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Health Advisory: Measles Outbreaks in Israel,New York City and Surrounding Areas — Nov. 20, 2018
Situation:Currently there is an outbreak of measles in Israel with over 1,500 cases diagnosed. Outbreaks of measles are now occurring in Orthodox Jewish communities in New York City and several surrounding communities in New York and New Jersey. Some of these cases had recent travel to Israel. There are no confirmed cases in Snohomish County presently. Providers should suspect measles in any patient with fever and rash, especially if they had recent travel to Israel, New York City, or any surrounding communities in New York or New Jersey.
Measles Clinical Presentation:Measles symptoms usually begin 10-12 days (up to 21 days) after exposure with a prodrome of fever (up to 105ºF) for 2-4 days followed by cough, conjunctivitis, or runny nose, and a maculopapular rash typically moving from the hairline down to cover the entire body. The rash lasts 5-6 days or longer. Severe illness can occur including pneumonia, encephalitis, and death.
Transmission and InfectionControl:Virus is spread directly fromperson to person by inhalation of suspended respiratory droplet nuclei or wheninfectious nasopharyngeal secretions come into contact with the mucousmembranes of a susceptible person. Measles virus is sensitive to strong lightand drying, but remains infectious in aerosol form in air for approximately 2hours.
Measles is one of the mostcontagious of all infectious diseases, with >90% attack rates amongsusceptible close contacts. Suspect measles cases should not be allowed inpatient waiting areas. They should be masked and placed immediately in anexamination room, with the door closed. Patients with suspect measles should beseen at the end of the day and use a separate entrance if possible. Theexamination room should not be used for at least two hours after the patienthas left.
Suspected measles patients should not be referred to commercial labs or other departments/facilities for testing or other services. Coordinate specimen collection with the Snohomish Health District if appropriate media is not available or additional guidance is needed.
Prevention:Routine vaccination with twodoses of measles-containing vaccine is the safest and most effective way toprevent disease. MMR vaccine is 90% to 95% effective in preventing measles. Thebest way to protect patients from measles and to meet school immunizationrequirements is to ensure that children receive their first dose of MMRroutinely at age 12 months and their second dose at age 4 to 6 years. Ask abouttravel plans. Infants traveling internationally should be protected againstmeasles by receiving a first dose between age 6 to 11 months, but will requiretwo additional doses at 1 year and between 4 to 6 years.
Exposed non-immuneimmunocompetent individuals should receive the MMR vaccine ≤72 hours after first exposure as an immediate prevention measure (PEP). If MMR vaccine is not administered within 72 hours of exposure it should still be offered to provide protection from future exposures.
Exposednon-immune immunocompromised persons, infants ≤ 12 months, and others at highrisk of complications from measles can be protected with immune globulin ≤ 6 days after exposure. Clinicians may consider administering immune globulin to any suspected contact in accordance with Washington State Department of Health Guidelines.