Measles

Background

• 10d incubation period
• 3d prodromal period

Current Outbreaks

• 2/14
  • 14 known measles cases in California
  • 5 of the patients recently traveled to the Philippines or had contact with international travelers
  • the majority of patients were unvaccinated
  • a recent outbreak in the Philippines has resulted in over 20 deaths and thousands of cases

Diagnosis

• Begins with URI symptoms: high fever, cough, coryza, and conjunctivitis
• Koplik's spots may appear in 2-3 days after onset of symptoms
  • Pathognomonic enanthem
  • Tiny red spots (base) with bluish-white centers on the mucosa of the cheek or palate
• Then 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, travel outside of the Americas, or contact with international travelers in recent weeks. Simple community transmission is also possible.

Work Up

• Usually you need (check with your lab):
  • 1-2 ml blood in a red-top tube
  • throat or nasopharyngeal swab using a viral culturette with viral transport media
  • 10-40 ml of urine in 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.

Post-Exposure Prophylaxis

• Can be administered to contacts
• Checking with your local health authorities
  • Within 72 hours of exposure use MMR vaccine
  • Up to 6 days after exposure use IM immune globulin

Infectious 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.

See Also

Rashes (Peds)

Source

• VEP HEALTH ADVISORY 2/25/14