. Potentially Exposed to Measles Infants < 12 months Pregnant patients without documented immunity (MMR, Hx of disease) or + IgGLab Immunocompromised (see Immunocompromised page) Yes and within 6 days of exposure* High Risk? If within 72 hours of exposure, go to av MHS Urgent Care for MMR if no immunity. If beyond 72 hours of exposure, watch for symptoms, recommend immunization at community site. *Exposure Day = Day 0 Example: Day 0 6/24/14 Day 1 6/25/14 Day 2=6/26/14 Day 3=6/27/14 Yes, but beyond 6 day of exposure* Notify physician of exposure Watch for symptoms for three weeks (Symptoms start with a fever, cough, runny nose, red watery eyes); rash will develop a few days later. Generally rash starts on face and spreads downward. Illness may last 7-10 days. If pt develops symptoms, call Drs. Office or Urgent Care for instructions on when and how to be treated. Patients with highly suspicious symptoms should not present directly to clinics or facilities without pre- notification (if at all possible). When and if they do present, follow algorithm posted on MHS net. Notify patients physician Infants < 12 months go to MB ED for Ig IM Pregnant patients go to TG L & D for Ig IV after IgG drawn Immunocompromised patients go to Puyallup Infusion Center (see Immunocompromised page) Not High Risk And Not-Pregnant Pregnant, with documented Immunity are considered immune. Patient should notify obstetrician, but no further treatment or follow-up needed. Measles Treatment Decision Algorithm for Exposed Individuals 6/28/14

2. Puyallup infusion address: 400 15th Ave. S.E. Puyallup, WA 98372 Saturday Hours: 830am-5pm Sunday Hours: 830am-1pm For non-MultiCare providers, no exceptions (faxed to 253-697-5066): · Order (attached and links below) o http://mhsnet/forproviders/good_samaritan_providers/Preprinted%20Orders/Infusion%20Center/78-0026- 8%20Immune%20Globulin.pdfhttp://mhsnet/forproviders/good_samaritan_providers/Preprinted%20Orders/Infusion%20Center/78-0026- 8%20Immune%20Globulin.pdf o found on MHSnet > web tools > click “pre-printed orders (Good Samaritan)” > Infusion Center > Immune Globulin · Recent H&P from treating provider · Current medication list · The ordering provider must be credentialed at MultiCare (any MHS hospital) · We prefer that any high-risk pregnancies be referred to the OBED at Good Sam for monitoring during IVIG We have spaces available on both Sat and Sun for infusions, if needed. To schedule, call 253-697-4210 and ask for the charge nurse to coordinate. Measles Treatment Decision Algorithm Immunocompromised Patients Immune Deficient Conditions Severe Primary Immunodeficiency Patients who have received a bone marrow transplant until at least 12 months after finishing immunosuppressive treatment (or longer in patients who have graft-versus-host disease) Patients on treatment for acute lymphocytic leukemia within and until at least 6 months after completion of immunosuppressive chemotherapy HIV infected persons with severe immunosuppression: CD4 percent 5 years) 6/28/14