2019 measles outbreak: What physicians need to know

1. How bad is it?

764 individual cases of measles have been confirmed in 23 states. The states with the worst outbreaks are:

• Arizona

• California

• Colorado

• Connecticut

• Florida

• Georgia

• Illinois

• Indiana

• Iowa

• Kentucky

• Maryland

• Massachusetts

• Michigan

• Missouri

• Nevada

• New Hampshire

• New Jersey

• New York

• Oregon

• Pennsylvania

• Texas

• Tennessee

• Washington

2. Why has measles spread?

According to the CDC:

• The majority of people who got measles were unvaccinated.

• Measles is still common in many parts of the world including some countries in Europe, Asia, the Pacific, and Africa.

• Travelers with measles continue to bring the disease into the U.S.

• Measles can spread when it reaches a community in the U.S. where groups of people are unvaccinated.

3. What are the signs and symptoms of measles?

The symptoms of measles generally appear about seven to 14 days after a person is infected.

Measles typically begins with

• high fever,

• cough,

• runny nose (coryza), and

• red, watery eyes (conjunctivitis).

• Tiny white spots (Koplik spots) may appear inside the mouth 2-3 days after symptoms begins.

• A rash that begins as flat red spots on the face at the hairline and typically spreads downward to the neck, trunk, arms, legs, and feet. Small raised bumps may also appear on top of the flat red spots.

4. Do adult patients need a measles booster?

The CDC’s vaccine recommendations are:

Children: CDC recommends routine childhood immunization with the MMR vaccine starting with the first dose at 12 through 15 months of age, and the second dose at 4 through 6 years of age, or at least 28 days following the first dose.

Students at post-high school educational institutions: Students without evidence of measles immunity need two doses of MMR vaccine, with the second dose administered no earlier than 28 days after the first dose.

Older adults: Patients born during or after 1957 who do not have evidence of immunity against measles should get at least one dose of MMR vaccine.

5. What should I do if I suspect a patient has measles?

If you suspect a patient has measles, ask about their:

• Vaccination status

• Recent international travel

• Travel to domestic venues frequented by international travelers

• Contact with anyone who has traveled internationally

• Measles in the local community

Physicians should report suspected measles cases to the local health department immediately. Laboratory confirmation is essential for all sporadic measles cases and all outbreaks. Physicians will need to 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 the virus.

6. How can I improve patient immunization rates at my practice?

Here are some tips from the CDC:

• Make patients aware of your immunization philosophy and policy.

• Keep updated on current vaccine guidelines.

• Make clinical resources readily available to staff.

• Assess a child patient’s immunization status at every visit.

• Explain the importance of each vaccine and every dose.

• Give handouts to answer specific questions.

• Schedule follow-up immunization appointments before the patient leaves the office.

• Remind patients about upcoming appointments and contact those who miss appointments.