Use strict infection control in the office. The recent outbreak in California where 4 children were infected in their physician’s office reinforces the need for strict infection-control practices. Do not allow patients with rash and fever to remain in a common waiting area. Move them to an examination room, preferably an airborne infection isolation room. Keep the door to the examination room closed, and be sure that all health care personnel who come in contact with such patients are immune. Do not use triage rooms for 2 hours after the patient suspected of having measles leaves. Do not send these patients to other health care facilities, such as laboratories, unless infection control measures can be adhered to at those locations. Guidelines on infection control practices in health care settings are available.9,10
Quick response
Quick control of these outbreaks shows the value of the public health infrastructure. Disease surveillance and outbreak response is vital to the public health system, and its value is frequently under-appreciated by physicians and the public.
MEASLES BASICS
Fewer than 100 cases of measles occur in the United States each year, and virtually all are linked to imported cases.3 Before vaccine was introduced in 1963, 3 to 4 million cases per year occurred, and caused, on average, 450 deaths, 1000 chronic disabilities, and 28,000 hospitalizations.1 Success in controlling measles is due largely to high levels of coverage with 2 doses of measles-containing vaccine and public health surveillance and disease control.
Measles virus is highly infectious and is spread by airborne droplets and direct contact with nose and throat secretions. The incubation is 7 to 18 days.
Measles begins with fever, cough, coryza, conjunctivitis, and whitish spots on the buccal mucosa (Koplick spots).4 Rash appears on the 3rd to 7th day and lasts 4 to 7 days. It begins on the face but soon becomes generalized. An infected person is contagious from 5 days before the rash until 4 days after the rash appears. The diagnosis of measles can be confirrmed by serum measles IGM, which occurs within 3 days of rash, or a rise in measles IGG between acute and 2-week convalescent serum titers.
Complications: pneumonia (5%), otitis media (10%), and encephalitis 1/1000). Death rates: 1 to 2/1000, varying greatly based on age and nutrition; more severe in the very young and the malnourished. Worldwide, about 500,000 children die from measles each year.5
Immunity is defined as:
- 2 vaccine doses at least 1 month apart, both given after the 1st birthday,
- born before 1957,
- serological evidence, or
- history of physician-diagnosed measles.