Tennessee measles case puts VUMC on heightened alert
The Tennessee Department of Health has confirmed a case of measles in an Eastern Tennessee resident who recently traveled to an outbreak area. As a reminder, measles is a highly contagious viral infection. The United States is currently involved in an outbreak situation involving five states. Additional measles cases are expected to be confirmed. Public Health is working directly with involved health care facilities and known contacts; however, susceptible persons may develop (or may have developed) measles illness following an unrecognized exposure to this case. Susceptible contacts of the known case may develop rash up to approximately May 8.
Epidemiology: Cases are infectious four days before rash onset through four days after rash onset. Average incubation period is 14 days (range 7-21 days) between exposure and rash onset. Measles is transmitted via respiratory droplets and is highly infectious. The virus may linger in the air of a room for up to two hours after an infectious person has left the area.
Clinical symptoms: Begins with a prodrome of fever (up to 105°F) and malaise, cough, conjunctivitis and runny nose (coryza). Small bluish-white spots with red bases may be seen on the buccal mucosa (Koplik’s spots). Rash onset is typically 3-7 days after onset of the prodromal symptoms, beginning on the face and spreading downward. Complications may include bacterial superinfections or encephalitis. Consider the possibility of measles when evaluating susceptible patients with an acute febrile rash illness, especially if the person has been in Eastern Tennessee since April 11.
Prevention: Vaccination is extremely effective, with two doses of MMR vaccine providing immunity to more than 97% of recipients. Ensure all patients ages 12 months and older are appropriately immunized and administer measles-mumps-rubella (MMR) vaccine to anyone over age 12 months who has not received MMR vaccine in the past 28 days and who does not have documentation of having received two doses of the vaccine. Infants may receive MMR vaccine after age 6 month in the event of an outbreak; however, the child would still require two doses after the first birthday to be considered appropriately vaccinated.
All VUMC health care providers should
Consider measles in patients with the acute onset of symptoms of measles fever (up to 105°F) and malaise, runny nose (coryza), cough, conjunctivitis. Small white spots on a red base may be seen on the buccal mucosa (Koplik’s spots). A macular rash appears 3-7 days after the onset of prodromal symptoms, beginning on the face and spreading downward. Consider measles when evaluating patients with an acute febrile rash illness, especially if the person has been in East Tennessee since April 11.
· Mask the patient and place these patient in Airborne Precautions in a negative-pressure room with the door shut.
· Notify Infection Prevention immediately using the on call pager 615-835-1205.
· IP and the Hospital Epidemiologist will notify the Tennessee Department of Health.
· Blood specimen (red top tube) and a throat swab (on viral transport medium) is collected from the patient and sent to the state lab. IP facilitates through the VUMC Laboratory.
· Prevention is essential with documented two doses of MMR vaccine especially for health care personnel.
- Health care personnel must have received two doses of MMR 28 days apart.
- Birth before 1957 DOES NOT qualify for presumptive evidence of immunity in a community with an ongoing outbreak.
Resources for the public and medical community are available at: http://www.cdc.gov/measles/. For questions or additional information, please contact the VUMC Department of Infection Prevention at 615-936-0725 or via pager 615-835-1205.
Resources:
CDC website at http://www.cdc.gov/measles/
Measles outbreaks or healthcare facilities: http://www.cdc.gov/vaccines/pubs/surv-manual/chpt07-measles.pdf
Tennessee Department of Health: https://www.tn.gov/content/tn/health/cedep/reportable-diseases/measles-rubeola.html
Measles testing algorithm: https://prd-medweb-cdn.s3.amazonaws.com/documents/infectioncontrol/files/Pictures/Measles%20Diagnosis%20Algorithm%20TN%20DOH%202019.pdf