Measles

Background

• Also known as Rubeola, which is not to be confused with German Measles (Rubella)
• 10d incubation period
• 3d prodromal period
• Patients are contagious from about 4 days before to 4 days after onset of rash

Current Outbreaks

• 2015
  • Large scale outbreak linked to DisneyLand, CA: children through teenagers affected, 70 known cases

Clinical Features

Koplik's Spots on Cheek

Koplik's Spots on Palate

Measle's Rash on Face

Measle's Rash on on Thorax

• Consider measles in a patient of any age who has an acute RASH and FEVER
• Typically begins with a prodrome of high fever, cough, coryza, and conjunctivitis
• Koplik's spots (appears day 2-3)
  • Pathognomonic enanthem
  • Tiny red spots (base) with bluish-white centers on the mucosa of the cheek or palate
• Rash (begins day 4 - lasts to day 7)
  • Red, blotchy, and maculopapular; rapidly progresses to confluence
  • Usually starts on the face (hairline and behind the ears)
  • Rapidly spreads to the chest, back, and finally the legs and feet
• Obtain a history of measles immunization, contact with known outbreak, travel outside of the Americas, or contact with international travelers in recent weeks

Differential Diagnosis

Pediatric Rash

• Atopic dermatitis
• Bed bugs
• Contact dermatitis
• Drug rash
• Erythema infectiosum (Fifth disease)
• Hand-foot-and-mouth disease
• Henoch-schonlein purpura (HSP)
• Herpangina
• Herpes simplex virus (HSV)
• Infectious mononucleosis
• Meningitis
• Measles
• Molluscum contagiosum
• Roseola infantum
• Rubella (German measles)
• Scabies
• Scarlet fever
• Smallpox
• Varicella (Chickenpox)

Work Up

• Usually you need (check with your lab):
  • Blood: 5-10 mL for measles IgG and IgM
    • Use a red-top tube and spin down serum if possible
  • Swabs: nasopharyngeal (or throat) for culture and PCR
    • Use a viral culturette with viral transport media
  • Urine: 50-100 mL of urine for PCR
    • Use a sterile container

Management

• Alert local health department ASAP
  • The risk of measles transmission to others and large contact investigations can be reduced if control measures are implemented immediately

Isolation Precautions

• For suspected patients
  • MASK the patient and ISOLATE immediately in an airborne infection isolation room
  • All personnel entering the room should use respiratory protection at least as effective as an N95 respirator
  • If possible, allow only personnel with documentation of 2 doses of live measles vaccine or laboratory evidence of immunity (measles IgG positive) to enter the room
  • Do not use the room for at least 2 hours after the patient leaves.

Post-Exposure Prophylaxis (Non-Immune Contact)

• Immunocompetent:
  • Within 72 hours of exposure use MMR vaccine
• Immunocompromised, children <12 months, and others at high risk of complications:
  • Consider checking with your local health authorities
  • Up to 6 days after exposure use IM immune globulin

Complications

• Severe illness can include pneumonia, encephalitis, and death

See Also

• Pediatric Rashes

Source

• 2/3/15 VEP HEALTH ADVISORY by Rob Wyman, MD