Measles Case Confirmed in an Idaho Resident

Summary

A case of measles has been confirmed in a Latah County, Idaho resident. This is the first confirmed case in Idaho since 2001. In addition to the Idaho case, there are ongoing measles outbreaks in Washington, New York, Pennsylvania, Maryland, Georgia, California and Michigan.

Healthcare providers should consider measles in patients presenting with a febrile rash illness and clinically compatible symptoms, especially if the patient recently travelled internationally or to areas in the United States experiencing a measles outbreak.

Symptoms

Measles is a febrile rash illness. It is characterized by a prodrome of fever (as high as 105 degrees F), malaise, cough, coryza, conjunctivitis, and Koplik spots. These symptoms are followed 2-4 days later by a maculopapular rash, which begins, on the face and moves downward and outward to trunk and extremities. Immunocompromised patients may not exhibit rash, or they may exhibit an atypical rash. The incubation period for measles from exposure to fever is usually about 10 days (range, 7 to 12 days)
and from exposure to rash onset is usually 14 days (range, 7 to 21 days).

Lab Testing

Healthcare providers should obtain BOTH a serum sample and a swab for PCR when testing patients suspected to have measles, at first contact with the patient. Providers are encouraged to use the Idaho Testing Guidance to determine if lab testing for measles is appropriate (see Resources below for URL).

Specimens should include:

• 5ml blood in a red top or serum separator tube for Measles IgM and IgG testing
• Throat or nasopharyngeal swab in viral transport media for PCR

Serology should be processed through commercial laboratories.
The Idaho Bureau of Laboratories (IBL) can offer PCR testing on specimens from patients with compatible symptoms only. Specimens must be accompanied by both a Clinical Test Request Form and Supplementary Testing Form (see Resources below for URL).

Healthcare Infection Control

The measles virus is transmitted by direct contact with infectious respiratory droplets or by airborne spread when an infected person breathes, coughs, or sneezes. Measles virus can remain infectious in the air for up to two hours after an infected person leaves an area.

When possible, use phone triage and assessment to determine if patients who might have measles need to be seen in-person.

If a patient needs to be evaluated in-person or arrives unexpectedly with symptoms compatible with measles, follow these recommendations:

• Immediately mask the patient, and place them in a room with the door closed
• Perform the evaluation in a negative pressure room, if possible
• Regardless of presumptive immunity status, all healthcare staff entering the room should use respiratory protection consistent with airborne infection control precautions (N95 respirator or a PAPR – powered air-purifying respirator).
• After the patient leaves, the exam room door should remain closed and the room should not be used for at least two hours.
• Instruct the patient to self-isolate at home if measles is likely.
• If an exposure occurs in the healthcare setting, attempt to record contact information to facilitate infection prevention / public health follow-up.

Reporting

Please report suspect measles case-patients to Central District Health Department at
(208) 327-8625 or the Bureau of Communicable Disease and Prevention at (208) 334-5939. If reporting after hours or weekends, contact State Comm at 1-800-632-8000.

Additional Information

For CDHD’s Measles Resources for Healthcare Providers including laboratory test request forms and testing and infection prevention guidance, see here
For information about presumptive evidence of immunity, see http://www.cdc.gov/measles/hcp/index.html#immunity
For MMR vaccine recommendations, see https://www.cdc.gov/measles/hcp/index.html#vaccination
For detailed information about measles laboratory testing, see http://www.cdc.gov/measles/lab-tools/index.html