Tag: contagious

If Measles Was Eliminated, Why Do We Still Have Measles?

Measles has been declared eliminated in the United States.

Unfortunately, that doesn’t mean that we totatly got rid of measles.

When Was Measles Eliminated in the United States?

That becomes clear when you realize that there were 86 cases of measles in the United States when measles was eliminated.

When was that?

Back in March 2000.

What Does Measles Elimination Really Mean?

So why do we still have measles if it was eliminated already?

It’s because elimination is not eradication.

Measles is much more contagious than smallpox, which is part of the reason we are stuck in the measles elimination phase.
Measles is much more contagious than smallpox, which is part of the reason we are stuck in the elimination phase.

And even then, technically measles itself hasn’t been eliminated in the United States.

The Endemic Spread of Measles

Only the endemic spread of measles has been eliminated.

“Endemic measles transmission is the existence of any continuous indigenous chain of transmission of measles virus that persists for >1 year in any defined geographic area (e.g., the United States).”

Orenstein on Defining and Assessing Measles Elimination Goals

That’s why we still have measles. All of the cases we do now have are either imported or linked to a case that was imported.

Unfortunately, as our measles outbreaks get longer and harder to control, it could be that we soon lose our designation of having eliminated measles and all of the progress that went with it.

More on Measles Elimination in the United States

Is Measles Really Airborne?

As we reach record numbers of measles cases, what are anti-vaccine folks concerned about?

Anti-vaccine folks trying to do research about measles and miss dozens of articles describing how measles is indeed airborne.
Anti-vaccine folks trying to do research about measles and miss dozens of articles describing how measles is indeed airborne.

Making sure their kids get caught up on their vaccines so that they don’t catch measles, since it is so contagious? Nope. They are still trying to find reasons to justify their decision to leave their kids unvaccinated and unprotected.

Is Measles Really Airborne?

Guess what?

Measles really is airborne!

Surpised?

Are you thinking that I am relying on a single experiment from 1964 or do you think I found some more evidence when I did my research?

Is this something folks really doubt, after all, if measles isn’t airborne, how would it be so contagious? How would people get sick after simply being in the same room as someone else with measles, even if the sick person had already left?

“During the past decade, increasing attention has been giving to the theory that indoor air is a vehicle of respiratory infection and to the logical sequence of such a theory, that the transfer from person to person of such infection can be reduced by increasing ventilation.”

Wells et al on Ventilation in the flow of measles and chickenpox through a community

In fact, even before the measles virus was actually discovered in the 1950s, it was known that measles was airborne. Wells did her experiments in the 1940s.

“It is far from clear to me yet whether measles is solely an airborne infection, as I think Wells believed, or whether contact and airborne routes both play roles in different circumstances. It is clear however that airborne infection is sufficiently common and important to be a dertermining factor in the continuance of measles at the present time. It must receive due respect and weight in planning the future steps necessary for eradication.”

Langmuir on Changing concepts of airborne infection of acute contagious diseases: a reconsideration of classic epidemiologic theories.

And those experiments were revisited in the 1970s, when measles wasn’t eradicated as quickly as expected. Alex Langmuir was Chief Epidemiologist at CDC at the time.

Did you ever hear about the story of the folks who got measles International Special Olympics Games in the Minneapolis-St. Paul metropolitan area during July 1991? It’s not a story the anti-vaccine groups would tell you. It’s a published case report, An outbreak of measles at an international sporting event with airborne transmission in a domed stadium.

“…the dynamic airborne transmission of measles illustrates the potential for transmission in the absence of a recognized exposure.”

Ehresmann et al on An outbreak of measles at an international sporting event with airborne transmission in a domed stadium

Several people at the Games got measles simply because they were in the domed stadium, even though they had no direct contact with anyone who had measles.

There are also reports of kids getting measles at their pediatrician’s office, simply because another kid with measles had been seen a little earlier.

Airborne Transmission of Measles in a Physician's Office

The kids described at the Michigan pediatrician’s office didn’t have any direct contact with the child with measles. They simply showed up in the same office an hour later.

