Measles

The United States is currently experiencing a large, multi-state outbreak of measles linked to an amusement park in California. The last confirmed case of measles in Maine was in 1997. 

On January 23, 2015, US CDC issued a Health Advisory to notify public health departments and healthcare facilities about the multi-state outbreak and to provide guidance for healthcare providers nationwide (http://emergency.cdc.gov/han/han00376.asp).

Measles is highly contagious and spreads through the air when an infected person coughs or sneezes. Measles can cause serious health complications, such as pneumonia or encephalitis, and even death. Children younger than 5 years of age and adults older than 20 years of age are at high risk of getting a serious case of measles. About 1 in 4 unvaccinated people in the U.S. who get measles will be hospitalized; about 1 in 500 may die.

Guidance for healthcare providers

• Ensure all patients are up to date on measles, mumps, rubella (MMR) vaccine.
• Consider measles in patients presenting with febrile rash illness and clinically compatible measles symptoms (cough, coryza, and conjunctivitis), and ask patients about recent travel internationally or to domestic venues frequented by international travelers, as well as a history of measles exposures in their communities.
• Promptly isolate patients with suspected measles to avoid disease transmission and immediately report the suspect measles case to the health department.
• Obtain specimens for testing from patients with suspected measles, including viral specimens for genotyping, which can help determine the source of the virus. Contact the local health department with questions about submitting specimens for testing.

For more information, go to http://www.cdc.gov/measles/ 

Measles alert

In the past week, Massachusetts identified 5 new cases of measles, ranging in age from 16 months to 65 years. All confirmed and suspect cases have either unknown or undocumented history of measles vaccination. Maine clinicians are asked to increase surveillance for rash illness suggestive of measles to help with early identification of potential cases and to assist in preventing the spread of disease in Maine.

Measles is a highly contagious respiratory disease caused by a virus and is spread from person to person through the air by infectious droplets. Symptoms include fever, runny nose, cough, loss of appetite, pink eye, and a rash. The rash usually lasts 5 – 6 days, beginning at the hairline, moving to the face and upper neck, and proceeding down the body.

Diagnosis

Maine CDC requests that clinicians report suspect case of measles to 1-800-821-5821 and advising suspect patients to remain at home until test results are known to prevent exposing others to the measles virus.

Measles testing is available at Maine’s Health and Environmental Testing Laboratory (HETL). Laboratory tests for acute measles infection include viral culture, serology, and PCR. Acceptable specimens include throat swabs, NP swabs, urine, and blood (requires acute and convalescent specimens). http://www.maine.gov/dhhs/etl/micro/measles_lsis.pdf

Case Management

It takes an average of 10 – 12 days from exposure to the first symptom which is usually fever. The measles rash does not usually appear until approximately 14 days after exposure. Measles is infectious for 4 days prior to 4 days after the onset of rash. All suspect patients should be placed in a separate waiting area or a private room with negative pressure.

Control Measures

Maine CDC will work with patients, and clinicians to identify all exposed contacts and to assess individuals for evidence of immunity. Measles vaccine may prevent disease if given within 72 hours of exposure.

Vaccinate

· Children. All children >12 months of age should receive their first dose of MMR at the 12-15 month routine health care visit, and every effort should be made to identify and vaccinate children who are not up-to date. All school-aged children should have two doses of MMR vaccine.

· Adults. All adults should have acceptable proof of immunity to measles. Certain groups at high risk should have received two doses of MMR, such as international travelers, health care workers, and college students. Women are advised not to receive any live virus vaccine during pregnancy including MMR.

Please report any suspicious cases and suspect cases of measles to Maine CDC at 1-800-821-5821