As we enter the 2019 summer camp season, we wanted to refresh our existing content surrounding measles and immunizations after recent outbreaks in the US.

For this update, ACA has partnered with medical and health professionals to provide the most up-to-date information available.

About Measles

• Measles is a serious respiratory disease caused by a virus. Measles starts with a fever. Soon after, it causes a cough, runny nose, and red eyes. Then a rash of tiny, red spots breaks out. It starts at the head and spreads to the rest of the body. The rash can last for a week, and coughing can last for ten days.
• Measles is highly contagious and spreads through the air when an infected person coughs or sneezes. It is so contagious that if one person has it, up to nine out of ten people around them will also become infected if they are not protected. You can get measles just by being in a room where a person with measles has been, even up to two hours after that person has left. An infected person can spread measles to others even before he or she develops symptoms — from four days before they develop the measles rash through four days afterward.
• Measles can cause serious health complications, such as pneumonia or encephalitis, and even death. Children younger than five years of age and adults older than 20 years of age are at high risk of getting a serious case of measles. About one in four unvaccinated people in the US who get measles will be hospitalized. One out of every 1,000 people with measles will develop brain swelling (encephalitis). One or two out of 1,000 people with measles will die, even with the best care.

The CDC’s Recommendations for Unvaccinated Exposure to Measles

If you’re not protected against measles and think you might have been exposed to someone with measles:

1. Stay home. Do not go straight to the doctor. Instead, call ahead to inform a healthcare professional of your possible exposure so you can get instructions about how to avoid exposing others.
2. Additionally, talk to your doctor about getting measles vaccine. If given within 72 hours of initial exposure, MMR vaccine may provide some protection or lessen the severity of disease.

Except in healthcare settings, unvaccinated people who receive their first dose of MMR vaccine within 72 hours after exposure may return immediately to childcare, school, or work.

Measles Immunization and Camps

ACA’s mandatory accreditation standard HW.1 addresses the issue of immunization:

HW.1 CAMPER HEALTH HISTORY
HW.1.1 Does the camp require each camper to submit a current, signed health history that includes all of the following information in relation to the activities in which the camper may participate:
A. Record of allergies and/or dietary restrictions;
B. Record of current medications, both prescribed and over-the counter;
C. Record of past health treatment, if any;
D. A statement from the custodial parent/guardian attesting that all immunizations required for school are up to date including the actual date (month/year) of last tetanus shot (a physician statement, a government immunization report, or a school immunization report is also acceptable);
E. Description of any current physical, mental, emotional, social health, developmental, or psychological conditions requiring medication, treatment, or special restrictions or considerations while at camp; and
F. Description of any camp activities the camper

A sample form is available to all ACA members.

Measles — Top Tips for Camps

1. Know each camper and staff member’s immunization status. Require an immunization history (including month and year for each type of immunization) for each camper and staff member on the camp’s health history form. This is particularly important when illness associated with lack of immunization occurs. Understand your state’s exemptions from school immunization requirements as well. (See section below on immunization for more information.)
2. Decide if you will allow unvaccinated campers and staff at your camp. Understand the risk if you do accept a camper or staff member who has not been immunized for measles. ACA accreditation standards allow for a camp to accept campers who have not been immunized due to medical, religious, or other reasons — requiring instead that the parent/custodial guardian can sign a waiver form. If someone not protected through immunization comes in contact with an infected person, many public health departments have initiated mandatory 21-day quarantine. Each public health department may handle this differently. For example, where the quarantine occurs (camp or elsewhere), who is quarantined, including potential distinctions between people who have a medically documented reason for not being immunized (e.g. immune-compromised) versus those whose parents chose not to immunize, etc.
3. Understand the facts about the disease. Measles is a highly contagious disease caused by a virus. Measles can be serious — even fatal — for young children. While rare, it can lead to pneumonia, encephalitis (swelling of the brain), and death. People exposed to measles who have not been vaccinated almost always get measles.
4. Understand why there has been an outbreak in the United States. As of May 2019, 764 new cases of measles have been reported across 23 states in the United States. Public health officials have declared that the disease has spread in part because of lower rates of vaccination in certain parts of the US.
5. Ensure you have educated healthcare staff. While only a physician can diagnose measles, ensure that your healthcare staff understand the symptoms and have procedures in place to immediately seek medical care if measles are suspected.
6. Consider tracking the percent of immunized campers and staff at your camp. This may be important information for parents of children who cannot be immunized; it helps them understand the potential risk exposure for their child. Use data from last season if tracking this season’s percent is challenging.

For more information about measles and camps, visit ACAcamps.org/resource-library/measles-information-camps.

Other Communicable Diseases

The potential for the spread of communicable diseases at camp means that camps must continue to pay diligent attention to communicable disease control strategies.

Top Five Tips for Camps Regarding Communicable Diseases

1. Partner with parents to reduce the introduction of communicable diseases in camp: Educate parents and caregivers about their role in illness prevention before camp begins. This parent flyer provides key messages for parents.
2. Establish “opening day” screening processes: Establish processes that screen campers for communicable diseases when they arrive at camp. Set a policy that states that the camp retains the right to refuse admission to someone who poses a communicable disease threat.
3. Establish and implement policies that prevent the spread of disease: Personal protective practices such as frequent hand washing, remaining hydrated, sleeping with the greatest distance between heads, and effectively covering coughs and sneezes (with an arm or sleeve — NOT a hand) should be included.
4. Establish policies to keep your staff healthy: Policies and performance evaluations should reinforce how important it is that staff take proper care of themselves, including getting sufficient amounts of rest.
5. Regularly evaluate and update your health care practices and procedures: Comply with standard HW.1.1 (2019). In addition, seek out and use the most-up-to-date information from trusted resources such as the Centers for Disease Control and Prevention (see Resources section below).

For more information and resources about camps and communicable disease, visit ACAcamps.org/resource-library/forms/health-forms-records.

Resources

• American Camp Association. Sample Health Forms and Records. (Members only.)
• American Academy of Pediatrics: Measles & Immunizations
• Association of Camp Nursing: Measles at Camp
• States with Religious and Philosophical Exemptions from School Immunization
• CDC Measles Website
• State Vaccination Requirements
• CDC Educational Measles Resources for Parents & Caregivers
• CDC Measles Website for Healthcare Professionals
• CDC Travelers’ Health Measles

Photo courtesy of ibreakstock / iStock / Getty Images Plus via Getty Images.