“Four children had transient contact with the source patient as he entered or exited through the waiting room; only one of the four had face-to-face contact within 1 m of the source patient. The three other children who contracted measles were never in the same room with the source patient; one of the three arrived at the office one hour after the source patient had left.”

Block et al on Measles outbreak in a pediatric practice: airborne transmission in an office setting

Researchers described a similar situation at a pediatrician’s office in DeKalb County, Georgia at around the same time.

“Airflow studies demonstrated that droplet nuclei generated in the examining room used by the source patient were dispersed throughout the entire office suite. Airborne spread of measles from a vigorously coughing child was the most likely mode of transmission.”

Block et al on Measles outbreak in a pediatric practice: airborne transmission in an office setting

And increasing, we are seeing that airborne transmission means more folks are at risk on airplanes.

There is no doubt that measles is contagious and that measles really is airborne. Just like there is no doubt that vaccines are safe, with few risks.

More on Is Measles Really Airborne?

What Is Your Protocol to Stop Measles Before Kids in Your Office Get Exposed?

Measles outbreaks have reached record levels this year. Unless you’re prepared, with a strict protocol to stop measles, that could mean that someone could get exposed in your office.

“Many of today’s physicians may never have seen a patient with measles— a disease that can cause serious complications in infants, young children, and adults. CDC is urging all physicians to “think measles” when evaluating patients who have fever and rash, and to know what to do to prevent, control, and report measles cases.”

CDC Asking Physicians to “Think Measles” and Help Stop the Spread

Have you ever seen a child with measles?

What Is Your Protocol to Stop Measles Before Kids in Your Office Get Exposed?

To help everyone understand how important it is to think about measles and prevent unnecessary exposures, it can help to understand what happens when a child with measles does go to their pediatrician, an urgent care center, or the ER.

Part of your protocol to stop measles will be making sure th unvaccinated children exposed to measles are quarantined for at least 21 days.
Unvaccinated children exposed to measles are quarantined for at least 21 days.

Since measles is so contagious and can remain infectious for up to two hours after a person has left a room, with each measles case, you will have to:

  • isolate the person with measles (or suspected measles) in a negative pressure isolation room. If that’s not possible, at least have the person wear a mask in their own private room and/or schedule them at the end of the day, bypassing the waiting room. You might even go out to their car for a quick interview and exam before they come into the office.
  • not use that exam room for at least two hours after the person with measles leaves.
  • report the case to your local health department ASAP, as they will likely have more extra resources to help you manage your patient.
  • locate everyone who could have been exposed, including anyone who was in the same area as the suspected case or entered the area over the next two hours. If they aren’t already immune, these folks might need immune globulin (younger than six months or immunocompromised) or a dose of MMR. They will probably also be quarantined to make sure they don’t develop measles and expose others.
  • only allow those who are immune to measles (two doses of MMR or natural immunity) to take care of the suspected case. Everyone should still wear an N95 respirator or at the very least, a general facemask, just in case.
  • limit anyone else’s exposure as you work to confirm that they have measles (PCR testing of throat swab and urine), provide supportive care as necessary, or quarantine them at home.

Unfortunately, it usually ends up being more than a single exam room that has to be closed when a child shows up with measles. After all, before they got to that exam room, they were probably in the waiting room and other general areas of the office.

And that’s why you will want to have a protocol in place to avoid or minimize these exposures.

Don’t Spread Measles

Of course, that starts with trying to get everyone vaccinated and protected, including an early dose of MMR when appropriate, so that your patients don’t get measles in the first place!

“Failure to promptly identify and appropriately isolate measles cases has led to the investigation of hundreds of healthcare contacts this year. Measles transmission has occurred in emergency departments and other healthcare settings, including transmission to one healthcare worker.”

Recommendations for Measles Case Identification, Measles Infection Control, and Measles Case and Contact Investigations

Next, make sure everyone understands how to recognize the signs and symptoms of measles. Otherwise, some of these kids might unexpectedly end up in your office when they are sick.

The classic measles rash, which begins on the face, typically doesn't begin until these kids have had fever for two or three days.
The classic measles rash, which begins on the face, typically doesn’t begin until these kids have had fever for two or three days. Photo by Jim Goodson, M.P.H.

