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Measles

Measles Alert: Identifying and Managing Outbreaks Webinar

With measles cases on the rise, emergency medicine physicians must be prepared to quickly identify and manage potential outbreaks. This webinar will provide a comprehensive update on measles detection, clinical presentation, and best practices for rapid response in the emergency department.

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The CDC is tracking the outbreaks and updates their information weekly.

This virus represents a challenge to emergency medicine because it is highly infectious and rarely has been seen in emergency departments in the recent past.

ACEP's fact sheet about this disease provides a review of its presentation, clinical course and implications for your emergency department:

Get ACEP's Fact Sheet on Measles
  • Measles, one of the most contagious infectious diseases (infecting up to 90% of susceptible people who are exposed), is showing up in the United States, primarily in the unvaccinated and immunosuppressed.
  • If there is a case in the emergency department, it is likely that everyone in that area has been exposed.
  • High fever, conjunctivitis, cough and coryza (runny nose) often precede the characteristic rash. Koplik spots (a pathognomonic enanthem in the oral cavity) may or may not be visible.
  • Patients who present with possible measles should have a PCR test performed, and if immunosuppressed, they may be a candidate for immunoglobulin.
  • Though not common, patients may develop pneumonia or encephalitis, and deaths have been reported. Years later, a few patients may develop Subacute Sclerosing Panencephalitis (SSPE).

Re-vaccination for Emergency Physicians?

The CDC says there's no harm in getting another dose of the MMR vaccine even if you already may be immune to measles. The disease is one of the most contagious and as a health care professional in the ED, you may be exposed during the current outbreaks nationwide.
  • Those born before 1957 likely have natural immunity because of the then-prevalence of the disease
  • Those who received a LIVE measles vaccine do NOT need to be revaccinated (this is likely a majority of practicing emergency physicians)
  • Those who received an inactive/killed vaccine prior to 1968 SHOULD get revaccinated (esepcially those vaccined from 1964-1967)
  • Those who do not know which type of vaccine they received SHOULD get revaccinated
Read more from the CDC

What to do if you suspect a patient has measles:

  • Due to the high infectivity of this virus, potential measles patients must be immediately isolated and should not spend time in a general waiting area.
  • Rapid triage and movement of a suspected measles case to a designated isolation room or isolation area is essential.
  • Adhering to Standard and Airborne Precautions for patients with known or suspected measles.
  • Only allow health care workers with presumptive evidence of measles immunity attend the patient.
  • Use N-95 masks or respirators.
  • Evaluate the patient and order measles confirmatory testing (collect a throat or nasopharyngeal swab for RT-PCR and serum for IgM measles testing).
  • Contact infection control if it is available at your facility.
  • Immediately report this suspected case to your local and/or state health department.
  • For questions regarding specimen collection, storage, and shipment, please review CDC Laboratory Testing for Measles. 

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