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Transcript
MEMORANDUM TO: Local Health Departments, Regional Offices of Illinois Department of Public Health, Hospital Emergency Departments, Infection Control Preventionists and Infectious Disease Physicians, Hospital Laboratories FROM: Communicable Disease Control Section DATE: July 12, 2013 SUBJECT: Measles cases in Illinois/ Reporting of suspect cases The Illinois Department of Public Health, along with the Centers for Disease Control and Prevention and local health departments, have been investigating a confirmed and suspect case of measles in persons who traveled together to Poland and returned to Illinois in late June. The investigations are still ongoing, but it appears both cases are imported. Measles cases are rare in Illinois but do occur. Since 2009, only three other cases have been reported and all had onset in 2011. Measles Disease Measles is a highly contagious viral illness that is characterized by a rash, fever, cold symptoms, conjunctivitis, malaise, and Koplik’s spots (tiny white spots with bluish-white center inside the mouth). While measles is almost eradicated in the United States due to high vaccination coverage levels, it still kills nearly 200,000 people each year around the world. Currently the virus is endemic in many African, Asian, and European countries. Measles should be considered as a diagnosis in unvaccinated persons presenting with a febrile rash illness as described above and recent international travel or contact with travelers or other persons with rash illness. Measles cases can develop complications, including encephalitis, pneumonia, ear infections (permanent loss of hearing can result) or diarrhea. These complications are more common among children under five years of age and adults over 20 years old. Measles infection can be fatal and can cause miscarriage, premature birth or a low-birth-weight baby in pregnant women. Reporting of Suspicious Cases Physicians and other providers should contact their local health department to report a suspected measles case as soon as possible but within 24 hours. In highly suspicious cases, health care providers should not wait for laboratory results before contacting their local health department. Laboratories should also report to their local health department positive lab tests for measles within 24 hours. In turn, local health departments should report cases to the IDPH CD Section within the same time period. Prompt recognition, reporting and investigation of measles cases are important since transmission can be limited with early case identification and vaccination of susceptible contacts. For cases that have recently traveled, obtaining travel details (e.g. flight dates, times and numbers) are important for identifying contacts among fellow travelers. Persons traveling abroad should inquire about vaccinations before traveling abroad to prevent measles illness. Resources The following resources on measles infections are available: IDPH Measles flier - attached IDPH Measles Health Beat – http://www.idph.state.il.us/public/hb/hbmeasles.htm IDPH Measles Summary for Health Care Providers – http://www.idph.state.il.us/health/infect/reportdis/measles_provider-info.htm Image of Koplik’s spots – http://phil.cdc.gov/phil/details.asp?pid=3187 If you have any questions regarding any of the above information, please contact the IDPH Communicable Disease Control Section at 217-782-2016. Measles Health Alert 2013 Recent measles outbreaks have originated from returning international travelers. Measles is highly contagious. Please protect patients, visitors, and staff! Keep an eye out for measles symptoms: Suspect measles in patients with: • fever and rash • history of international travel in the past 3 weeks or contact with international visitors Note: A history of 2 doses of MMR vaccine does not exclude a measles diagnosis. Prodrome · Mild to moderate fever · Cough · Coryza · Conjunctivitis Rash onset · Fever spikes, often as high as 104º to 105º F · Red, maculopapular rash that may become confluent—typically starts at hairline, then face, and spreads rapidly down body · Koplik's spots (tiny blue/white spots on the bright red background of the buccal mucosa) may be present Act immediately if you suspect measles: • Implement airborne infection control precautions immediately, mask and isolate patient—negative pressure room, if available. • Permit only staff immune to measles to be near the patient. • Notify local health department immediately • Expedite measles serologic (IgM and IgG) and PCR testing at IDPH lab; use of commercial labs may delay definitive diagnosis. • Safeguard other facilities: assure airborne infection control precautions before referring patients. • Do not use any regular exam room for at least 2 hours after a suspected measles patient has left the room. Visit www.GetImmunizedCA.org for more information