Tag: measles exposure

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

The Puget Sound Measles Outbreak

Breaking News – there is a new case in King County (see below)

Everyone is likely familiar with the large outbreaks that we have been seeing this year in New York (Brooklyn and Rockland County), Michigan, and the Pacific Northwest.

There have already been 79 cases of measles in Washington so far this year.
There have already been 79 cases of measles in Washington so far this year.

After all, those outbreaks make up the majority of measles cases that have occured so far this year.

The Puget Sound Measles Outbreak

Have you heard of the latest outbreak?

This one, also centered in the Pacific Northwest, began with exposures to a traveler with measles at Seattle-Tacoma International Airport on April 25.

“A Canadian resident from British Columbia who traveled to the Seattle area in late April 2019 has been diagnosed with measles. The traveler, a man in his 40s, has since recovered from his illness.

Prior to arriving in King County, he spent time in Japan and New York during the period that he was infected, two places that currently have measles outbreaks. This case has no connection to the recently-ended measles outbreak based in Clark County, Washington state.

While he was infectious with measles, he spent time in the Seattle area at several locations, including popular tourist attractions and Sea-Tac Airport. Anyone who does not have immunity to measles through vaccination or from previously having measles is at risk for infection if they were at a location of measles exposure.”

Measles case in traveler to King County

Those exposures have led to cases in:

  • King County – 6
  • Pierce County – 2
  • Snohomish County – 1

The latest case is a six-month old infant in King County, with exposures at the Seattle Children’s Hospital Emergency Dept on May 24.

“This case was a household contact of a person diagnosed with measles earlier this month, and was not exposed to measles in the community.”

A new case of measles diagnosed in a King County resident

With exposures in Bothell, Lynnwood, Mill Creek, Orting, Bonney Lake, Puyallup, Renton, Auburn, Issaquah, Woodinville, Kent, and Seattle.

And that’s what has led to the name Puget Sound outbreak. The Puget Sound is an inlet of the Pacific Ocean along the northwest coast of Washington, near Everett, Olympia, Seattle, and Tacoma.

How big will this outbreak get?

Immunization rates in the Puget Sound area are a bit better than in Clark County, where the last Pacific Northwest outbreak was centered.
Immunization rates in the Puget Sound area are a bit better than in Clark County, where the last Pacific Northwest outbreak was centered.

It’s anyone’s guess at this point, keeping in mind that all it would take is for one of these exposures to be in a “pocket of susceptibles” with low immunization rates to start a big outbreak.

And all it would take to stop the outbreaks is for folks to get vaccinated and protected, understanding that vaccines are safe and necessary.

More on the Puget Sound Measles Outbreak

Is Measles Dangerous If You Are Pregnant?

While folks often try and make it seem like measles is a common childhood illness, we know that it can be dangerous.

“One of the patients was a 20-year-old pregnant woman who had rash onset on January 5 following exposure to her 12-year-old brother. After delivering a healthy baby on January 6, the mother developed severe pneumonia that was followed by respiratory arrest. She was resuscitated and transferred to an intensive care unit in a larger hospital nearby in Tennessee.”

Epidemiologic Notes and Reports Transmission of Measles Across State Lines — Kentucky, New Hampshire, Tennessee, Virginia

Rarely do people who have really had measles describe it as just a fever and a rash. They remember that it was called a harmless killer for a reason.

Is Measles Dangerous If You Are Pregnant?

And there are some situations in which measles can be especially dangerous, including if you get sick when you are very young, very old, or have immune system problems.

Pregnant women should be screened for measles immunity.
Pregnant women should be screened for measles immunity.

And what if you are pregnant when you get measles?

“The Health Department announced today that the number of measles cases has grown to 390, including two pregnant women diagnosed with the infection, one diagnosed in mid-April.”

The Number of Measles Cases Grows to 390

If you are pregnant and you are exposed to someone with measles, you can get IVIG post-exposure prophylaxis to prevent you from actually getting measles, but this typically only works if given within six days of the exposure.

“To date, studies have not identified an increased risk for birth defects when pregnant women get the measles during pregnancy. However, studies suggest that measles infection is associated with an increased risk for miscarriage, stillbirth, prematurity and the baby being born with a measles infection.”

When Measles Strike, It’s Not The Happiest Place On Earth For Pregnant Women

Unlike a rubella infection during pregnancy, a measles infection is not thought to cause birth defects. Tragically, it can, like rubella, lead to an increased risk for having a miscarriage.

“Infants who develop congenital measles are at increased risk for mortality and for subacute sclerosing panencephalitis, which is more common when measles is diagnosed in infancy. In addition, subacute sclerosing panencephalitis in newborns infected with measles either congenitally or shortly after birth appears to be more severe, with a shorter latency and rapidly progressive course.”

What Obstetric Health Care Providers Need to Know About Measles and Pregnancy

And if the mother gets measles very late in her pregnancy, it can also lead to a case of congenital measles, or a baby being born with an active measles infection.

“In 52% of cases, measles was likely acquired from a relative. Complications included pneumonia in one child; two pregnant women required hospitalization, including one who miscarried.”

Notes from the Field: Measles Outbreak Among Members of a Religious Community — Brooklyn, New York, March–June 2013

Don’t take the risk that you might get measles while you are pregnant.

Make sure you are vaccinated and protected before you ever start thinking about getting pregnant, as pregnancy is a contraindication to getting the MMR vaccine. And you should wait at least 4 weeks after getting vaccinated before getting pregnant.

More on Measles in Pregnancy

What Should You Do If Your Child Might Have Measles

As you hear more and more about measles outbreaks, eventually you might think that your child has measles.

Why?

Until a child develops the classic measles rash, the symptoms of measles can mimic many other more common viral illnesses, as they include fever, cough, coryza, red eyes, and irritability.

What Should You Do If Your Child Might Have Measles

And while many other viruses can cause a fever and rash, it is really only measles that causes the classic pattern of 3 or 4 days of high fever, followed by the appearance of a rash with continued fever.

Unfortunately, by the time your child has developed the rash, you may have already have gone to the doctor or ER a few times, exposing a lot of people to measles.

If your child has measles, don’t give it to anyone else.

That’s why it’s important to try and recognize measles as early as possible, so that you don’t expose anyone else and get them sick too.

It is especially important to think about measles if your child:

  • traveled out of the country in the past 7 to 21 days, the incubation period for measles
  • recently traveled to or lives in an area that is experiencing measles outbreaks
  • is not yet fully vaccinated, with two doses of MMR, keeping in mind that a small minority of people can get measles even if they are fully vaccinated

So what do you do if your child might have measles?

Ideally, you would call your health care provider, clinic, or emergency room ahead of time and let them know that you are concerned about measles. That allows them to take steps to minimize the risk that your child will expose others to measles.

While the child is isolated, health care professionals can then decide if it is necessary to do further testing for measles. If they do suspect measles, they may even call the local health department for further help.

If necessary, post-exposure prophylaxis might also be provided for the child’s contacts.

What if you aren’t sure if your child has measles? Put a mask on them anyway if there is any doubt! Don’t take a chance on causing a big outbreak.

During some outbreaks, communities have even had to implement universal masking of all patients and all family members to help get their outbreak under control.

And remember that the best way to stop these outbreaks is for everyone to get fully vaccinated on time and on schedule.

More on Measles Exposure Prevention Measures