COUNTY OF ERIE
GALE R. BURSTEIN, MD, MPH, FAAP
DEPARTMENT OF HEALTH
COMMISSIONER OF HEALTH
HEALTH ALERT PRIORITY #345
May 23, 2017
MEASLES EXPOSURES IN NEW YORK STATE – MAY 11TH AND MAY 12TH
Please distribute to Healthcare Providers, Infection Control Department, Emergency Department, Infectious Disease Department, OB/GYN, Family Medicine, Pediatrics, Director of Nursing, Medical Director, Laboratory Service, Pharmacy, and all patient care areas.
MEASLES EXPOSURES IN NEW YORK STATE – MAY 11TH AND MAY 12TH
- The New York State Department of Health (NYSDOH) has been notified that a traveler from India who was diagnosed with measles visited multiple New York State venues on May 11th and 12th while infectious, potentially exposing others to measles.
- Anyone who visited the following locations may have been exposed to measles:
- The Iroquois Travel Plaza (rest stop) between Exit 29 (Canajoharie) and Exit 29A (Little Falls) on the NYS Thruway between 8:30 p.m. – 12:30 a.m. on May 11 – 12th.
- The Hampton Inn, 4873 Lake Road, Brockport, N.Y. on May 12th between 12 a.m. (midnight) and 12 p.m. (noon).
- Niagara Falls State Park, Niagara Falls, N.Y. on May 12th between 11:00 a.m. - 5:00 p.m. Exposures may have occurred on the Maid of the Mist.
- Swagat Fine Indian Cuisine, 24 Buffalo Avenue, Niagara Falls, N.Y. May 12th between 2:00 – 6:00 p.m.
- Individuals who were exposed and not immune to measles could develop signs and symptoms of measles 7-21 days after exposure. Symptom onsets from the exposures listed above could range from as early as May 18th to as late as June 2nd.
- Healthcare providers should have a high index of suspicion in patients who present with symptoms consistent with measles and have visited the locations listed. To expedite public health containment strategies, providers should implement appropriate infection control measures when measles is suspected and immediately contact the Erie County Department of Health (ECDOH) at (716) 858-7697 during normal business hours and (716) 961-7898 after hours to report suspect measles cases, facilitate specimen collection and determine appropriate follow-up.
Measles can be severe and is highly infectious; following exposure, up to 90% of susceptible persons develop measles. It is spread by airborne contact with an infected person through coughing and sneezing. Measles virus can remain active and contagious for up to 2 hours in the air or on surfaces. The incubation period for measles from exposure to fever is usually about 10 days (range, 7 to 12 days) and from exposure to rash onset is usually 14 days (range, 7 to 21 days). Persons with measles are infectious from 4 days before to 4 days after rash onset.
Measles is characterized by a prodrome of fever (101–105 degrees F) followed by cough, coryza, and/or conjunctivitis. An erythematous, maculopapular rash presents 2-4 days later and lasts 5-6 days. It usually starts on the face and proceeds down the body to involve the extremities last, including the palms and soles. The rash is usually discrete but may become confluent on the upper body; it resolves in the same order that it appeared. Koplik’s spots (punctate blue-white spots on the bright red background of the buccal mucosa) may be present, often before the rash develops, but are often not seen and are not required for the diagnosis of measles.
Measles is spread via airborne transmission and direct contact with infectious droplets. Cases of fever and rash illness should immediately be placed in airborne isolation. If an airborne infection isolation room is not available, then the exam room used to isolate a suspect measles case should not be used for 2 hours after the case leaves the room and the number of people entering and leaving should be minimized. When transporting a patient through the hospital, the patient should be masked. If possible, elevators and corridors should not be used for two hours after the patient has passed through them. If possible, any procedures required for the patient should be performed in the patient’s room or delayed until the patient is no longer infectious.
Viral specimens (throat or nasal-pharyngeal swab and urine) and serology (IgM and IgG) should be obtained for diagnostic testing and confirmation. Use of commercial laboratories for measles testing may take up to a week to obtain results. Reporting suspected cases of measles enables access to rapid testing through the NYS Wadsworth Center Laboratory. The LHD can assist in arranging testing at the Wadsworth Center Laboratory. Viral specimens that result in a positive PCR or culture will be forwarded to CDC for confirmation and genotyping.
