Alert for Providers in the DMV: Possible Measles Exposure at Local Airports
A Clinical Outreach Communication Activity (COCA) bulletin – Stay Alert for Measles Cases – was released by CDC’s Office of Emergency Risk Communications on January 25th after CDC was notified of 23 U.S. cases of measles, including 7 direct importations of measles by international travelers and 2 outbreaks of measles with more than 5 cases each. Most of these cases were among children and adolescents who did not get a measles-containing vaccine (MMR or MMWR), even if eligible.
An American Academy of Pediatrics (AAP) press release on January 24th noted that a traveler may have exposed others to the highly contagious disease at Dulles International and Ronald Reagan Washington National Airports.
Due to the recent cases, the CDC states that healthcare providers should be on alert for patients who have: (1) febrile rash illness and symptoms consistent with measles (e.g., cough, coryza, or conjunctivitis), and (2) have recently traveled abroad, especially to countries with ongoing measles outbreaks. Infected people are contagious from 4 days before the rash starts through 4 days afterwards.
CDC’s COCA bulletin also lists a number of recommendations for healthcare providers including:
- Isolate: Do not allow patients with suspected measles to remain in the waiting room or other common areas of the healthcare facility; isolate patients with suspected measles immediately, ideally in a single-patient airborne infection isolation room (AIIR) if available, or in a private room with a closed door until an AIIR is available. Healthcare providers should be adequately protected against measles and should adhere to standard and airborne precautions when evaluating suspect cases regardless of their vaccination status.
- Notify: Immediately notify local or state health departments about any suspected case of measles to ensure rapid testing and investigation. Measles cases are reported by states to CDC through the National Notifiable Diseases Surveillance System (NNDSS) and can also be reported directly to CDC at measlesreport@cdc.gov.
- Test: Follow CDC’s testing recommendations and collect either a nasopharyngeal swab or throat swab for reverse transcription polymerase chain reaction (RT-PCR), as well as a blood specimen for serology from all patients with clinical features compatible with measles. RT-PCR is available at CDC, at many state public health laboratories, and through the APHL/CDC Vaccine Preventable Disease Reference Centers.
- Manage: In coordination with local or state health departments, provide appropriate measles post-exposure prophylaxis (PEP) to close contacts without evidence of immunity, either MMR or immunoglobulin. The choice of PEP is based on elapsed time from exposure or medical contraindications to vaccination.
- Vaccinate: Make sure all your patients are up-to-date on measles vaccine, especially before international travel. People 6 months of age or older who will be traveling internationally should be protected against measles.