Ripley County Health Center

08/31/2026

Infection Prevention & Control
Guidance for health care professionals to prepare the clinical office for a patient with suspected measles.

Immediately report all suspected measles cases to your local health department or the Missouri Department of Health and Senior Services (DHSS). Do not wait for lab results to be returned.
Local Public Health Agencies [directory] or DHSS Emergency/Disease Reporting (24/7) 1-800-392-0272

Preparation Checklist
 Immunity: All health care workers should have documented immunity to measles or two documented doses of MMR. Only staff immune to measles should provide care. For patients, immunity is considered to be two documented doses of MMR vaccine or born before 1957or having a documented measles infection. Patients vaccinated between 1963-1967 and are unsure of vaccine type, should be considered unvaccinated.
 Screening: Screen patients over the phone for signs/symptoms of measles at the time of booking an appointment. Make efforts to arrange appointments for symptomatic patients at the end of the day when there are no other patients present.
 PPE: Ensure N95 masks are available for staff and that staff has been fit-tested. All health care providers regardless of presumptive immunity to measles are to wear appropriate PPE when providing care to clients with suspect or confirmed measles. Establish an area to don and doff PPE (mask, gowns, gloves, and eye protection) away from other patients and staff. To avoid contamination with clean PPE, place clean PPE at a distance of 6 feet away from the doffing area.
 Testing: Ensure your office has testing specimen containers, supplies, and requisitions for testing all 3 measles tests: Nasopharyngeal Swab/Throat Swab, Urine. Check expiry dates of specimen kits. Please consult with your local public health agency or DHSS prior to collecting samples.
 Cleaning: Ensure you have an appropriate disinfectant to clean the office space, exam rooms, and shared
medical equipment.
Steps for Patients Visiting a Clinical Office
1. If the patient has not arrived at clinic, route the patient to a mobile unit, or even through a pre-established secondary entrance to avoid consequential exposure.
2. If the patient is already inside clinic, quickly triage patients out of common waiting areas and move symptomatic patients to an exam room. Isolate suspected or confirmed cases of measles immediately into a single room with the door closed. Provide a medical mask for the patient to wear at all times.
**Note: The preferred placement for patients who require airborne precautions is in a single-patient airborne infection isolation room (AIIR) or negative air pressure room. To prevent possible exposure of measles, the patient should remain completely isolated from other patients, and the exam room should not be used for 2 hours after the patient has departed.
3. If possible, have the symptomatic patient enter and exit through a separate entrance and enter and exit the exam room directly.
4. Clinicians should consider measles in patients presenting with non-specific signs and symptoms (fever, cough, runny nose, and conjunctivitis), especially if they are unvaccinated, partially vaccinated, or immunocompromised and there is a potential exposure risk, including recent travel. https://www.cdc.gov/infection-control/hcp/ measles/index.html
5. If you are referring a patient for diagnostic testing, the receiving facility (e.g., lab or hospital emergency department) must be notified before arrival of the patient, to allow for proper IPAC measures.
6. Clean the exam room and other common areas after the patient has left the office. Consider how you will notify exposed patients, if necessary.
August 2026

Access guidelines and resources for infection control in healthcare settings.

08/31/2026

MEASLES RESPONSE GUIDANCE
For Employers in Non-Health Care Settings

Measles is one of the most contagious viral infectious diseases. The Missouri Department of Health and Senior Services (DHSS) developed this guidance, based on the most current public health recommendations, to help employers address a measles situation in a workplace when a measles case or measles exposure occurs.
The average timeframe from exposure to onset of the symptoms of measles is 11-12 days. The measles rash occurs an average of 14 days following an exposure, but that time could be as short as 7 days and as long as 21 days. Persons can spread measles to others from 4 days before through the 4 days after the rash appears. Persons exposed and infected with measles are generally not infectious during the first 7 days after an exposure though could spread measles in the following 7 to 21 days, even before knowing they have the disease. Therefore, persons with exposures to measles are typically observed for 21 days following the last exposure to determine if measles symptoms develop.