MEASLES POST-EXPOSURE PROPHYLAXIS (PEP)
The successful initiation of measles PEP requires rapid intervention. LHDs can assist with the proper PEP recommendations and infection control measures. Measles vaccination should be administered to susceptible contacts of a measles patient within 72 hours of exposure and may offer protection. Immune globulin is indicated for susceptible household or other close contacts of patients with measles, particularly those contacts younger than 1 year of age, pregnant women and/or immunocompromised persons, for whom risk of complications is highest. Immune globulin should be given within 6 days of exposure to prevent or lessen the severity of measles.
VACCINE RECOMMENDATIONS AND IMMUNITY
Children ≥ 12 months, Adolescents, and Adults
- All children should receive an MMR vaccine at 12 – 15 months of age. The second dose of MMR is routinely administered at age 4 – 6 years typically before entering kindergarten, but may be administered as soon as 28 days after the first dose. Vaccination should be provided at the earliest opportunity based on the ACIP recommended schedule.
- Children over one year of age who have received one dose of MMR vaccine and who have recently been exposed to measles infection or are planning travel outside the U.S. should receive a second dose as soon as possible, as long as 28 days have passed since the first dose. Second doses of MMR are valid as long as they are administered after 12 months of age and at least 28 days after the first dose was administered.
- Anyone who has received two valid doses of MMR, or other live measles-containing vaccine, has documented laboratory evidence of immunity, or was born before 1957 is considered immune and not likely to become infected. Anyone who lacks proof of measles immunity, as defined above, should receive at least one dose of MMR vaccine. Two appropriately spaced doses of MMR vaccine are recommended for health-care personnel, college students, and international travelers.
Children 6–11 months of age who are traveling outside the U.S.
- Should receive one dose of MMR vaccine prior to international travel.
- MMR vaccine given before 12 months of age should not be counted as part of the routine series. Children who receive MMR vaccine before age 12 months will need two more doses for a total of three doses, the first of which should be administered at 12 – 15 months of age and the second at least 28 days later (typically at age 4 – 6 years or before beginning kindergarten).
Health care providers should increase their index of suspicion for measles in clinically compatible cases. The LHD should be notified of any suspect case immediately. Reports should be made at the time of initial clinical suspicion. If the diagnosis of measles is being considered and diagnostic testing for measles is ordered, then the case should be reported at that time. LHDs should also be notified of discharge plans from the health care setting. This is especially important if the case lives in a multifamily dwelling, dormitory, group home or has young children at home.
Providers are required to report a suspected measles case to the ECDOH at 716-858-7697 during normal business hours or 716-961-7898 evenings, weekends and holidays.
- Complete information on MMR vaccine recommendations: https://www.cdc.gov/mmwr/pdf/rr/rr6204.pdf
- 2017 Immunization Schedules: https://www.cdc.gov/vaccines/schedules/
- The NYSDOH Measles Fact Sheet is available at: http://www.health.ny.gov/diseases/communicable/measles/fact_sheet.htm
- Destination specific travel immunization information is available on the CDC and Prevention’s Travelers’ Health website at: http://wwwnc.cdc.gov/travel/destinations/list
- For additional information on measles outbreak control measures, clinical presentation and diagnostic tests please refer to the CDC website at: http://www.cdc.gov/vaccines/pubs/surv-manual/chpt07-measles.html
- The NYSDOH Outbreak Control Manual is available at: http://www.health.ny.gov/prevention/immunization/providers/outbreak_control_guidelines.htm
- CDC Measles Cases and Outbreaks: http://www.cdc.gov/measles/cases-outbreaks.html
- CDC Measles Elimination: https://www.cdc.gov/measles/about/faqs.html#measles-elimination
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The Erie County Department of Health does not provide medical advice. The information provided on the Erie County Department of Health website is not an attempt to practice medicine and is not intended as a substitute for professional medical advice, diagnosis, or treatment. It is for informational purposes only. Always seek the advice of your personal physician or other qualified health provider with any questions you may have regarding a medical condition or issue. Never disregard professional medical advice or delay in seeking it because of the content found on the Erie County Department of Health website or this correspondence.