Guidance for primary care optometry settings and optical practices

Local NHS public health authorities have recently issued guidance to support healthcare settings to prepare for and manage suspected or confirmed cases of measles, following reports of local outbreaks across the UK. This guidance is applicable to primary care optometry settings and optical practices.  

Measles is highly infectious, acute respiratory disease – the most infectious of all diseases transmitted through the respiratory route. In a population with no immunity to measles a single case of measles will infect between 10 and 20 others – this is known as the basic reproduction number (R0), with measles being around ~R15.  This compares to COVID-19 with ~R2-R4 and seasonal influenza with ~R1-R2. 

We have previously issued guidance on managing patients who contact practices with symptoms of respiratory infection, which is relevant to measles outbreaks. Measles has specific symptoms and is spread via droplet and airborne particles. This means specific transmission based precautions (TBPs) are required when providing face-to-face care. Measles is also a notifiable disease, meaning any suspected or confirmed cases must be reported to your local health protection team.  

Contractors who have received notification from their local NHS authority, practices should undertake a risk assessment to identify which risk mitigation measures they should implement in order to reduce or prevent the spread of measles. The advice below sets out guidance on safely managing patients with suspected or confirmed measles and what steps practices that are able to or required to provide face-to-face eye care can take to protect staff and other patients. 

Frequently asked questions

In the first instance, patients who contact the practice with symptoms of respiratory infection, including measles, should postpone their eye care unless it is urgent or an emergency.  

Symptoms of measles are:  

  • high temperature or fever AND
  • rash (typically spreads from the face to rest of the body)
  • AND include at least one of the following:
    • conjunctivitis,
    • cough, or
    • runny nose (coryza)

Where patients have a single symptom, other than high temperature or fever, you should use your professional judgement to determine infection risk and not unnecessarily defer appointments or refer to other pathways as these symptoms may be due to non-infectious causes.  

If patients have high fever AND rash AND at least one of conjunctivitis, runny nose or cough, this is indicative of measles infection so you should defer routine care until at least 4 full days after the onset of the rash or until they are well, whichever is later. However if clinically necessary and in the patient’s best interest, you may offer remote consultation to address their needs.  

If these patients require face-to-face care that cannot be postponed, you should apply the relevant transmission based precautions (TBPs) according to your nation’s National Infection Prevention and Control Manual (NIPCM) and any local guidance. If this is not possible they should be referred to an appropriate local service that is able to apply these measures, or you should contact your local hospital eye department for advice. 

As measles is a legally notifiable disease, you must report suspected cases (including those whose care you have deferred on this basis) to your local health protection team (HPT) urgently by telephone and advise the patient to contact their GP. You can find your local HPT here: 

Practices should identify the immunisation status of all staff (clinical and non-clinical) who may be exposed to suspected or confirmed cases of measles. Those considered to have protection against measles have either documented evidence of a full immunisation record or a positive measles antibody test (which confirms previous exposure and acquisition of IgG immunity). You can find your immunisation record on the NHS app if available or by contacting your GP practice.  

Practices should support their staff to obtain measles vaccinations in addition to all other relevant occupational vaccinations and boosters. This helps to reduce the risk of infection, complications associated with infection, transmission of infection and help practices plan where staff are exposed. 

Staff who may be at high risk of measles infection or complications associated with measles infection should undergo an individual risk assessment to ensure they continue in their current role safely or for consideration of redeployment in line with normal business practices.  

A patient screening and triaging protocol should be in place to identify those with suspected or confirmed measles and history of urgent or emergency visual or ocular symptoms. Staff involved in the administration of patient appointments should be appropriately trained in this. 

Staff who are able to provide care should wear an FFP3 mask or equivalent respiratory protective equipment (RPE) when providing direct care to these patients, in line with NIPCM recommendations. This legally requires fit testing to ensure safe and effective use. 

Practices should ensure all staff are trained in appropriate infection prevention and control measures, including when to wear personal protective equipment (PPE) and the correct donning, doffing and disposal of PPE. 

Practices should ensure they have sufficient levels of PPE and RPE available for staff and patients who attend the practice with symptoms of any respiratory infection to enable your practice to continue to provide eye care safely. 

Practices providing face-to-face care should undertake a practice based risk assessment by appropriately qualified individuals in order to determine the relevant droplet and airborne transmission risk mitigation measures for measles infection in the following areas: 

  • Attending the practice 
    • Appointments should be scheduled at quieter times of the day and the patient advised to attend the practice alone where possible 
  • Placement in the practice 
    • Patients should be isolated at the time of arrival (eg in a separate waiting area or room or straight into the consulting room). Patients and those accompanying them should be asked to wear a fluid resistant surgical mask for source control 
  • In the consulting room 
    • Staff providing direct care should wear the following PPE and RPE: 
      • Single use disposable gloves 
      • Single use disposable apron  
      • Eye/face protection (goggles or visor) 
      • Fit tested FFP3 mask or equivalent (RPE) 
    • Ensure adequate levels of ventilation 
  • Decontaminating (cleaning and disinfecting) the practice 
    • All equipment and surfaces that have made contact with the patient should be cleaned and disinfected appropriately after the care episode.

Guidance has been issued to support this process, including a set of measures based on the hierarchy of controls for managing infection risk for England (Appendix 1). This may be applied in other UK nations but you should follow your nation's recommendations where available. 

Staff are not considered exposed to measles if appropriate PPE and RPE is worn. 

Staff are considered exposed to measles if they are not wearing appropriate PPE, RPE and:  

  • they provide direct care (face-to-face) for any length, or 
  • spend more than 15 minutes in a small confined area with the patient.

Asymptomatic staff who have been exposed to measles but do have documented evidence of protection against measles (full measles immunisation record or positive measles antibody test) can continue to attend work. 

Asymptomatic staff who have been exposed to measles but do not have documented evidence of protection against measles (full measles immunisation record or positive measles antibody test) should not attend work from the 5th day after exposure to 21 days from the last exposure. However, if they are tested within 7 days of exposure and receive a positive measles antibody result, they can return to work. This is in line with government guidelines for measles exposure.  

However, if any staff develop measles symptoms (high temperature or fever AND rash; AND at least one of cough, runny nose or conjunctivitis) between 7 days after the first exposure and 21 days after the last exposure; they should not attend work until 4 full days after the onset of the rash or until they are well, whichever is later.