Surgery in Patients with Active Measles

Infectious Period and Transmission Risk

Patients with measles are infectious from 4 days before rash onset through 4 days after rash onset, and the disease is highly contagious, transmitted through aerosols, posing a high-risk for transmission in the operating room environment 1, 2
Healthcare personnel and other patients in the surgical suite face substantial exposure risk during procedures requiring airway manipulation or prolonged close contact 1

Adults with measles require hospitalization in 25% of cases, indicating significant systemic illness, and encephalitis or death follows measles in approximately 1 per 1,000 cases, with the highest risk among adults and infants 3

When surgery cannot be delayed, patients should be placed in an airborne-infection isolation room immediately, and all healthcare personnel must use N95 respirators or equivalent respiratory protection regardless of immunity status 1, 2
Only staff with documented presumptive evidence of measles immunity should participate in care when possible, and airborne precautions should be maintained throughout the perioperative period until at least 4 days after rash onset 1, 2

Exposed healthcare workers without evidence of immunity must be excluded from work from day 5-21 following exposure, and even healthcare workers with documented immunity should observe airborne precautions due to ~1% vaccine failure rate 1, 2
Rapid vaccination of susceptible contacts is essential to prevent further spread 1, 2

Measles during pregnancy increases rates of spontaneous abortion, premature labor, and low birth weight, and pregnant women with measles require hospitalization more frequently than non-pregnant adults 3
Immunocompromised patients face higher risk of severe complications and prolonged viral shedding, and consideration should be given to higher dose immune globulin (0.5 mL/kg) for post-exposure prophylaxis if surgery exposure occurs 5

Airborne precautions with N95 respirators are mandatory even in negative pressure rooms, and isolation alone is not sufficient 1, 2
Elective surgery should not be performed during the infectious period, as the risk to healthcare workers and other patients is unacceptable 1, 2
Vitamin A supplementation (200,000 IU for adults/children ≥12 months, 100,000 IU for younger children) should not be neglected, as it reduces measles severity and mortality 5
Fever, respiratory infection, and systemic illness are not contraindications to measles vaccination for exposed contacts, but active measles itself necessitates supportive care first 6, 7, 8