Measles
Background
- Also known as Rubeola (not to be confused with German Measles (Rubella)
- 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
Clinical Features
- Begins with URI symptoms: 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, travel outside of the Americas, or contact with international travelers in recent weeks. Simple community transmission is also possible.
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):
- 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
Source
- 2/25/14 VEP HEALTH ADVISORY by Rob Wyman, MD