An increase in measles cases in the U.S. has been identified by the Centers for Disease Control and Prevention (CDC). Although cases of Measles have not yet spread to Louisiana, we want clinicians to be on the lookout. Measles is still common in many parts of the world, including some countries in Europe, Asia, the Pacific, and Africa. Ukraine and Israel are having especially large outbreaks. Travelers with measles continue to bring the disease into the U.S and measles can spread when it reaches a community where groups of people are unvaccinated.
All healthcare providers throughout Louisiana are requested to consider measles in the initial differential diagnosis of patients with a clinically compatible febrile rash illness, particularly those who have traveled abroad or come into contact with a known measles case and are unvaccinated. Measles is characterized by a prodrome of fever (as high as 105°F) and malaise, cough, coryza, and conjunctivitis, followed by a maculopapular rash that appears on the face at the hairline and spreads downward to the neck, trunk, arms, legs, and feet. Tiny white spots (Koplik spots) may appear inside the mouth 2 or 3 days after symptoms begin.
If you suspect a patient has measles:
- Immediately report any suspected cases to the Louisiana Office of Public Health Infectious Disease Epidemiology Hotline at 800-256-2748 to coordinate confirmatory testing through the OPH Laboratory.
- Provide education on contact precautions (washing hands, avoiding touching infected surfaces or objects) and droplet precautions (respiratory etiquette). Suspected cases that are not hospitalized should self-isolate for four days after rash onset or
- If the patient is hospitalized, airborne precautions are indicated (negative pressure room and N95 mask with proper seal).
Only healthcareproviders with proof of vaccination against measles should come intocontact with the patient.
Measles is a highly contagious virus found in the nose and throat mucus of an infected person. It takes approximately 11-12 days (range 7-21 days) from time of exposure to start to exhibit symptoms. It can spread to others through respiratory droplets and droplet nuclei released when coughing, sneezing speaking. Also, measles virus can remain for up to two hours in an airspace where the infected person was present. If other people breathe the contaminated air or touch infected surfaces, then touch their eyes, noses, or mouths, they can become infected. Measles is so contagious that if one person has it, 90% of the people close to that person who are not immune will also become infected.
Infected individuals can spread measles to others from four days before through four days after the rash appears.
Measles can be serious in all age groups. However, children younger than 5 years of age and adults older than 20 years of age are more likely to suffer from measles complications.
Common measles complications include ear infections and diarrhea.
- Ear infections occur in about one out of every 10 children with measles and can result in permanent hearing loss.
- Diarrhea is reported in less than one out of 10 people with measles.
Some people may suffer from severe complications, such as pneumonia (infection of the lungs) and encephalitis (swelling of the brain). They may need to be hospitalized and could die.
- As many as one out of every 20 children with measles gets pneumonia, the most common cause of death from measles in young children.
- About one child out of every 1,000 who get measles will develop encephalitis (swelling of the brain) that can lead to convulsions and can leave the child deaf or with intellectual disability.
- For every 1,000 children who get measles, one or two will die from it.
Measles may cause pregnant women to give birth prematurely or have a low-birth-weight baby.
From January 1 to 31, 2019, CDC reported 79 confirmed cases of measles in 10 states (California, Colorado, Connecticut, Georgia, Illinois, New Jersey, New York, Oregon, Texas, and Washington). Three outbreaks have been reported (New York State, New York City, and Washington State) and are associated with travelers who brought measles back from countries where transmission is ongoing. The majority of people who have gotten measles were unvaccinated. No confirmed cases have been identified in Louisiana in 2019.
In 2018, the US experienced 17 outbreaks. There were 372 cases reported to CDC and 82 of the cases were from people bringing measles to the U.S. from other countries. This is the greatest number of imported cases since measles was eliminated from the U.S. in 2000. During 2018, Louisiana had two confirmed cases of measles, both in unvaccinated travelers and there was no local transmission.
The measles vaccine is very effective. One dose of measles vaccine is about 93% effective at preventing measles if exposed to the virus. Two doses are about 97% effective.
That means that only three out of 100 people who get two doses of measles vaccine will still get measles if exposed to the virus. In addition, fully vaccinated people who get measles are much more likely to have a milder illness, and they are also less likely to spread the disease to other people, including people who can’t get vaccinated because they are too young or have weakened immune systems. Additional information about measles is available at https://www.cdc.gov/measles/index.htmlIn Louisiana, measles, mumps, rubella (MMR) vaccine is required for school entry. The MMR vaccination rate for kindergartners in Louisiana for the 2017-2018 school year was 96.1%. (https://www.cdc.gov/vaccines/imz-managers/coverage/schoolvaxview/data-reports/coverage-reports/2017-18.html) Providers should also take appropriate infection control precautions and immediately report any suspected measles cases to the Louisiana Office of Public Health Infectious Disease Epidemiology Hotline at 800-256-2748.