2019 Measles Case Identified

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.

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:

1. 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.
2. Provide education on contact precautions and droplet precautions. Suspected cases that are not hospitalized should self-isolate for four days after rash onset or until labs result.
3. If the patient is hospitalized, airborne precautions are indicated (negative pressure room and N95 mask with proper seal). Only healthcare providers with proof of vaccination against measles should come into contact 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. 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.

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. Some people may suffer from severe complications, such as pneumonia and encephalitis. They may need to be hospitalized and could die.

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.

In 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%. 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.