FROM THE BENCH
The Public Health Laboratory Role in Response to Measles
By Michael A . Pentella , PhD , director , State Hygienic Laboratory at the University of Iowa system has the potential to delay that important communication .
3D illustration showing structure of measles virus with surface glycoprotein spikes heamagglutinin-neuraminidase and fusion protein . Photo : Dr . Microbe
Test options outside the public health laboratory also lack characterization support . Characterization testing of measles specimens by genotyping is critical as it is the only way to distinguish between wild type virus infection and a rash caused from recent measles vaccination . Additionally , genotyping is critical for epidemiologists to understand where cases may have been imported from and to link transmission pathways in an outbreak . These two situations further demonstrate the essential role public health laboratories play in measles testing and why close coordination between public health , clinical laboratories and physicians is needed .
Measles is a highly contagious viral disease that can have serious and even fatal consequences . According to Robert Kruse , MD , MPH , FAAFP , state medical director and division director for the Division of Public Health at Iowa Department of Health and Human Services , “ Urgent testing for measles is critical to quickly identify and isolate infected individuals , prevent outbreaks and protect the health of our communities .” Measles is so contagious that if one person has it , up to 90 % of the people close to that person who are not immune will also become infected . 1 Halting the spread of measles is a major task , which is why prompt test results and close coordination with a healthcare team are so crucial .
A Lost Opportunity
A 7-month-old baby traveled overseas and returned home to Iowa . When the signs and symptoms of measles appeared , the baby was taken to the pediatrician . While the physician suspected measles , instead of sending the sample to the public health laboratory it was sent to an out-of-state commercial laboratory as a routine diagnostic test . By the time the result was reported to public health , it was too late to provide vaccination or immunoglobulin to anyone exposed . In addition , the parents were not advised of how contagious measles is and there was some community exposure . In this instance , early communication with the state public health laboratory and epidemiologist would have led to quicker results and additional education of the parents , which could have impacted patient care and community exposure .
Building a Better Healthcare Team
Until recently , measles RNA detection was only available in public health laboratories . However , clinical and large commercial laboratories have begun offering measles through real-time polymerase chain reaction ( RT-PCR ) testing . While improved access to testing is important , rapid turnaround time , robust demographic data collection and close collaboration between the laboratory and epidemiologist is critical to limiting the spread of measles . Testing outside of the public health
It is essential for public health laboratories to communicate their role in responding to measles cases to physicians and clinical laboratories . While measles virus is , fortunately , rarely seen in the United States , a suspect case is a public health emergency and requires the action of a team to respond to the event . The healthcare provider , the epidemiologist , the clinical laboratory and the public health laboratory are critical members of the team to prevent the spread of measles in our communities . g
References :
1 . CDC . Transmission of measles ( website ). Available from https :// www . cdc . gov / measles / transmission . html .
6 LAB MATTERS Summer 2023
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