PUBLIC HEALTH
of our most effective vaccines. Measles infects up to 90% of unvacci-
nated people who are exposed to an infected person according to the
CDC. In an unvaccinated population, one person with measles can
infect 12 to 18 others. The CDC estimates that two doses of MMR
vaccine are about 97% effective at preventing measles and one dose
is about 93% effective.
Let’s briefly examine measles outbreaks in the US over the past
few years.
·
2018: The US experienced 17 outbreaks. Three outbreaks
in New York State, New York City, and New Jersey respec-
tively, contributed to most of the cases. Cases in those
states occurred primarily among unvaccinated people
in Orthodox Jewish communities. These outbreaks were
associated with travelers who brought measles back from
Israel, where a large outbreak continues. Eighty-two people
brought measles to the US from other countries in 2018.
This is the greatest number of imported cases since measles
was eliminated from the US in 2000.
· 2017: A 75-case outbreak was reported in Minnesota in
a Somali-American community with poor vaccination
coverage.
· 2015: The United States experienced a 147-case multi-state
measles outbreak linked to Disneyland in California. It
is believed that the outbreak started from a traveler who
became infected overseas with measles, then visited the
amusement park while infectious; however, no source
was identified. Analysis by CDC scientists showed that
the measles virus type in this outbreak (B3) was identical
to the virus type that caused the large measles outbreak
in the Philippines in 2014.
·
2014: The US experienced 23 measles outbreaks, includ-
ing one large outbreak of 383 cases occurring primarily
among unvaccinated Amish communities in Ohio. Many
of the cases in the US in 2014 were associated with cases
brought in from the Philippines, which experienced a large
measles outbreak.
Before the measles vaccination program began in the US in
1963, an estimated 3 to 4 million people got measles each year,
48,000 were hospitalized, 1,000 developed encephalitis and 500
died. Measles is a highly contagious disease, easily spread through
respiratory droplets either by direct contact or from aerosolization
with breathing, coughing and sneezing. The virus can remain in the
air for up to two hours after an infectious person leaves an area.
Measles can be deadly, particularly in children; two to three out of
every 1,000 people infected will die from measles. Encephalitis and
subacute sclerosing panencephalitis (SSPE) can also result. Please
consider a measles diagnosis in patients presenting with febrile rash
or other clinically compatible measles symptoms, especially if the
person recently traveled internationally or was exposed to a person
with febrile rash illness. Please also report suspected measles cases
to the Louisville Metro Department of Public Health and Wellness
within 24 hours.
Physicians can do much to reverse this trend of totally unnec-
essary measles transmission. Please consider the following:
1. Discuss the importance of MMR vaccine with parents.
Listen and respond to parents’ questions. When parents
have questions, it does not necessarily mean they won’t
accept vaccines. Sometimes they simply want your answers
to their questions.
2. Make sure all your patients are up to date on MMR vaccine.
Ask patients about their immunization history and rec-
ommend MMR vaccine to unvaccinated patients without
contraindications.
3. Consider measles in patients presenting with febrile rash
illness and clinically compatible measles symptoms (cough,
coryza and conjunctivitis), and ask patients about recent
travel internationally or to domestic venues frequented
by international travelers, as well as a history of measles
exposures in their communities.
4. Educate frontline staff to ask about rash or other symptoms
that might suggest infection, and ensure appropriate pre-
cautions are in place to prevent exposure to other patients
and health care facility staff in clinics and emergency
rooms.
5. Per 902 KAR 2:020, report cases of suspected or confirmed
measles immediately by phone to the Louisville Metro
Department of Public Health and Wellness at (502) 574-
6677 or FAX Epid 200 reports to (502) 574-5865. The Epid
200 form can be found at: https://louisvilleky.gov/sites/
default/files/health_and_wellness/communicable_disease/
epid_200_kentucky_reportable_disease_form.pdf
The Louisville Metro Department of Public Health communi-
cable disease staff is available to assist you with any questions you
may have. A team member is available at (502) 574-6677.
Thank you in advance for helping to protect our community
through early recognition and reporting of any suspected or con-
firmed measles cases you encounter.
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MAY 2019
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