Exposure means sharing the same airspace as someone with measles, including 2 hours after an infected person has left the airspace. No minimum duration has been established for exposure, but longer exposures and face-to-face interactions represent a higher risk for measles transmission than brief exposures.

Immunity to measles can significantly decrease the risk of developing measles after exposure to the virus. The following is considered proof of measles immunity in adults:
• Birth before 1957.
• Written documentation with date of receipt of at least one dose of measles-containing vaccine. People who received the killed measles vaccine between 1963 and 1967, or are unsure of their vaccine history, need a booster dose of the live measles vaccine to be considered immune.
• Laboratory evidence of measles immunity (positive antibody titer also called an IgG antibody test).
• Laboratory confirmation of previous measles disease.

High-Risk Measles Exposure
Involves those with unknown or no documented immunity, as well as those who are at a high-risk of experiencing severe illness if they become infected with measles, or to whom the transmission potential is high. Examples of high-risk contacts include immunocompromised persons, pregnant women, household contacts, contacts with prolonged exposure, and persons in settings with known unvaccinated persons (e.g., infant care settings). A high-risk setting is one in which transmission risk is high (e.g. setting with many measles-susceptible persons, an infant care setting, etc.), or where there are multiple high-risk contacts, particularly persons who could experience severe disease if infected with measles. Those who have one dose of measles vaccine but high intensity exposure to a case of measles, such as sharing living quarters, sharing small, enclosed workspaces or vehicles, or engaging in regular or prolonged close contact, are also considered at high risk.

Exclusion from Work for Those with High-Risk Measles Exposure
• Any exposed worker who cannot show proof of immunity should be excluded from work to prevent possible measles transmission beginning from day 7 through day 21 after the last measles exposure (day of exposure is day 0) and may return on day 22 unless proof of immunity is provided sooner.
• If the excluded worker receives one documented dose of MMR within 72 hours after an initial exposure to measles, they may return to work immediately. A second dose of MMR should be given at least 28 days later to complete the 2-dose series.
• Unvaccinated workers who do not receive a dose of MMR within 72 hours of exposure, including those who have a medical or other exemption to vaccination, should be excluded from work beginning from day 7 through day 21 after the last measles exposure (day of exposure is day 0). If an exposed individual can produce alternate evidence of immunity, such as a blood test showing antibodies to measles (also called an IgG antibody test), exclusion may be downgraded to symptom monitoring instead after the consultation with their local public health agency or DHSS. If there are multiple cases of measles at a workplace, the worker’s exclusion might be extended beyond 21 days, since the 21-day period would reset with the identification of each individual new case.
• Workers with high intensity exposure to a case, and who have only one documented dose of MMR, should be excluded until they either receive a second dose of vaccine as soon as possible (at least 28 days needed since they received the first dose), or demonstrate immunity with a positive IgG titer. If the worker does not receive a second vaccine and has a negative IgG titer (or does not get one at all), they should be excluded from work beginning from day 7 through day 21 after the measles exposure (day of exposure is day 0).
Quarantine Recommendations for Those with High-Risk Measles Exposure
• Excluded employees should quarantine to prevent infecting others. Quarantine includes staying at home, away from others, and away from all public places, including work, social activities, sports, recreation events, all extracurricular activities, and public places like grocery stores and churches.
• If symptoms consistent with measles develop during the quarantine period, the employee should immediately isolate, and the local public health agency or DHSS need to be notified. Persons quarantining should be instructed to notify their local public health agency or DHSS if symptoms occur.

Low Risk Measles Exposure
Occurs among persons with documented immunity or one documented MMR dose, AND without high-intensity exposure. Any exposed worker who can show proof of immunity may continue working but must monitor for signs and symptoms of measles for 21 days after last known exposure. Workers who have only one documented dose of MMR, but had low intensity exposure to a case, are strongly recommended to get a second dose of MMR as soon as possible, and to self-monitor for symptoms for 21 days after last known exposure to a case.

This document is meant only as guidance for employers and is not an order of the Missouri Department of Health and Senior Services. Responding to measles in a workplace can be complex, time-consuming, and warrant additional situation specific guidance. DHSS strongly recommends that employers collaborate with local public health authorities and DHSS during the response to provide employees with the best public health recommendations.

