How Do We Treat Patients in a Measles Outbreak: Part Two

This is a bar graph from the CDC indicating the number of cases of measles over the years from 2010 until present date. It was last updated Monday April 26th 2019. It is updated weekly. https://www.cdc.gov/measles/cases-outbreaks.html

How many measle cases do we have so far this year?

Well, if you review the bar graph above, as of April 26th 2019 we have reached 704 confirmed cases of measles. These cases are all over the USA. Per the California Department of health: “In 2019, four outbreaks linked to patients with international travel have been reported in California. As of April 24, 2019, 38 confirmed measles cases, including 28 outbreak-associated cases, have been reported.”  Since the illness is so highly contagious and the droplets can hang in the air for at least 2 hours after the patient has already left the room, the magnitude of exposed patients can occur exponentially, especially in busy airports like LAX and at University campuses. See news article on students at UCLA and Cal State LA who were quarantined.

Diagnosis of Measles:

Your clinical suspicion should be high considering the presentation or recent international travel as well as the presentation. A sample of serum for Measles IgM and also sputum or nasopharyngeal throat culture for Measles RNA for RT-PCR. Genotyping can also be done to track the trend of the outbreak and detect wild type measles versus a reaction to the measles vaccine. Per the CDC: Private citizens, health practitioners and hospitals must contact their local (city or county) health department to submit specimens.

What is the treatment for Measles?

This is the MMR vaccine that is needed to prevent the illness and also used as post exposure prophylaxis. Picture courtesy of https://img.medscape.com/thumbnail_library/dt_170511_measles_mumps_rubella_mmr_vaccine_800x600.jpg


Since Measles is a viral infection it is supportive care only. Those who have been exposed to an infected person will need to be quarantined until serology can confirm the person has antibodies to the illness.  WHO current policy advocates administering Vitamin A to all acute cases to prevent blindness and delayed recovery.

The recommended age specific doses are 50 000 IU of Vitamin A for infants aged < 6 months, 100,000 IU of Vitamin A for infants aged 6 months to 11 months, and > 200,000 IU of Vitamin A for children aged > 12 months. A high dose of Vitamin A is given on the day of diagnosis and repeated the next day and if the child/adult has signs of Vitamin A deficiency (bitot’s spots) then a 3rd dose should be given 4-6 weeks later. The WHO states that even in countries where measles is not usually severe, Vitamin A should be given to all cases of severe measles.

Teenager with measles rash, photo courtesy from CDC:http://www.vaccineinformation.org/photos/measpmh002.jpg

Post-exposure prophylaxis:

For those who cannot show immunity to measles by serology or documentation of having had vaccinations, they need to either get the MMR within 72 hours of exposure or get IVIG (Intravenous Immunoglobulin) within 6 days of exposure. Do not administer both, as the IVIG will invalidate the vaccine. If the person exposed is not in healthcare and receives the first dose of the MMR, then the individual can return to work or school or childcare.

Measles rash, photo courtesy of the CDC. http://www.vaccineinformation.org/photos/meascdc004.jpg

The MMR vaccine:

This is usually a vaccine that is administered as a child between the ages of 12 months through 12 years. Usually the second dose is given around age 4 or 6 years.  One dose is usually effective for coverage 93% of the time and getting the second dose increases the protection to 97%. The second dose is essentially used to cover for vaccine failure. Students attending university without evidence of measles immunity, should get 2 doses of the MMR 28 days apart. Adults born during or after 1957 without evidence of immunity (immunization cards or serology) should get at least one dose of the MMR vaccine. The MMR is a live virus and so the vaccine should not be given to pregnant woman, immunocompromised patients, or those who have had a severe allergy to a vaccine. If you got the inactivated measles vaccine between 1963 and 1968, then you should be revaccinated as you are likely not protected.

Please check your immunization cards to make sure you got the MMR vaccine! This is not a drill folks.  If you have any further questions, please refer to the CDC website frequently asked questions or write comments below.

  2 comments for “How Do We Treat Patients in a Measles Outbreak: Part Two

  1. Jennifer Hollywood
    May 1, 2019 at 4:24 pm

    What to do if you’ve had three vaccines and still are seronegative?

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