2/21/2019: Lab Advisory: Clinical Laboratory Biosafety Recommendations for Measles

CDC's Laboratory Outreach Communication System (LOCS)

Audience: Clinical Laboratory Partners and Laboratories

Level: Lab Advisory: Important information for a specific incident or situation; contains recommendations or actionable items to be performed by public health officials, laboratorians, and clinicians


From January 1 to February 14, 2019, 127 individual cases of measles have been confirmed in 10 states. (1). Measles is a highly contagious disease, for which a highly effective vaccine is available.  Clinical laboratory professionals play an important role in responding to measles outbreaks by providing laboratory confirmation of infection to help guide control measures. For the clinical laboratory community, strict adherence to proper safety procedures is required to prevent laboratory-acquired infections when handling clinical samples from suspected patients.  Below is a summary of the recommended safety practices to support the implementation of appropriate biosafety mitigation measures to minimize the risk of exposure to laboratory personnel.


Measles virus (Rubeola) is classified as a Risk Group 2 agent, and Occupational Safety and Health Association (OSHA) Bloodborne Pathogens Standard 29CFR 1910.1030 and Standard Precautions should be observed when handling clinical samples suspected of and containing measles virus (2, 3). Measles can be spread by respiratory droplets, and by direct contact with secretions from the nose and throat of an infected person (1, 4). Direct contact is the primary mode of transmission, and airborne droplet and indirect contact are less common modes of transmission. However, because of its high communicability and low infectious dose, additional precautions may be necessary.

Implementation of laboratory biosafety measures should always be based on a comprehensive risk assessment of the activities that occur in the laboratory. In particular, the risk assessment for work with clinical samples from suspect measles cases should consider:

  • MMR vaccination status of laboratory professionals (including current titer due to variation in vaccine efficiency)
  • Immune status of laboratory professionals
  • Nature of laboratory/diagnostic work being performed
  • Type of diagnostic equipment used (open vs. closed systems)
  • Method of transport of specimens
  • Method of waste disposal
  • Availability of post-exposure prophylaxis/treatment

For More Information/References:

  1. Measles (Rubeola). Centers for Disease Control and Prevention. https://www.cdc.gov/measles/index.html and https://www.cdc.gov/measles/cases-outbreaks.html
  2. ABSA International Risk Group Database. https://my.absa.org/tiki-index.php?page=Riskgroups
  3. Bloodborne Pathogen Standard (BBPS). 29CFR 1910.1030. Occupational Safety and Health Association (OSHA). https://www.osha.gov/SLTC/bloodbornepathogens/index.html
  4. Pathogen Safety Data Sheets: Infectious Substances – Measles virus. Public Health Agency of Canada. https://www.canada.ca/en/public-health/services/laboratory-biosafety-biosecurity/pathogen-safety-data-sheets-risk-assessment/measles-virus.html
  5. Measles & Rubella Laboratory Manual. World Health Organization. 2018. https://www.who.int/immunization/monitoring_surveillance/burden/laboratory/manual/en/
    Section 4.6 General safety precautions on receipt of samples
    Section 8.6 Laboratory Safety
  6. Transmission-Based Precautions. Centers for Disease Control and Prevention. https://www.cdc.gov/infectioncontrol/basics/transmission-based-precautions.html
  7. Biosafety in Microbiological and Biomedical Laboratories (BMBL) 5th Edition. U.S. Department of Health and Human Services. https://www.cdc.gov/labs/BMBL.html
  8. Sharps Safety for Healthcare Settings. Centers for Disease Control and Prevention. https://www.cdc.gov/sharpssafety/

Laboratory Outreach Communication System | Division of Laboratory Systems (DLS)

Center for Surveillance, Epidemiology, and Laboratory Services (CSELS)

Centers for Disease Control and Prevention (CDC)