Managing measles in asylum seeker accommodation settings
This document sets out principles for managing an outbreak of measles in an asylum seeker accommodation setting. It is made for regional health protection teams.
This document is intended to support regional health protection teams (HPTs) in their management of measles in asylum seeker accommodation settings. It is not intended to replace existing published guidance and standard operating procedures (SOPs). Teams may consider integrating the principles listed here into their own SOPs and process documents.
Always complete a risk assessment and undertake management as per regional SOP and national guidance.
The following actions should be considered as additional measures, depending on the severity and risk assessment of the situation, which could be undertaken upon the identification of a confirmed or suspected case of measles:
- consider urgently testing the first suspected case
- urgently identify any vulnerable individuals in the setting: pregnant women, children aged under 12 months and immunosuppressed people
- consider urgent immunoglobulin G (IgG) testing of any vulnerable contacts ahead of confirmation of diagnosis of the index case
- consider convening an incident management team (IMT) after a single confirmed or likely/probable case
- ensure contact details are recorded for accommodation staff and any linked healthcare provider, documenting organisation and role
- record the category (for example initial accommodation centre (IAC), contingency hotel, bridging hotel) and layout of the accommodation setting, and the general demographics and country of origin of residents
- urgently identify any linked settings for case and contacts; in particular, educational settings and transport to / from these
- establish whether there are specific health providers supporting the setting:
- establish how an urgent clinical assessment or testing would be undertaken if required, including for any pregnant women, children aged under 12 months and immunosuppressed people who are considered contacts
- if services are insufficient, consider escalating this, for example with the Integrated Care Board (ICB)
- advise that all confirmed and suspected cases are excluded and isolated appropriately:
- this should be in accommodation with separate access, own kitchen / bathroom, or food in the room
- it may be appropriate to move confirmed or suspected cases to a separate housing unit, as long as transfer can be undertaken safely, without additional exposure risk, and with cases isolated immediately at the new setting
- cohorting should only be considered if there are no other options available, with the exception of child cases who should not be separated from their family
- consider advising that there should be no relocation of other residents (no movements in or out of the setting), with a priority on not moving residents to settings with people who may be at greater risk from measles infection (younger children, pregnant women and immunosuppressed people):
- an exception to this would be to consider moving people who may be at greater risk from measles infection out of the setting, if there was significant risk to them (for example an escalating outbreak)
- other considerations may mean that transfers should continue (for example care placement for unaccompanied asylum-seeking children (UASC)), but this should be done alongside information about the current risks within the setting, and clear public health advice regarding isolation and other protective behaviours
Resident contacts
Consider advising isolation for close contacts of a confirmed or suspected case where you cannot confirm whether they have been fully vaccinated or have immunity from previous measles exposure.
Staff contacts
Where staff have been exposed to a confirmed or suspected case of measles:
- consider whether exposed staff who do not have satisfactory evidence of measles immunity should be excluded from work from 5 days after the first exposure to 21 days after the final exposure
- if staff are tested rapidly after exposure, they can continue to work if found to be measles IgG positive within 7 days of exposure (as this is too early to be due to infection from the recent exposure)
- where MMR vaccine is given post-exposure, it is unlikely to prevent the development of measles, but if the staff member remains symptom-free for at least 14 days after MMR was given, they can return at that stage
Depending on the risk assessment and where staffing levels might lead to concerns for residents’ or staff safety, the following may be considered for asylum seeker accommodation non-healthcare staff:
- if a staff member has history of receiving 1 dose of MMR (or other measles containing vaccine), they can continue to work but should be excluded if they feel at all unwell
- if a staff member gets an MMR dose within 72 hours of exposure, they can continue to work but should be excluded if they feel at all unwell
Communication
- send translated letters to cases (or parents of a child case)
- if a confirmed measles case is identified, ensure the local health system is aware of the situation including GPs, NHS 111 and A&E in local NHS trusts
- if arranging an immunisation intervention, ensure that a translated consent form is used
- ensure a factsheet translated into the appropriate language is provided to all cases and contacts
- share Measles Information for Asylum Seeker Accommodation Providers
- inform regional UKHSA comms team, but note that the Home Office would normally lead on any external comms
- communicate with the local authority public health and comms teams, the local authority education department and any schools that the case or contacts may attend
- communicate with staff working in the setting
Vaccination
- consider setting up an outbreak response vaccine clinic through liaison with the local Integrated Care System (ICS) / NHS - this decision should only be considered in severe or high-risk outbreaks and should be made at an IMT
- recommend all residents are registered with a GP
- recommend keeping records of administered vaccinations, including an electronic record - consider providing written proof of vaccination to individuals not registered with a GP