Think that’s easy? You just watch out for kids with a fever and a rash, right?

Wrong.

If you wait until they have the classic measles rash, you will likely miss the diagnosis the first time they come to your office. Remember, the rash typically doesn’t show up until they have already had a fever for three or four days.

Unfortunately, these kids are contagious well before they have a rash. They are even contagious before they have a fever and know they are sick.

As part of your protocol to stop measles, post a warning sign before parents come into your office.
As part of your protocol to stop measles, post a warning sign before parents come into your office.

So you should suspect measles in kids:

  • with a high fever and cough, coryza, and conjunctivits, even if they don’t yet have a rash
  • with classic measles symptoms who have had a possible exposure. This includes kids who recently traveled out of the country (get a travel history), had contact with international travelers, or just because there are a lot of cases in your area.
  • who are unvaccinated or not completely vaccinated, with two doses of MMR. Keep in mind that even fully vaccinated kids can sometimes get measles though.

And then, if you suspect that a child has measles, work to limit their exposure to others. Patients should know to call ahead. Staff at your office, lab, or the ER should be alerted and ready to see anyone with suspected measles. That way the family knows to wear a mask before going inside.

Ideally, if you have a strong suspicion that the child has measles, this visit will occur in a facility with a negative pressure airborne infection isolation room.

What’s the problem with this kind of protocol?

Lots of kids have fever and rashes! And since you can’t send everyone that calls with adenovirus, roseola, or hand, foot and mouth disease to the ER, part of your protocol should likely be that a health care professional carefully assesses the child’s signs, symptoms, and risks for measles before deciding what to do.

Mostly, be suspicious if a child has returned from a trip oversees, especially if they are unvaccinated, and they have a febrile illness.

More on Your Protocol to Stop Measles Before Kids in Your Office Get Exposed

Who’s Getting Measles?

We will soon pass the last record high number of measles cases – 963 cases – set in 1994.

We will soon pass the last record high number of measles cases - 963 cases - set in 1994.

With 839 cases as of mid-April, it’s hard to believe that only 55 cases were reported during all of 2012!

Who’s Getting Measles?

So what do we know about the people who are getting measles?

More importantly, the thing that most parents want to know – are their families at risk?

We know that of the 839 cases right now:

  • 442 are in Brooklyn among the Orthodox Jewish community, where only 4% of cases have been fully vaccinated
  • 125 are in Rockland County, New York, among the Orthodox Jewish community, where only 3% of cases have been fully vaccinated
  • 78 were in the Pacific Northwest Outbreak (Washington and Oregon), where none were fully immunized – (ended)
  • 43 are in Michigan, mostly among Oakland County’s Orthodox Jewish community, triggered by a man who had recently traveled from New York

So just over 80% of cases are associated with four outbreaks, one of which has been declared over, and mostly among children and adults who were intentionally not vaccinated.

The rest of the 200 cases?

Among 45 cases in California, are 30 cases in these four outbreaks.
Among 45 cases in California, are 30 cases in these four outbreaks.

They are spread out in smaller outbreaks in other states, including Arizona, California, Colorado, Connecticut, Florida, Georgia, Illinois, Indiana, Iowa, Kentucky, Maryland, Massachusetts, Mississippi, Missouri, Nevada, New Hampshire, New Jersey, Oklahoma, Pennsylvania, Tennessee, and Texas.

Does that mean that you don’t have to worry about measles?

It means that you don’t have to panic about measles.

Get your kids vaccinated and protected, which might include an early dose of MMR, learn the signs and symptoms of measles, and keep up on news of outbreaks in your area.

That should help decrease the risk that they get caught up in an outbreak.

And double check your own vaccine records! Have you had an MMR vaccine? Have you had two doses?

Unfortunately, not everyone can get vaccinated and protected, which is causing some folks to panic. This includes those who are too young to be vaccinated, or fully vaccinated, and those with immune system problems.

That’s not fair.

Let’s stop the outbreaks so we don’t get to the point that measles truly is everywhere and even more high-risk people are put at risk.

More on Who’s Getting Measles