2019 Measles Update Susan Sullivan MS, RN-BC VPD Nurse Consultant - PowerPoint Presentation

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2019 Measles Update

Susan Sullivan MS, RN-BC VPD Nurse ConsultantJustin Albertson MS, VPD Epidemiologist

April

2019

Objectives

Discuss measles clinical presentation Review current epidemiology

Discuss appropriate lab testing

Describe control measures

Measles

Acute viral illness

Transmitted via airborne particles or droplets

Airborne virus can remain infectious for up to 2 hours after a case occupied that space

Incubation period: 7-21 days (average 14 days

)

Infectious period: 4 days before and after rash onsetPrevented by measles-mumps-rubella vaccine (MMR)2 doses recommended (1 dose-93%; 2 doses-97% effectiveness)1st at 12-15 months of age2nd at 4-6 years of age

Clinical Picture

Prodrome

(typically lasts 2-4 days)

High fever (up to 105°), cough, coryza (runny nose), conjunctivitis

Koplick

spots

Rash (typically lasts 4-7 days)Begins a few days after prodromeMaculopapular (flat lesions and small, solid raised lesions)Begins on head and faceSpreads to trunk and extremitiesFades in order of appearance

Fifth’s Disease-parvovirusHand, Foot and Mouth Disease- coxsackie virus

Roseola-human herpesvirus 6, 7Scarlet fever-strepRocky Mountain Spotted FeverRecent antibiotic useContact dermatitis

Heat rash

Recent MMR vaccination

In sexually active adults, please rule out syphilis

Other Fever/Rash Causes

Measles Lab Testing

PCR (NC SLPH w CD Branch approval)

Throat or nasopharyngeal swab

Urine

Collect

within 3 days

of rash onsetNC SLPH now able to perform measles PCRIgM (any commercial lab)Serum specimenCollect 3 days or later after rash onsetIn vaccinated persons, there is often a blunted and/or transient production of IgMNegative

IgM in vaccinated persons suspected of having measles should not be used to rule out the

case

Viral culture (LabCorp)

Still common in Europe, Asia, the Pacific, and Africa

Travelers with measles continue to bring disease into U.S.Measles spreads in a community where groups of people are unvaccinated

Large majority of people who get measles are unvaccinated

https

://www.cdc.gov/measles/cases-outbreaks.html

Measles in the U.S.

Global View

Measles in the U.S.

https://www.cdc.gov/measles/cases-outbreaks.html

Measles in North Carolina, 2009-2018

Wake – Johnston County Measles Case: June 2018

Unvaccinated index case returned from vacation in France on 6/2/18Rash onset 6/10/18; infectious 6/6 to 6/14Exposed persons in 3 different healthcare settings on 5 separate visits from 4 other states and 15 counties

Over 300 contacts investigated; 2 family members infected

Genotype D8A; associated with outbreak strain in Europe

Health Care Settings

Presumptive immunity2 valid doses MMR

Lab evidence of immunity or previous

disease

Furlough non-immune exposed staff

The Window: Incubation period 7 to 21 days, average 14 days

6/10

Rash onset

Infectious

4

days

before & after rash onset6/66/14

6/26 - End of

incubation period

for 6/6 exposures

7/4 - End

of

incubation period

for 6/14 exposures

PEP-MMR within 3 days of exposure;

IG within 6 days of exposure

§ 130A-145. Quarantine and isolation authority

(a) The State Health Director and a local health director are empowered to exercise quarantine and isolation authority. Quarantine and isolation authority shall be exercised only

when and so long as the public health is endangered, all other reasonable means for correcting the problem have been exhausted, and no less restrictive alternative exists.

(b) A person convicted under this section for violation of G.S. 130A-145 shall not be sentenced under Article 81B of Chapter 15A of the General Statutes but shall instead be sentenced to a term of imprisonment of no more than two years…

1. Immune Status

Shot record, disease history?Vaccine effectivenessWaning immunity?2. Clinical Presentation

Onset date of each symptom

Classic or modified presentation?

Lab results

3. Epidemiology

What is incubation period? Infectious period?Demographics, travel, employment, activities, school, congregate settings 163 Basic VPD Questions: ICE

ScreenImmune status

Clinical informationEpi, activities, travel, exposure historyIsolateAirborne precautions for measles2 hour timeframe even after patient leaves

Call public health immediately

Assure control measures are initiated

Arrange for appropriate testing

Begin contact investigation

3 Basic Response Steps for Healthcare Settings

Identify infection; manage case

Define population at riskManage non-immune exposed personsVaccinate?

Exclude?

4. Obtain appropriate clinical specimens

5. Maintain surveillance

18

5 VPD Control Strategies for Public Health

Educate

!

Most clinicians have never seen a true case of measles

Immune status, clinical presentation and epi (travel history) need to be assessed for every patient presenting in an urgent care settingMost adults do not have ready access to their shot recordsUnvaccinated returning travelers continue to be a source of measles spread in the U.S.

Lessons learned