IDAHO HEALTH ALERT NETWORK

Health Message Details - Sent/Archived
  
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Message ID:   1671      Public Message
Subject:   Measles Outbreak in Clark County, Washington
Sent By:   PHD3 Date Sent:   1/25/2019 9:27:27 AM
Priority:   Advisory Status:   Sent (Delivered)
PHIN Specific Data:
Severity:   Moderate Delivery Time:   15 Minutes
PHIN Status:   Actual Message Type:   Alert
Sensitivity:   Non Sensitive Acknowledgement:   No
Attachments:
File NameDate/TimeSize 
Measles Outbreak in Clark County WA Jan 2019.pdf1/25/2019 9:22:59 AM 381752 Download
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Message Text:
Measles Outbreak in Clark County, Washington Outbreak Update:  As of January 24, 2019, 24 children and one adult from Clark County, Washington have developed lab-confirmed measles; most were unvaccinated. Clark County is currently investigating an additional 12 suspect cases. For updated information on the Clark County investigation, visit: https://www.clark.wa.gov/public-health/measles-investigation. To date, no measles cases have been reported in Idaho as a result of this outbreak. Healthcare providers should consider measles in patients presenting with febrile rash illness and clinically compatible symptoms, especially if the patient recently travelled internationally or to locales in the United States experiencing a measles outbreak (see https://www.cdc.gov/measles/cases-outbreaks.html) including Clark county, Washington and Portland, Oregon. Clinical Features: Measles is a highly contagious viral respiratory illness that is vaccine-preventable.  It is characterized by a prodrome of fever (as high as 105?F), malaise, the “three C’s” (cough, coryza, and conjunctivitis), and Koplik spots (https://phil.cdc.gov/details.aspx?pid=6111) followed (2-4 days later) by a maculopapular rash which begins on the face and moves downward and outward to trunk and extremities. Common complications of measles include diarrhea, otitis media, and pneumonia. Incubation period: The incubation period of measles, from exposure to prodrome averages 10-12-days. From exposure to rash onset averages 14 days (range, 7-21 days). Period of Communicability: The period of communicability extends from 4 days before rash onset to 4 days after rash appearance. Testing for Measles: Healthcare providers should obtain BOTH: * Serum sample for serology (measles IgM and IgG) * Throat or nasopharyngeal swab for detection of measles RNA by RT-PCR (real-time polymerase chain reaction. Treatment: There is no specific antiviral therapy for measles. Medical care is supportive and to help relieve symptoms and address complications such as bacterial infections. Prevention/Vaccination: Measles vaccine (MMR or MMRV) is 93% to 97% effective and protection is lifelong. Healthcare providers are encouraged to assess the measles vaccination status of their patients. Recommended immunization schedules can be found at https://www.cdc.gov/vaccines/schedules/hcp/imz/child-adolescent.html and https://www.cdc.gov/vaccines/schedules/hcp/imz/adult.html. Post-exposure prophylaxis: People exposed to measles who cannot readily show that they have evidence of immunity against measles should be offered post-exposure prophylaxis (PEP). MMR vaccine, if administered within 72 hours of initial measles exposure, or immunoglobulin (IG), if administered within six days of exposure, may provide some protection or modify the clinical course of disease among susceptible persons. For more information on PEP, see https://www.cdc.gov/measles/hcp/index.html. Healthcare Infection Control: Measles is one of the most contagious of all infectious diseases; approximately 9 out of 10 susceptible persons with close contact to a measles patient will develop measles. The virus is transmitted by direct contact with infectious respiratory droplets or by airborne spread when an infected person breathes, coughs, or sneezes. Measles virus can remain infectious in the air for up to two hours after an infected person leaves an area. When possible, use phone triage and assessment to determine if patients who might have measles need to be seen in-person. If a patient needs to be evaluated in-person or arrives unexpectedly with symptoms compatible with measles, then follow these recommendations: 1. Immediately mask the patient, and place them in a room with the door closed 2. Perform the evaluation in a negative pressure room, if possible 3. Regardless of presumptive immunity status, all healthcare staff entering the room should use respiratory protection consistent with airborne infection control precautions (N95 respirator or a PAPR – powered air-purifying respirator). 4. After the patient leaves, the exam door should remain closed and the room should not be used for at least two hours. 5. Instruct the patient to self-isolate at home if measles is likely. 6. If an exposure occurs in the healthcare setting, attempt to record contact information to facilitate infection prevention / public health follow-up. Reporting Measles: All cases (including suspect cases) of measles are reportable within one working day. Southwest District Health Confidential Reporting Phone: (208) 455-5442 Southwest District Health Confidential Reporting Fax: (208) 455-5350