08/17/2026

NOTICE OF PUBLIC HEARING

Ripley County Public Health Center
1003 East Locust
Doniphan, Missouri 63935

Board of Trustees
Dorothy Walker, Chairman
Mark Thompson
Sheila Featherston
Sherrie Newman
Janet Arnold

Tammy Cosgrove, Director
Phone: 573-996-2181 Fax: 573-996-7632
E-mail: [email protected]
www.ripleycountyhealth.com

August 17, 2026

Notice of Public Hearing

A hearing will be held at 4:30 p.m., Tuesday, August 25, 2026, at the Ripley County Public Health Center, 1003 East Locust Street, Doniphan, MO on the tax rate. The tax rates are set to produce revenue which the budget for the fiscal year beginning January 1, 2027, shows to be required from the property tax.

2025 2026
Real Estate $113,941,660 $122,244,010
Personal Property $29,154,531 $29,140,853
Total Assessed Valuation $143,096,191 $151,384,863
Tax Rate Proposed $0.1309 per 100 $0.1283 per 100
Revenue Budget $187,312.91 $194,226.78

By order of the Ripley County Public Health Center Board of Trustees Chairman, Dorothy Walker

An Equal Opportunity/Affirmative Action Employer
This institution is an equal opportunity provider
Services Provided On A Nondiscriminatory Basis

08/11/2026

Come join us! This event is open to all pregnant and breastfeeding moms in Ripley County.

08/10/2026

The Ripley County Health Center can help with the required immunizations or written exempt. Call 573-996-2181 today to schedule an appointment or come by. We take walk-in’s. The RN’s will send your designated school your immunization records so that you don’t have to worry about it.

State health regulations require adequate immunization or a written exemption from the immunization. After your child has received the required immunization, please send a copy of the record to school. You may fax a copy to 573-996-5222 or bring it by the appropriate office. Your child will need to have this immunization to be able to start school on the first day in August. Grades typically impacted by immunization requirements are kindergarten, 8th grade and 12th grade. Thank you for your prompt attention concerning this matter. Any questions concerning this, please contact the nurse's office at (573)996-3667.

07/27/2026

MoDNR has updated the Missouri Flood & Drought app to include boundaries and labels for all 93 state parks and historic sites, making location tracking seamless for visitors.

Developed over three years, this free app uses a statewide network of streamgages and soil-moisture sensors to deliver real-time water level data and local weather impacts. Users can set custom alerts for nearby streams to receive safety notifications and plan safe routes during flooding events.

Key features and highlights:
Real-time monitoring: Track stream levels, water velocity and soil saturation directly on the app or desktop at mohic.hub.arcgis.com.

Custom weather and flood alerts: Get instant notifications to avoid hazardous travel routes.

Enhanced park safety: Complements Missouri State Parks' emergency response protocols and local responder coordination to support rapid evacuations and shelter procedures.

06/02/2026

The Ripley County Health Center Registered Nurses are all at a training today. We are open but no RN services available. They will be back tomorrow!

05/31/2026

Attention Parents, Guardians, Caretakers
Of school age children.

We are having these clinics to give you some alternative days to get your child’s required immunizations. Take advantage of these dates. No appointment needed but if you call us first we can pull your child’s record and be ready for you.

Attention Ripley County Parents and Guardians,

Ripley County Health Center has scheduled upcoming immunization clinics to help keep our students healthy and ready for next school year.

These clinics will provide all required and recommended vaccines in a safe and convenient setting.

Clinic Details:

Date: June 1, 2026 Date: June 15, 2026
Location: Ripley County Health Center
Time: 8:00 a.m. to 4:30 p.m.

Vaccinations are essential for preventing illness and maintaining a safe school environment for all students. Don’t wait until the last minute to get your child his or her required immunizations. Take advantage of these clinics and get it done, so you and your child or children can enjoy the summer.

Call 573-996-2181 today to schedule your child’s appointment so we can ensure enough vaccines are available. Walk-ins will also be accepted during these clinics.

Plan ahead. Stay Protected. Keep your child in school!

05/28/2026

May 28, 2026