Measles? Seriously, don’t we only need to talk about Measles in medical school during virology… RNA virus, funny spots in the mouth, blah, blah… next question… how can a Morsel on Measles be useful? We have eradicated Measles in the US… haven’t we?
Well, unfortunately, in our society, popular TV and Movie stars have more powerful voices than do physicians, so not everyone vaccinates their children. This has allowed for a recent outbreak within the USA.
- During 2001-2008, a median of 56 measles cases a year were reported to CDC.
- During the 1st 19 weeks of 2011, 118 cases have been reported (highest number since 1996).
- 23 states and New York City reported cases: largest outbreak was in Minnesota (21 pts).
- Ages: 3 months – 68 years: 55% were less than 20 years old.
- 89% associated with importation from other countries (yeah, world travel!).
- Cases are considered imported if at least some exposure occurred within 21 days of entry into the USA.
- Majority had contact in Europe or South-East Asia. France is the source of most imported measles cases from Europe.
- 89% were UNVACCINATED.
- 40% required hospitalization.
- Measles is HIGHLY infectious – 90% of susceptible persons who are exposed develop measles.
- Measles is a reportable disease – all cases of suspected measles should be reported to the local or state health department without waiting for diagnostic results.
What I learned in Medical School (and have since forgotten):
- Acute febrile illness with Cough, Coryza, Conjunctivitis, and red maculopapular rash.
- Koplik spots are pathognomonic.
- Acute Otitis Media
- Acute Encephalitis (1 out of 1,000 cases) – often with permanent brain damage
- Subacute Sclerosing Panencephalitis (rare) – CNS degenerative process
- Death (1-3 out of 1,000 cases) – usually respiratory or neurologic insults
- Pts are contagious 1-2 days before the onset of symptoms (3-5 days before rash) to 4 days after rash disappears.
What should I do?
- Ask good Vaccination history and Travel history in febrile patients, especially if they have a funny rash.
- Get a good look in the mouth (Koplik spots may appear before the rash).
- If considering Kawasaki’s Disease, make sure to consider Measles.
- Report your suspicion to local health department and get recommendations.
- Testing is primarily via measles IgM… IgG requires convalescent and acute levels, but can be used to confirm. The IgM may be falsely negative if done during 1st 72 hours after rash onset, so may require an additional level later.
- Management is primarily symptomatic care.
- For severely affected and immunocompromised children with measles, Ribavirin may be given (no controlled studies of its efficacy and it isn’t FDA approved – but measles is susceptible in vitro).
Center for Disease Control and Prevention. Measles – United States, January – May 20, 2011. MMWR; May 27, 2011 / 60(20); 666-668.
American Academy of Pediatrics. “Measles.” In Red Book, 27th Edition. 2006; pp. 441- 444.