Measles For Healthcare Providers From The CDC

Today, I review, link to, and excerpt from the CDC’s (Centers For Disease Control and Prevention) Measles For Healthcare Providers.

In addition to today’s resource, please see Lab Tools [for the diagnosis of measles] from the CDC.

All that follows is from the above outstanding resource.

Clinical features

Measles is an acute viral respiratory illness. It is characterized by a prodrome of fever (as high as 105°F) and malaise, cough, coryza, and conjunctivitis -the three “C”s -, a pathognomonic enanthema (Koplik spots) followed by a maculopapular rash. The rash usually appears about 14 days after a person is exposed. The rash spreads from the head to the trunk to the lower extremities. Patients are considered to be contagious from 4 days before to 4 days after the rash appears. Of note, sometimes immunocompromised patients do not develop the rash.

Complications

Common complications from measles include otitis media, bronchopneumonia, laryngotracheobronchitis, and diarrhea.

Even in previously healthy children, measles can cause serious illness requiring hospitalization.

  • One out of every 1,000 measles cases will develop acute encephalitis, which often results in permanent brain damage.
  • One to three out of every 1,000 children who become infected with measles will die from respiratory and neurologic complications.
  • Subacute sclerosing panencephalitis (SSPE) is a rare, but fatal degenerative disease of the central nervous system characterized by behavioral and intellectual deterioration and seizures that generally develop 7 to 10 years after measles infection.

People at high risk for complications

People at high risk for severe illness and complications from measles include:

  • Infants and children aged <5 years
  • Adults aged >20 years
  • Pregnant women
  • People with compromised immune systems, such as from leukemia and HIV infection

Transmission

Measles is one of the most contagious of all infectious diseases; up to 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 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.

Diagnosis and laboratory testing

Healthcare providers should consider measles in patients presenting with febrile rash illness and clinically compatible measles symptoms, especially if the person recently traveled internationally or was exposed to a person with febrile rash illness. Healthcare providers are required to report suspected measles cases to their local health department.

Laboratory confirmation is essential for all sporadic measles cases and all outbreaks. Detection of measles-specific IgM antibody in serum and measles RNA by real-time polymerase chain reaction (RT-PCR) in a respiratory specimen are the most common methods for confirming measles infection. Healthcare providers should obtain both a serum sample and a throat swab (or nasopharyngeal swab) from patients suspected to have measles at first contact with them. Urine samples may also contain virus, and when feasible to do so, collecting both respiratory and urine samples can increase the likelihood of detecting measles virus.

Molecular analysis can also be conducted to determine the genotype of the measles virus. Genotyping is used to map the transmission pathways of measles viruses. The genetic data can help to link or unlink cases and can suggest a source for imported cases. Genotyping is the only way to distinguish between wild-type measles virus infection and a rash caused by a recent measles vaccination.

For more information, see Measles Lab Tools.

Measles Clinical Presentation, Diagnosis, and Prevention COCA Call video

Measles Clinical Presentation, Diagnosis, and Prevention COCA Call

Learn more about measles and other causes of febrile rash illness, how to diagnose and report measles, and the MMR vaccine.

Medscape CDC Expert Commentary

Measles in the US: 5 Things You Need to Know (medscape.com)

Measles Diagnosis At A Glance

To learn more about how to promptly recognize and diagnose measles, check out this Measles Clinical Diagnosis Fact Sheet in English and Spanish.

Video: Measles Clinical Features & Diagnosis

Measles Clinical Features and Diagnosis Video

Learn the signs and symptoms of measles for quicker diagnosing and share this resource with health care providers in your community.

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