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Exposure to Confirmed Measles Case

The New Jersey Department of Health and Senior Services (NJDHSS) is requesting that all public health and medical professionals be alert for individual presenting with signs or symptoms compatible with measles. Appropriate isolation precautions must be instituted immediately for all suspected and confirmed cases.

NJDHSS was informed of a laboratory-confirmed case of measles in a visitor from Kuwait who arrived at JFK, NY Airport on August 8. She was seen at a hospital in NYC on August 10. She took a private jet from Teterboro Airport, NJ to MN on August 11 leaving at 18:22. The rash onset was August 12. We are working with the CDC and State and local health departments to identify and notify potential NJ contacts. The exposure to rash onset averages 14 days (range, 7 - 18 days). As always, we ask that health care providers be on alert for individuals with signs or symptoms compatible with measles so that appropriate isolation precautions can be initiated immediately. Updates will be provided as additional information is obtained.

We would also like to take this opportunity to remind everyone of the importance of ensuring that all individuals are age appropriately immunized against vaccine-preventable diseases.

Measles is an immediately reportable disease as per N.J.A.C 8:57 which can be accessed at: http://nj.gov/health/cd/reporting.shtml . Please report all suspect cases to your local health department. If unable to reach the local health department, notify the NJDHSS Vaccine Preventable Disease Program during regular business hours at (609) 826-4861. After business hours, or on the weekend, call NJDHSS at (609) 392-2020.

Measles Overview

Measles is a highly contagious disease that is transmitted by respiratory droplets and airborne spread. The disease can result in severe complications, including pneumonia and encephalitis. The incubation period for measles ranges from 7 to 18 days. The diagnosis of measles should be considered in any person with a generalized maculopapular rash lasting = 3 days, a temperature = 101ºF (38.3ºC), and cough, coryza, or conjunctivitis. Immunocompromised patients may not exhibit rash or may exhibit an atypical rash.

Recommendations

Healthcare providers should maintain vigilance for measles importations and have a high index of suspicion for measles in persons with a clinically compatible illness who have traveled abroad or who have been in contact with travelers. They should assess measles immunity in U.S. residents who travel abroad and vaccinate if necessary. Measles is endemic in many countries, including popular travel destinations, such as Japan and India. Suspected measles cases should be reported immediately to the local health department, and serologic and virologic specimens (serum and throat or nasopharyngeal swabs) should be obtained for measles virus detection and genotyping. A culture is preferable to serology in vaccinated individuals. Laboratory testing should be conducted in the most expeditious manner possible.

Preventing Transmission in Healthcare Settings

To prevent transmission of measles in healthcare settings, airborne infection control precautions (available at http://www.cdc.gov/hicpac/2007IP/2007isolationPrecautions.html ) should be followed stringently. Suspected measles patients (i.e., persons with febrile rash illness) should be removed from emergency department and clinic waiting areas as soon as they are identified, placed in a private room with the door closed, and asked to wear a surgical mask, if tolerated. In hospital settings, patients with suspected measles should be placed immediately in an airborne infection (negative-pressure) isolation room if one is available and, if possible, should not be sent to other parts of the hospital for examination or testing purposes.

All healthcare personnel should have documented evidence of measles immunity on file at their work location. Having high levels of measles immunity among healthcare personnel and such documentation on file minimizes the work needed in response to measles exposures, which cannot be anticipated.

As an added precaution, hospital Emergency Departments are encouraged to provide signage which directs staff and/or patients to identify anyone presenting with fever and rash.

In Summary

1) Report all suspect measles cases (febrile illness accompanied by generalized maculopapular rash) immediately (DO NOT WAIT FOR LABORATORY CONFIRMATION) to the local health department. If unable to reach the local health department, notify the NJDHSS Vaccine Preventable Disease Program during regular business hours at (609) 826-4861. After business hours, or on the weekend, call NJDHSS at (609) 392-2020.
2) Place all patients with suspected measles in airborne isolation immediately.
3) Obtain clinical specimens for diagnostic testing from blood (for both IgM and IgG to measles), urine, nasopharyngeal aspirates, or throat swabs.
4) Offer measles vaccine or immune globulin to susceptible exposed contacts.
5) Assure that all those eligible for MMR vaccine receive appropriate and timely vaccination.

Resources

http://www.cdc.gov/measles/index.html
http://www.cdc.gov/vaccines/pubs/pinkbook/downloads/meas.pdf

http://www.nj.gov/health/cd/vpdp/index.shtml