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Testing and Reporting Suspected Measles Cases
The United States is currently experiencing a large, multi-state outbreak of
measles. From December 28, 2014 to February 27, 2015, 140 people from 7
states in the U.S. [AZ(7), CA (124), CO (1), NE (2), OR (1), UT (3), WA
(2)] were reported to have measles and are considered to be part of a large,
ongoing outbreak linked to an amusement park in California.
This Health Alert specifically focuses on the need for Louisiana physicians
to appropriately test, and immediately report, without waiting for laboratory
confirmation, all suspected cases of measles. Immediate reporting of
suspected cases allows timely public health interventions to control disease
outbreaks.
Measles is an acute viral respiratory illness. It is characterized by a
prodrome of fever (as high as 105°F) and malaise, cough, coryza, and
conjunctivitis -the three “C”s -, a pathognomonic enanthema (Koplik spots)
followed by a maculopapular rash. The rash usually appears about 14 days
after a person is exposed; however, the incubation period ranges from 7 to
21 days. The rash spreads from the head to the trunk to the lower
extremities. Patients are considered to be contagious from 4 days before to 4
days after the rash appears. Of note, sometimes immunocompromised
patients do not develop the rash.
In the decade before the live measles vaccine was licensed in 1963, an
average of 549,000 measles cases and 495 measles deaths were reported
annually in the United States. However, it is likely that, on average, 3 to 4
million people were infected with measles annually; most cases were not
reported. Of the reported cases, approximately 48,000 people were
hospitalized from measles and 1,000 people developed chronic disability
from acute encephalitis caused by measles annually.
Outbreaks in countries to which Americans often travel can directly
contribute to an increase in measles cases in the United States. In recent
years, measles importations have come from frequently visited countries,
including, but not limited to, England, France, Germany, India, and the
Philippines, where large outbreaks were reported.
Common complications from measles include otitis media,
bronchopneumonia, laryngotracheobronchitis, and diarrhea.
Even in previously healthy children, measles can cause serious illness
requiring hospitalization.
• One out of every 1,000 measles cases will develop acute encephalitis,
which often results in permanent brain damage.
• One or two out of every 1,000 children who become infected with measles
will die from respiratory and neurologic complications.
• Subacute sclerosing panencephalitis (SSPE) is a rare, but fatal
degenerative disease of the central nervous system characterized by
behavioral and intellectual deterioration and seizures that generally
develop 7 to 10 years after measles infection.
People at high risk for severe illness and complications from measles
include:
• Infants and children aged <5 years
• Adults aged >20 years
• Pregnant women
• People with compromised immune systems, such as from leukemia and
HIV infection
Measles is one of the most contagious of all infectious diseases;
approximately 9 out of 10 susceptible persons with close contact to a
measles patient will develop measles. The virus is transmitted by direct
contact with infectious droplets or by airborne spread when an infected
person breathes, coughs, or sneezes. Measles virus can remain infectious on
surfaces and in the air for up to two hours after an infected person leaves an
area.
Reporting and Laboratory Testing
Healthcare providers should consider measles in patients presenting with
febrile rash illness and clinically compatible measles symptoms, especially if
the person recently traveled internationally or was exposed to a person with
febrile rash illness. Healthcare providers should report suspected measles
cases to the Immunization Program Office Monday through Friday, 8am to
4:30pm at 504-838-5300. After hours, call the Louisiana Epidemiology
Hotline at 800-256-2748.
Laboratory confirmation is essential for all sporadic measles cases and all
outbreaks. Detection of measles-specific IgM antibody and measles RNA by
real-time polymerase chain reaction (RT-PCR) are the most common
methods for confirming measles infection. Healthcare providers should
obtain BOTH a serum sample and a throat swab (or nasopharyngeal swab)
from patients suspected to have measles at first contact with them. Synthetic
swabs are recommended. Urine samples may also contain virus, and when
feasible to do so, collecting both respiratory and urine samples can increase
the likelihood of detecting measles virus. Throat, NP or nasal swabs should
be placed in viral transport medium (do not allow to dry out). Louisiana
Office of Public Health staff can provide guidance for laboratory sample
collection.
Please keep your practice vigilant, and immediately report any suspected
case of measles to the Department of Health and Hospitals Office of Public
Health Immunization Program Office Monday through Friday 8am to
4:30pm at 504-838-5300. After hours, call the Louisiana Epidemiology
Hotline at 800-256-2748. Direct questions on how to submit suspected
measles specimens to the OPH Virology Laboratory at 225-219-5200, or
after-hours at 504-458-9537.