By A.J. Plunkett
Be on the lookout for patients presenting with symptoms of measles after an unvaccinated person attended a gathering in Kentucky with an estimated 20,000 people from the U.S. and other countries, the CDC warned Friday, March 3.
The CDC issued a Health Alert Network (HAN) health advisory “to notify clinicians and public health officials about a confirmed measles case at a large gathering’ from February 17-18, during the infectious stage. According to the Kentucky Department for Public Health (KDPH), the case involves “an unvaccinated individual with a history of recent international travel.”
The CDC provided these recommendations for healthcare professionals:
- Consider measles as a diagnosis in anyone with a febrile illness and clinically compatible symptoms (e.g., rash, cough, coryza, or conjunctivitis) who:
- attended the Kentucky event during the exposure dates of February 17 or 18 or has had contact with an attendee.
- has recently traveled abroad, especially to countries with ongoing outbreaks.
- Immediately notify local or state health departments about any suspected case of measles to ensure rapid testing and investigation.
- Recommend MMR vaccine for patients who are unvaccinated or not fully vaccinated.
- Do not allow patients with suspected measles to remain in the waiting room or other common areas of the healthcare facility. Isolate patients with suspected measles immediately, ideally in a single-patient airborne infection isolation room (AIIR) if available.
- Follow CDC’s testing recommendations and collect either a nasopharyngeal swab, throat swab, or urine specimen for Reverse Transcription Polymerase Chain Reaction (RT-PCR) as well as a blood specimen for serology from all patients with clinical features compatible with measles. RT-PCR is available at many state public health laboratories and through the APHL/CDC Vaccine Preventable Disease Reference Centers. Nasopharyngeal or throat swabs are preferred over urine specimens.
- Collect the first (acute-phase) serum specimen (IgM and IgG) as soon as possible upon suspicion of measles disease. If the acute-phase serum specimen collected ≤3 days after rash onset is negative and the case has a negative result for real-time RT-PCR (rRT-PCR), or one was not done, a second serum specimen collected 3–10 days after symptom onset is recommended because the IgM response may not be detectable until 3 days after symptom onset.
- Healthcare personnel (HCP) should use respiratory protection (i.e., a respirator), that is at least as protective as a fit-tested, NIOSH-certified disposable N95 filtering facepiece respirator, regardless of presumptive evidence of immunity, upon entry to the room or care area of a patient with known or suspected measles.
- Contact your state or local health department to determine where to submit specimens and how to ship them.
- Ensure all patients are up to date on MMR vaccine and other recommended vaccines.
- For people traveling abroad, CDC recommends that all U.S. residents older than 6 months be protected from measles and receive MMR vaccine, if needed, prior to departure.
To potentially provide protection or modify the clinical course of disease among susceptible people, either:
- Administer MMR vaccine within 72 hours of initial measles exposure, or immunoglobulin (IG) within six days of exposure.
- For vaccine eligible people aged ≥12 months exposed to measles, administration of MMR vaccine is preferable to using IG, if administered within 72 hours of initial exposure.
- The following patient groups are at risk for severe disease and complications from measles and should receive IG: infants aged <12 months, pregnant women without evidence of measles immunity, and severely immunocompromised people.
- IG can be administered to other people who do not have evidence of measles immunity, but priority should be given to people exposed in settings with intense, prolonged, close contact (e.g., household, daycare, and classroom).
- Do not administer MMR vaccine and IG simultaneously, as this practice invalidates the vaccine.
A.J. Plunkett is editor of Inside Accreditation & Quality, an HCPro publication.