Dear VEP Providers,

Please take a minute to read the following information about measles (rubeola).  It combines info from the CDC, ACEP, and multiple state departments of public health.

OVER 100 CASES OF MEASLES have been reported in 2015 so far, mostly in California but in 13 other states as well.  Most cases seem to have originated in Disneyland.  Measles can kill.  Your expert eye, diagnostic skills, and prompt reporting of suspect measles cases to public health authorities can make a difference in stopping the spread of this highly contagious disease.

CLINICAL INFORMATION:

  • Consider measles in a patient of any age who has an acute RASH and FEVER.
  • Measles typically begins with a prodrome of fever, cough, coryza, and conjunctivitis.
  • Koplik’s spots may appear in 2-3 days (see 2 photos below) on the mucosa of the cheek or palate.  They are tiny red spots with bluish-white centers.
  • At this time, fever can reach 104 and the rash appears.  The rash is red, blotchy, and maculopapular and it may become confluent.  It usually starts on the face (hairline and behind the ears).  It rapidly spreads to the chest, back, and finally the extremities including palms and soles (see 2 photos below).
  • Patients are contagious from about 4 days before to 4 days after onset of rash.
  • Severe illness can include pneumonia, encephalitis, and death.
SPECIMENS:
  • Blood:  5-10 ml blood for measles IgG and IgM.  Use a red-top tube and spin down serum if possible.
  • Swabs:  nasopharyngeal (or throat) for culture and PCR.  Use a viral culturette with viral transport media.
  • Urine:  50-100 mL of urine for PCR.  Use a sterile container.
POST-EXPOSURE PROPHYLAXIS FOR NON-IMMUNE CONTACTS:
  • Immunocompetent:  Within 72 hours of exposure use MMR vaccine.
  • Immunocompromised, children <12 months, and others at high risk of complications:  Up to 6 days after exposure use IM immune globulin.
  • You should consider checking with your local health authorities.
PREVENT SPREAD:
  • If you suspect measles, MASK the patient and ISOLATE immediately in an airborne infection isolation room.  If one is not available, use a private room with the door closed.
  • All personnel entering the room should use respiratory protection at least as effective as an N95 respirator.  Do not use just a surgical mask.
  • If possible, allow only personnel with documentation of 2 doses of live measles vaccine or laboratory evidence of immunity (measles IgG positive) to enter the room.
  • Do not use the room for at least 2 hours after the patient leaves.  The virus can live for up to 2 hours on surfaces and in the air.
  • ALERT YOUR LOCAL HEALTH DEPARTMENT ASAP.  The risk of measles transmission to others and large contact investigations can be reduced if control measures are implemented immediately.
  • Notify any location where the patient is being referred about the suspect measles status.  Do not refer suspect measles patients to other locations unless you know appropriate infection control measures can be implemented there.
Check out the pictures below.  Please feel free to contact me if you have any questions or suggestions. Thanks.
Rob Wyman, MD
Vice President of Quality
Valley Healthcare, Inc.
rwyman@vephealthcare.com
925-658-2030

 

Koplik’s Spots on the cheek:                                               Koplik’s Spots on the palate:
          

 

Red, blotchy, maculopapular rash which starts           Rash spreading to the thorax:
on the face:
                         

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