Measles Guidance for NC Child Care, Schools and Colleges/Universities

Child Care

Children in child care are required to get their:

• First dose of the MMR vaccine between 12-15 months of age. Any child 16 months or older who has not gotten their first dose should not attend child care until they do.
• Second dose between the ages of 4-6 years, before kindergarten.

Some children ages 6-11 months may get a dose early because:

• They were exposed to someone with measles, or
• They are traveling to an area of the U.S. that has measles cases or are traveling internationally.

Doses administered before 12 months of age do not count toward the one-dose requirement between 12-15 months.

More information: Child Care Immunization Requirements

Schools and Colleges/Universities

Students entering school or college for the first time in North Carolina must have received two doses of the MMR vaccine:

• K-12 Schools Immunization Requirements
• College/University Immunization Requirements

More Information and Resources

• NC Rules and Laws on Immunizations
• Exemptions for Medical or Religious Reasons
• Immunization Resources for NC Schools and Child Care Facilities

Take these quick actions to prevent further spread of disease to others:

1. Contact your local health department. If you can't reach them, call the state epidemiologist on-call at 919-733-3419, available 24/7.
2. Immediately isolate anyone experiencing symptoms in a private area until they can seek health care.
   • Child care/schools: Children should stay isolated until a parent/guardian can pick them up. Follow guidance from the health department on when children and staff can return.
   • Colleges/universities: Follow isolation/quarantine guidance for campuses.
3. Work with public health staff to communicate with your community. Immediately notify parents/guardians of children who are susceptible to measles.

How local and state public health support you

Public health staff will: 

• Interview the person with measles (or their parent/guardian if the sick person is a child)
• Identify all people potentially exposed to measles
• Offer post-exposure prophylaxis to people who were exposed and do not have proof of immunity
• Provide guidance around quarantine/isolation
• Coordinate with staff and leadership or administration for the above activities 

What people can expect during public health outreach for infectious diseases

• Written documentation of:
  • One or more doses of a measles-containing vaccine administered on or after the first birthday for preschool-age children and adults not at high risk
  • Two doses of a measles-containing vaccine, administered at least 28 days apart, for school-age children and adults at high risk, including college students, health care workers and international travelers
• Birth before 1957
• Laboratory evidence of immunity (documented positive Rubeola/Measles IgG)
• Laboratory confirmation of disease

People with measles are infectious four days before rash onset, until four days after rash onset. This is the infectious period when they can expose others to the virus.

People who are exposed to measles include:

• Anyone who was in the same room as the ill person during the infectious period
• Anyone who was in the room up to two hours after the ill person left the room during the infectious period
• Anyone living in the same dorm/dorm suite as the ill person
• Anyone who was in the common areas (hallways, cafeterias, residence hall common spaces, etc.) as the ill person

Anyone exposed to measles needs to monitor themselves for symptoms for 21 days.

• People with proof of immunity do not need to quarantine and may attend or work at child care or school.
• Two doses of the MMR vaccine are 97% effective at preventing measles, but there is a small risk that a person who was vaccinated can become infected. It’s important for staff and parents/guardians to know about measles symptoms and what to do if they or their child develop symptoms.
  • Get a shareable fact sheet (multiple languages available)

These are general guidelines for return to child care, school or classes and activities. Consult with your local health department on these decisions.

• Anyone who has measles may return on the fifth day after rash onset.
• Anyone who was exposed to measles may return:
  • After proof of immunity is confirmed, or
  • After getting the MMR vaccine within 72 hours of exposure, or
  • After the 28th day following exposure after getting immunoglobulin as post-exposure prophylaxis, or
  • After the 21st day following the most recent exposure, if MMR vaccine or immunoglobulin is not received.

To prevent the spread of measles on campus, follow these guidelines:

1. Immediately isolate students or staff with suspected or confirmed measles to prevent airborne transmission. The measles virus lingers in the air for up to two hours.
2. Isolation lasts until four days after rash onset. The person must stay home, away from others and away from all public places, including classes, extracurricular and social activities and work.
3. If feasible, students may return home for the isolation period but only if it’s possible to do so without exposing people who are not immune. Public transportation is not allowed (buses, trains, airplanes, etc.).

Students and staff who were exposed to measles and do not have proof of immunity need to stay home from classes and activities and quarantine until they get the OK to return.

On-Campus Isolation Planning

Housing and On-Campus Accommodations

• Identify and prepare isolation housing
  • Private room
  • Separate bathroom
  • Located away from the general campus population
• Develop a contingency plan for students unable to return home

Support and Supplies

• Arrange delivery of:
  • Meals
  • Medications/supplies
  • Hygiene essentials
• Only staff with documented measles immunity should make deliveries.
• Assign staff to check in regularly with isolated students.