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Measles Update - The Who, What, Where & Why of Measles.

Greg Wallace, MD and Mizuho Morrison, DO
00:00
22:05

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Updates on current Measles outbreaks and practical tips on clinical management.

BACKGROUND 

  • Once thought to be eliminated in the US in 2000, measles has made a comeback in the US! Americans are importing measles back to the US as they travel back from endemic countries. 
  • CDC data demonstrated 288 outbreaks from January-May 2014 with clusters in CA, OH, and NYC. 
     

What are the clinical symptoms of measles?  

  • Measles is a highly contagious viral illness with a 90% transmission rate 
  • It is spread via person-to-person transmission through direct contact with respiratory droplets. 
  • Clinical symptoms are: 
    • high fevers (105 deg F or 40.5 deg C)
    • maculopapular, pruritic rash that spreads from the head to trunk to extremities,
    • pathognomonic Koplik spots (clustered white lesions on the buccal mucosa that can easily be missed)  
    • 3 C’s: cough, coryza, and conjunctivitis
  • Incubation period is an average of 10-12 days from exposure to prodrome followed by symptoms in about 7-14 days.
     

What are the potential complications of measles? 

  • Most common complications: diarrhea and otitis media.
  • Serious complications: pneumonia, hepatitis, pancytopenia, thrombocytopenia, and encephalitis.
  • Universally fatal complication: subacute sclerosing panencephalitis (SSPE)—a rare and fatal neurologic degenerative complication 
    • occurs about 7-10 years after the measles infection
    • presents with dementia and neuromuscular disorders 
  • Risk of mortality from measles is highest in infants, young children, the immunosuppressed, and pregnant women who have not been vaccinated against measles.
     

Measles has been eliminated in the United States in 2000, so why the resurgence in 2014? 

Two main reasons:

  1. Measles is still endemic in many parts of the world. Americans travel to these regions and import measles into the US. 
  2. After measles is imported into the US, it is spread within the US among unvaccinated hosts.
     

When should I think about measles or dengue fever in the differential?  

  • Travel to tropical areas should trigger you to think of dengue and measles too.
  • With any travel history, review patient vaccine records as well.
     

What should we do with patients who have classic measles signs, but are nontoxic and do not need to be hospitalized?   

  • First, inform the health department immediately!
  • Health department will help with self-quarantine instructions and initiate a contact tracing for potential exposed persons well as their immunity status.
     

What is the treatment for measles?

  • Supportive care and quarantine.
  • Measles is infectious 4 days before symptoms onset to 4 days after rash appearance.
     

How effective are vaccines and what are the CDC measles vaccine recommendations for travelers? 

  • Measles vaccine is very effective! 93% protective after first dose and 97% effective after second dose 
  • For travelers going anywhere, CDC recommends: 
    • 6-11 month old infants receive one dose of MMR vaccine.
    • greater or equal to 12 month old infants receive 2 doses of MMR vaccine, separated by one month.
    • adults with only one MMR vaccine receive a second MMR vaccine. 
       

What can we say to families who choose not to vaccinate for any variety of reasons? 

  • Measles is a safe and very effective vaccine. Outbreaks only occur when enough people in a population do not get vaccinated.
  • Measles is the most contagious of the vaccine preventable diseases. If not vaccinated, there is a 90% likelihood of getting measles. 
  • Measles is not benign; prior to the vaccine, hundreds of children died in the US due to measles
     

What Is the risk of death from measles?

  • Globally, 14 people per hour die from measles
  • In developed countries, death rate is 1-2 per 1,000 cases, and in developing countries, death rate is 1-2 per 100 cases.
     

Final thoughts on measles?

  • Early detection and isolation is key to prevent the spread of the measles. 

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These Crazy Kids Are All Elbows and Rashes Full episode audio for MD edition 203:42 min - 96 MB - M4AHippo Peds RAP February 2015 Summary 498 KB - PDF