Authors: Wanta B et al.
Anesthesia Patient Safety Foundation Newsletter, volume 41, number 1, February 2026.
Summary
This article provides practical guidance for perioperative management and infection control when caring for patients with suspected or confirmed measles, emphasizing early identification, strict airborne precautions, and appropriate case deferral to protect health care workers and other patients. Given the resurgence of measles in the United States and globally, perioperative teams must be prepared to recognize and manage this highly contagious viral illness.
Measles is among the most transmissible infectious diseases, spreading via respiratory droplets, aerosols, and direct contact with bodily secretions. Patients are contagious from four days before to four days after rash onset, and viral particles can remain airborne for hours. Typical clinical features include fever, cough, coryza, conjunctivitis, Koplik spots, and a characteristic maculopapular rash that begins on the face and spreads caudally. Serious complications such as pneumonia, encephalitis, keratoconjunctivitis, and prolonged immune suppression may occur, particularly in infants, pregnant patients, and immunocompromised individuals.
The authors stress that elective surgical procedures should be postponed until the patient has fully recovered and is beyond the infectious period. This delay reduces transmission risk within health care facilities and allows time for acute complications and immune suppression to resolve. Emergency and urgent procedures may proceed when necessary, but only with strict infection control measures in place.
For patients requiring anesthesia during or shortly after measles infection, anesthesia professionals should anticipate potential airway challenges due to mucosal edema and friability. Full airborne and contact precautions are required, including use of N95 masks or powered air-purifying respirators, eye protection, gowns, and gloves. Even though many anesthesia professionals are presumed immune due to vaccination or prior infection, full personal protective equipment is recommended because transmission to immunized health care workers has been reported in the absence of adequate protection.
The article also highlights the importance of postexposure management. For staff with uncertain immunity, postexposure prophylaxis is effective when administered promptly. Vaccination within 72 hours of exposure or immune globulin within six days can prevent or mitigate infection in nonimmune or high-risk individuals. Environmental decontamination is critical following care of a contagious patient, and standard disinfectants effective against enveloped viruses are considered adequate.
Finally, the authors note that measles-associated immune suppression may persist for weeks to months after recovery, increasing the risk of secondary infections and delayed wound healing. While no firm consensus exists on how long to delay surgery beyond the infectious period, heightened vigilance and monitoring are recommended, particularly in high-risk populations.
Key Points
Measles is extremely contagious and requires early identification and strict airborne precautions in perioperative settings
Patients are infectious from four days before to four days after rash onset
Elective surgery should be deferred until after the infectious period and symptom resolution
Urgent or emergent procedures may proceed with full airborne and contact precautions
Anesthesia teams should anticipate airway edema and respiratory complications
Postexposure vaccination or immune globulin is effective for nonimmune or high-risk staff
Measles-related immune suppression may persist after recovery, warranting increased postoperative vigilance
Thank you to the Anesthesia Patient Safety Foundation for allowing us to summarize and share this important patient safety article from the APSF Newsletter.