With multiple measles outbreaks reported throughout the country, the Centers for Disease Control and Prevention (CDC) issued a Health Alert Network (HAN) advisory Friday stating that “measles-mumps-rubella (MMR) vaccination remains the most important tool for preventing measles.”
The CDC recommends health care professionals ensure all patients are up to date on MMR vaccination to prevent infection and spread. The first dose is given at 12-15 months of age, and the second is given at 4-6 years of age. Two doses of MMR are 97% effective against measles.
The CDC also said vitamin A may be administered to infants and children in the United States with measles as part of supportive management, which is consistent with AAP guidance. Children with severe measles, such as those who are hospitalized, should receive vitamin A under the supervision of a health care provider. Vitamin A, however, is not a substitute for vaccination, and overuse can lead to toxicity.
As of March 7, more than 220 cases of measles have been reported across 12 states, including outbreaks in west Texas (198 cases) and southeast New Mexico (30 cases).
Two deaths have been reported: a school-age child in Texas who was hospitalized with measles infection and had no underlying conditions and a New Mexico resident who tested positive for measles after death. The New Mexico resident did not seek medical care before dying, and the official cause of death is under investigation. Both deaths involved unvaccinated individuals.
A majority of the cases throughout the United States involve unvaccinated children and adults, according to the CDC.
With spring and summer travel upcoming, the HAN alert recommends everyone, including those planning international travel, be up to date on MMR vaccine. Travelers can check the CDC’s Travel Health page for advice and a list of countries where measles outbreaks have been reported.
Advice for health care providers
Health care providers should be vigilant for cases of febrile rash illness that meet the measles case definition and share effective measles prevention strategies, including vaccination guidance for international travelers.
If a measles infection is suspected, the CDC recommends clinicians isolate patients immediately, ideally in a single-patient airborne infection isolation room (AIIR) or in a private room with a closed door until an AIIR is available. Patients with suspected measles should not remain in the waiting room or other common areas of a health care facility.
Health care providers also should protect themselves by adhering to standard and airborne precautions when evaluating confirmed or suspected cases, regardless of their vaccination status. Health care providers without presumptive evidence of measles immunity who are exposed to measles should be excluded from work from day 5 after the first exposure until day 21 following their last exposure and offered post-exposure prophylaxis, as appropriate.
Providers also should offer measles testing outside facilities to avoid possible transmission in health care settings.
If a measles case is suspected, providers should notify state, tribal, local or territorial health departments immediately to ensure rapid testing and investigation. States report measles cases to CDC.
Laboratory confirmation should be pursued for all patients with suspected measles. The CDC recommends collecting either a nasopharyngeal swab or throat swab for reverse transcription polymerase chain reaction testing as well as a blood specimen for serology testing from all patients with clinical features compatible with measles.
The measles virus is transmitted by contact with infectious droplets or by airborne spread when an infected person breathes, coughs or sneezes. Measles virus can remain infectious in the air up to two hours after an infected person leaves an area.
Illness onset (high fever, cough, runny nose and red, watery eyes) begins a week or two after someone is exposed. A few days later, a rash breaks out as flat, red spots on the face and then spreads down the neck and trunk to the rest of the body. A person is contagious about four days before the rash appears to four days after.
Other measles symptoms may include small spots in the cheek area inside the mouth, diarrhea and ear infection. Measles can lead to pneumonia, swelling of the brain, deafness, intellectual disability and death.
Most children who get measles are not up to date on recommended vaccines or are not old enough to get measles vaccine.
Resources
- AAP Red Book chapter on measles
- CDC clinical overview of measles
- Information for families from HealthyChildren.org on how to protect children during a measles outbreak
- FAQs on how to protect babies from a measles outbreak from HealthyChildren.org
- Interim infection prevention and control recommendations for measles in health care settings from the CDC
