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Quarantine and Isolation During the Sedgwick County Measles Outbreak, July 2014 Christine Steward, MPH Epidemiologist Sedgwick County Health Department 11/12/14 Source: Bunyen/Getty Images Outline What is measles? Summary of the Sedgwick County outbreak Measles control measures Measles Prodrome 2-4 days Caused by measles virus A.K.A. rubeola Symptoms: Fever Cough, runny nose, eye infection Tiredness Koplik spots Rash Complications 30% of measles cases develop >1 complication Pneumonia (1 in 20) Ear infections (1 in 10) Diarrhea (1 in 12.5) Encephalitis (1 in 1,000) Death (1-2 in 1,000) Infection during pregnancy: miscarriage, premature birth, low-birth-weight baby Measles is Contagious Incubation period: about 10 days 7-18 days from exposure to onset of fever As long as 21 days Communicable period: 1 day before the beginning of prodrome to 4 days after rash 1 2 3 Fever, cough, etc. 4 5 Rash starts 6 7 8 9 Measles is Highly Infectious Disease Transmission *R0 Measles Airborne 12–18 Pertussis Airborne droplet 12–17 Diphtheria Saliva 6–7 Smallpox Airborne droplet 5–7 Polio Fecal-oral route 5–7 Rubella Airborne droplet 5–7 Mumps Airborne droplet 4–7 HIV Sexual contact 2–5 SARS Airborne droplet 2–5 Influenza (1918 pandemic strain) Airborne droplet 2–3 *The average number of secondary cases generated by a primary case at the onset of an epidemic in an entirely susceptible population Sedgwick County Outbreak July 2014 Eleven confirmed cases of measles 4 children under 6 years old + 7 adults Association with the Kansas City cases Onset of Sedgwick Co. cases: 6/21 – 7/15 Two were unvaccinated Three were too young to be vaccinated Five had unknown vaccination status One was vaccinated General Measles Control Measures - Vaccinating on schedule - Post-exposure Vaccination within 72 hours of exposure Immune globulin (IG) within 6 days of exposure - Quarantine of exposed, susceptible individuals for 21 days following last exposure - Isolation for 4 days following onset of rash Sedgwick County Measles: Quarantine of Susceptible Contacts Susceptible contacts: - Three orders of quarantine were issued • • Non-compliance Travel ticket reimbursement - Daily quarantine checks Cases: - Infectious until 4 days after rash onset. Sedgwick County Health Dept. Thank you