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Delaware Health Alert Network #265

February 2, 2012 1:53 pm


Health Alert
DELAWARE DIVISION OF PUBLIC HEALTH CONFIRMED MEASLES

The Delaware Division of Public Health (DPH) alerts the medical community of a laboratory-confirmed case of measles. The case is a 6 year old, fully vaccinated, child from Kent County. The child did not require hospitalization and did not suffer any complications due to illness. DPH worked closely with the child’s school while the child was appropriately isolated at home during the infectious period. The case had not traveled and had no known sick contacts. No secondary cases have been identified and the source of the illness is not know.

Background

DPH has only confirmed a total of 5 cases since 1995 --- one each in years 1996, 1998, 2005, 2011 and 2012.

Measles, also called rubeola, is a highly communicable viral disease with prodromal fever, conjunctivitis, coryza, cough and small spots with white or bluish-white centers on an erythematous base on the buccal mucosa (Koplik spots). A characteristic red blotchy rash appears on the third to seventh day; the rash begins on the face and then becomes generalized lasting 4-7 days. Complications may result from viral replication or bacterial superinfection and include pneumonia, encephalitis, croup, otitis media and diarrhea.

Reporting

Measles is considered a rapidly reportable disease in Delaware. Laboratories and healthcare providers are required to report any suspect case to DPH, Bureau of Epidemiology (1-888-295-5156 or 1-302-744-1033). An epidemiologist is available 24/7 to take your call.

Transmission

Measles is transmitted airborne by droplet spread and direct contact with nasal or throat secretions of infected persons. Less commonly, it can be transmitted by articles freshly soiled with nose and throat secretions. Individuals are infectious from 1 day before the beginning of the prodromal period (usually about 4 days before rash onset) to 4 days after rash appearance. All persons who have not had the disease or been successfully immunized are susceptible.

Diagnosis

A confirmed diagnosis of measles can only be accomplished with laboratory confirmation. The detection of measles-specific IgM antibody, present 3-4 days after rash onset, confirms the diagnosis. Measles IgM testing is available through many commercial laboratories. Further, the Centers for Disease Control and Prevention (CDC) offers serological testing as well as RT-PCR.

Prevention and Control

  • Routine 2-dose MMR immunization is indicated for all persons not immune to measles.
    • Initial dose is at 12-15 months followed by the second dose at 4-6 years (usually at school entry).
  • Suspect measles cases should be isolated at home for 4 days after appearance of the rash
    • If hospitalized, droplet precautions from onset of catarrhal stage of the prodromal period up to and including the fourth day of rash.
    • Immediately report all suspect cases to DPH to ensure a prompt public health response
  • Immunization of susceptible contacts within 72 hours of exposure.
    • Alternatively, measles immunoglobulin may be given within 6 days of exposure for immunocompromised or those persons at high risk for complications (i.e., contacts < 1 year of age or pregnant women)
  • Consider measles as a diagnosis in anyone with a febrile rash illness lasting 3 days or more and clinically compatible symptoms (cough, coryza, and/or conjunctivitis) who has recently traveled abroad or who has had contact with someone with a febrile rash illness. Immunocompromised patients may not exhibit rash or may exhibit an atypical rash. The incubation period for measles from exposure to fever is usually about 10 days (range of 7-18 days) and from exposure to rash onset is usually 14 days and rarely as long as 19-21 days)
  • Obtain serology for measles-specific IgM testing

Resources

CDC: http://www.cdc.gov/measles/index.html

CDC/Measles Vaccination: http://www.cdc.gov/vaccines/vpd-vac/measles/default.htm

CDC/Immunization Schedules: http://www.cdc.gov/vaccines/recs/schedules/default.htm

Additional Information

DPH, Bureau of Epidemiology (24/7): 1-888-295-5156

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