News & Views: Have You Ever Diagnosed Measles?
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Vaccine Update for Healthcare ProvidersPublished on
Vaccine Update for Healthcare ProvidersIn the first five months of 2014, the United States has experienced more cases of measles than in the first five months of any other year since the disease was declared eliminated in 1994. Indeed, the U.S. Centers for Disease Control and Prevention (CDC) recently announced in the MMWR that to date, during 2014, 288 cases of measles have been diagnosed in 18 states and New York City. Of the cases, almost 80 percent were from 15 separate outbreaks with the largest occurring in Ohio among unvaccinated Amish communities. As of June 16, 2014, more than 400 cases of measles have been reported.
Increasingly, someone could come into your office ill with measles. For many healthcare providers, this has never happened before. In fact, in the CDC’s recent MMWR announcement, the authors indicated misdiagnoses of measles as Kawasaki disease, dengue and scarlet fever as well as other illnesses.
Measles diagnosis can be confused with other illnesses because of its common presentation as a rash accompanied by fever. When a patient has these symptoms, the following should also be considered to help distinguish measles from other possible illnesses:
Children presenting with measles typically appear to be miserable.
Measles is one of the most contagious diseases spreading most commonly, but not only, via large droplets. The virus is so contagious that if a susceptible person occupies an elevator or other enclosed space up to four hours after a person infected with measles, he or she is likely to be infected. The period of highest contagion is four days before to four days after onset of rash. Because of this ease of spread, it is imperative to isolate infected patients from susceptible patients, such as those who are too young to be immunized. Methods for decreasing chance of transmission in the waiting room include the following:
Current isolation precautions were published in 2007 and can be accessed online. Isolation procedures for infections transmitted via airborne routes in ambulatory settings can be found on pages 58-9 of the document.
Get a serum sample and throat or nasopharyngeal swab from the patient. A urine sample may also contain viral proteins. The most common tests are an IgM test and a real-time polymerase chain reaction (RT-PCR) test; either of these can typically be used for laboratory identification of measles. The CDC has a comprehensive section on its website related to measles lab tests.
Suspected cases of measles should be reported to local public health officials within 24 hours.
The MMR vaccine should be given at 12 to 15 months of age with a second dose between 4 and 6 years of age as recommended on the approved immunization schedule. The current measles outbreaks provide a compelling argument for not choosing to delay the MMR vaccine. Two studies provide additional reasons for children to be immunized as soon as they are of age:
Medscape recently posted a special report on measles with a wealth of information, including a two-and-a-half minute video by Dr. Offit discussing the recent cases of measles in the U.S.
Contributed by: Charlotte A. Moser, MS, Paul A. Offit, MD
Categories: News and Views About Vaccines
Materials in this section are updated as new information and vaccines become available. The Vaccine Education Center staff regularly reviews materials for accuracy.
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