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Child with measles rash on face.

CDC issues alert after measles case confirmed at large Kentucky gathering

March 3, 2023

The Centers for Disease Control and Prevention (CDC) issued a health advisory Friday after a confirmed case of measles was identified in an unvaccinated person who was infectious while attending a large religious gathering Feb. 17-18 in Kentucky.

An estimated 20,000 people from Kentucky, other states and other countries attended the spiritual revival at Asbury University in Kentucky during that time, according to the CDC.

“Anyone who attended the revival may have been exposed to measles,” Steven Stack, M.D., commissioner of the Kentucky Department for Public Health, said in a statement.

Measles is a highly contagious, acute viral illness that begins with a prodrome of fever, cough, coryza and conjunctivitis lasting two to four days prior to rash onset. The rash typically occurs three to five days after symptoms begin and usually appears on the face and spreads downward.

Measles can cause severe health complications, including pneumonia, encephalitis and death, even in previously healthy children. The virus is transmitted by direct contact with infectious droplets by airborne spread when an infected person breathes, coughs or sneezes.

Primarily due to vaccination, the measles virus had not circulated widely in the United States for decades. However, outbreaks have been increasing since 2010 because it is easily carried by unvaccinated travelers and can spread in under-immunized communities. Declines in vaccination rates were seen during the COVID-19 pandemic, and measles outbreaks are occurring in all World Health Organization regions, including in Europe, Africa, the Eastern Mediterranean and Southeast Asia regions, according to the CDC.

“Although measles is uncommon, pediatricians should consider the possibility, particularly when an unimmunized child presents with fever, respiratory symptoms and rash,” said Kristina K. Bryant, M.D., FAAP, a professor of pediatrics in the Division of Pediatric Infectious Diseases at the University of Louisville School of Medicine.  

Pediatricians also should ask symptomatic patients about potential exposures, including the Kentucky event and international travel, said Dr. Bryant, a member of the AAP Committee on Infectious Diseases. Children in whom measles is suspected should not sit in the waiting room, since infectious measles virus can remain in the air for up to two hours after a patient leaves the area.

Patients ages 2 years and older should wear a mask before arrival to the office and be taken to an exam room immediately. Health care providers should wear an N95 mask when examining patients with suspected measles, according to the CDC.

“Historically, one in 20 children with measles will develop pneumonia, and one in 1,000 will develop potentially life-threatening brain inflammation,” Dr. Bryant said.

In 2019, more than 1,200 cases of measles were reported in the United States, the highest number in decades, according to the CDC. In 2022, 121 cases of measles were reported in the U.S., all among children who weren’t fully vaccinated, including outbreaks in Minnesota and Ohio.

“There are no antiviral treatments for measles, but there are safe and effective vaccines,” Dr. Bryant said. “Vaccination is the best way to protect children from measles infection. Many children fell behind with routine immunizations during the pandemic, including MMR (measles, mumps, rubella) vaccine. Two doses of measles vaccine are 97% effective at preventing infection.”

The CDC advises health care professionals to notify a state or local health department about any suspected case of measles to ensure rapid testing and investigation occur. Providers also should recommend MMR vaccine for patients who are unvaccinated or not fully vaccinated.

The CDC recommends collecting a nasopharyngeal or throat swab for reverse transcription polymerase chain reaction as well as a blood specimen for serology from all patients with clinical features compatible with measles. Urine specimens can be collected but are not preferred. Health care providers should contact their state or local health department to find out where to submit specimens and how to ship them.

Those at highest risk of acquiring a measles infection include unvaccinated children or adults, incompletely vaccinated children or adults and individuals with known exposure to measles or recent travel to areas with active measles transmission.

Those at greatest risk of severe measles infection or complications of measles include infants and children under 5 years, adults over 20 years, pregnant women and people with compromised immune systems, such as from cancer, chemotherapy or HIV infection.


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