Measles Health Advisory January 14, 2015 General Public Health, Measles 0 HEALTH ADVISORY – January 7, 2015 Measles has been confirmed in seven California residents in 2015 and two Utah residents; all visited Disneyland or Disney California Adventure Park between December 17th and 20th, 2014. Testing is underway on three additional California residents who also visited Disneyland during this same time period. The California confirmed cases reside in five local health jurisdictions and range in age from 8 months to 21 years. Of the seven confirmed cases, six cases were unvaccinated for measles (2 were too young to be vaccinated, and 1 had received appropriate vaccination (two doses of MMR vaccine). Several large contact investigations are ongoing. To prevent additional measles cases, California healthcare providers are recommended to: Remember the diagnosis The recent cases in California highlight the need for healthcare professionals to be vigilant about measles. Your expert eye, diagnostic skills, and prompt reporting of suspect measles patients to public health can make a difference in stopping the spread of this highly contagious disease in your community: Consider measles in patients of any age who have a fever AND a rash regardless of their travel history. Fever can spike as high as 105°F. Measles rashes are red, blotchy and maculopapular and typically start on the hairline and face and then spread downwards to the rest of the body. Obtain a thorough history on such patients, including: Travel outside of North or South America or contact with international travelers (including transit through an international airport or a visit to an international tourist attraction in the United States) in the prior three weeks. However, since measles cases have occurred throughout California undetected community transmission cannot be ruled out; and Prior immunization for measles. Please note that although documentation of receipt of two doses of MMR vaccine or a prior positive measles IgG test result makes the diagnosis of measles less likely, measles can still occur in such persons. If you suspect your patient may have measles, isolate the patient immediately (see below) and alert your local health department as soon as possible. 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 within 72 hours of exposure (MMR vaccine) or up to 6 days after exposure (Immune globulin - intramuscular). Please consult with your local health jurisdiction regarding appropriate administration. Collect specimens for measles testing: Draw 7-10 ml blood in a red-top or serum separator tube; spin down serum if possible. NOTE: capillary blood (approximately 3 capillary tubes to yield 100 µl of serum) may be collected in situations where venipuncture is not preferred, such as for children <1 year of age. Obtain a throat or nasopharyngeal swab; use a viral culturette and place into viral transport media. Collect 50-100 ml of urine in a sterile centrifuge tube or urine specimen container. Please arrange for measles testing at a public health laboratory. If measles is suspected (complete infection control guidance at: http://tinyurl.com/lfpk3yn) Mask suspect measles patients immediately. If a surgical mask cannot be tolerated, other practical means of source containment should be implemented (e.g., place a blanket loosely over the heads of infants and young children suspected to have measles when they are in the waiting room or other common areas). Do not allow suspect measles patients to remain in the waiting area or other common areas; isolate them immediately in an airborne infection isolation room if one is available. If such a room is not available, place patient in a private room with the door closed. For additional infection control information, please see the CDC “Guideline for Isolation Precautions” at: http://www.cdc.gov/hicpac/2007IP/2007isolationPrecautions.html If possible, allow only healthcare personnel with documentation of 2 doses of live measles vaccine or laboratory evidence of immunity (measles IgG positive) to enter the patient’s room. Regardless of immune status, all healthcare personnel entering the patient room should use respiratory protection at least as effective as an N95 respirator per CalOSHA requirements. If possible, do not allow susceptible visitors in the patient room. Depending on the number of air changes per hour (see information in link above), do not use the examination room for up to one hour after the possibly infectious patient leaves. If possible, schedule suspect measles patients at the end of the day. Notify any location where the patient is being referred for additional clinical evaluation or laboratory testing about the patient’s suspect measles status and do not refer suspect measles patients to other locations unless appropriate infection control measures can be implemented at those locations. Instruct suspect measles patients and exposed persons to inform all healthcare providers of the possibility of measles prior to entering a healthcare facility so that appropriate infection control precautions can be implemented. Make note of the staff and other patients who were in the area during the time the suspect measles patient was in the facility and for one hour after the suspect measles patient left. If measles is confirmed in the suspect measles patient, exposed people will need to be assessed for measles immunity. Immunize them before they go Un- or under-vaccinated Californians who are traveling to countries where measles is circulating should receive MMR vaccine before they go. Infants traveling to these countries can be vaccinated as young as six months of age (though they should also have the two standard doses of MMR vaccine after their first birthday). Post flyers in your clinic Visiting another Country Flyer English Visiting another Country Flyer Tagalog Attention: You Could Have Measles poster Measles Alert flyer (for providers) Thank you for your continued efforts to protect the health of Californians. Comments are closed.
