Measles Disclosures I have no disclosures Meg Fisher, MD Medical - PDF document

Measles Disclosures • I have no disclosures Meg Fisher, MD Medical Director • I may be mentioning off label uses of drugs Measles Objectives • RNA virus: family Paramyxoviridae, genus Morbillivirus • Recognize measles • Transmitted by droplets and air • Manage a child with measles • Extremely contagious • Prevent transmission • Incubation period 8 to 12 days • Advise families regarding measles • Contagious 4 days prior to 4 days immunization after the rash appears Measles in the US Measles in the US • 1 st Vaccine • 2014: over 600 cases and licensed 23 outbreaks 1963 • US travelers bring measles home • About 95% • Travelers to US bring measles along effective • Secondary spread to unimmunized • US measles free since contacts 2000 1

2015 Outbreak Clinical Illness • Fever, cough, conjunctivitis • Day 2 to 3 of fever, Koplik spots appear • One to 3 days later, rash appears on the face, maculopapular to confluent • Rash spreads and then fads over days Koplik spots Fever, Cough, Conjunctivitis Confluent Rash Complications • Otitis media • Respiratory: pneumonia (viral and bacterial); laryngotracheitis • Encephalitis • Subacute sclerosing panencephalitis 2

Treatment Diagnosis • Clinical • Isolate the patient: air and droplet • Confirm with serology: IgG and IgM • Report the case • Virus isolation: nasopharyngeal swab, urine • Vitamin A: Once daily for two days • Report all suspected cases: 200,000 IU age > 12 mo; 100,000 IU local health department – 6 ‐ 11 mo; 50,000 IU < 6 mo if not available, call the state • Ribavirin: in vitro, not approved daytime: (609) 826 ‐ 5964 after hours: (609) 392 ‐ 2020 Prevention Infection Control • Measles vaccine: MMR • Staff: all should be immune • Proof of immunity: seropositive; 2 doses Routine: 12 ‐ 15 mo, 4 ‐ 6 yr • Born 1957 and later: seropositive or 2 doses of Post ‐ exposure: within 72 hours vaccine at least 28 days apart • Immunoglobulin 0.25 ml/kg (max 15) • Born before 1957: generally considered • Travelers/outbreaks: MMR for ages 6 immune but serology recommended; vaccine to 12 mo; child: give 2 nd dose if not seropositive Take Home Messages Infection Control • Think measles: fever, cough, • Triage is essential conjunctivitis and then rash • When possible, make the diagnosis outside of your office: car or hospital • Notify local health department stat • If the child is in your office, put into a room • Get the proper specimens: serology • Mask on the child if possible and viral culture (NP preferred) • The area is considered contaminated for 2 hours after the patient leaves • Get everyone protected and immunized: staff and patients • Airflow in the office: air may be re ‐ circulated 3

Questions • My special thanks to Barbara Montana, MD for help reviewing my slides. She will help me answer your questions • Thank you for listening – the program will be available for viewing in the future • If you have additional questions, please send them to cmott@njaap.org 4