User Tools

Site Tools


measles

measles

see also:

  • WARNING Jan 2014 Victoria
    • several cases in melbourne
    • immediately isolate and mask all patients with possible measles:
      • born after 1966
      • high fevers with cough and either conjunctivitis or rash

introduction

  • also called rubeola
  • measles virus (MV), a negative-sense enveloped RNA virus, is a member of the Morbillivirus genus in the Paramyxoviridae family.
  • measles is a highly communicable acute disease spread by airborne spread
  • incubation period from exposure to onset of symptoms ranges from 8-12 days
  • causes generalised immunosuppression which increases the risk of bacterial otitis media and bronchopneumonia.
  • 0.1% develop acute encephalitis
  • rarely, persistent measles infection may result some years later (mean 10.8 years) in subacute sclerosing panencephalitis (SSPE) which causes a chronic degenerative illness characterised by behavioral and intellectual deterioration, and seizures.
  • approximately 30 million measles cases are reported annually. Most reported cases are from Africa
  • measles caused an estimated 345,000 deaths worldwide in 2005 - 85% in Africa and South East Asia
  • at the end of 2005, with the partnership of several global organizations, over 217 million children were vaccinated worldwide, reducing the number of deaths by 75% in Africa.
  • highest fatality rates are among infants aged 4-12 months and in children who are immunocompromised because of human immunodeficiency virus (HIV / AIDS) infection or other causes
  • risk factors for severe disease and its complications:
    • malnutrition
    • underlying immunodeficiency (eg. HIV / AIDS)
    • pregnancy
    • vitamin A deficiency
  • measles-related mortality, most often due to respiratory and neurologic complications, occurs in 0.1-0.3% of reported US cases.

patients at risk or who may have measles in Australia

  • those at risk (born after 1966 without vaccination):
    • children or adults born during or after 1966 who do not have documented evidence of receiving two doses of a measles containing vaccine or documented evidence of laboratory confirmed measles are considered to be highly susceptible to measles.
  • clinical features:
    • high fever present at the time of rash onset
    • conjunctivitis, coryza, cough - onset usually precedes onset of rash by 3-7 days
    • Koplik’s spots - generally seen 2 days prior to the appearance of the rash and lasts until 2 days after the rash appears.
    • morbilliform (red blotchy) rash that generally begins on the face and spreads downwards before becoming generalised including palms/soles and lasts 5 days
      • desquamation and brown staining, which spares the palms and soles, may occur after one week
      • rash may be absent in patients with underlying deficiencies in cellular immunity
    • patients appear most ill during 1st 2 days of rash.
    • generalized lymphadenopathy, mild hepatomegaly, and appendicitis may occur because of generalized involvement of lymphoid tissue

Mx of suspected cases in ED

  • patients need nursing in respiratory isolation, preferably in a negative pressure room
  • be alert for new measles cases — make sure all staff, particularly triage nurses, have a high index of suspicion for patients presenting with a febrile rash illness, especially if associated with a preceding cough.
  • triage nurse should notify senior medical officer immediately a person with suspected measles presents to ED.
  • patient to don N95 mask and be triaged to with ATS urgency code 3
  • avoid keeping patients with a febrile rash illness in waiting areas.
  • isolate suspected cases within the department until a measles diagnosis can be excluded.
  • if possible, move patient to a negative pressure room ASAP
  • if no negative pressure room available, transfer to a consultation room where the door can be closed to limit airborne spread
    • this room should not be used for another patient until at least 2 hours after it has been vacated by the measles patient
  • only persons who have been vaccinated against measles and/or were born before 1966 should care for the patient
  • limit number of doctors and nursing staff involved with the patient
  • assess by ED doctor as soon as possible and then liaise with hospital's Infectious diseases unit
  • notify hospital Infection Control
  • take blood for serological confirmation.
  • send measles PCR nasopharyngeal swab and send to VIDRL marked as URGENT
  • notify suspected measles cases immediately to the Communicable Disease Prevention and Control Unit on telephone 1300 651 160.
  • if patient requires admission, admit to a ward with a negative pressure room
  • if patient is well enough may be discharged after d/w ID but to stay at home pending confirmation

post-exposure prophylaxis

  • seek advice from DHS regarding the management of susceptible contacts:
    • on DHS advice, follow up all persons attending the Emergency Department at the same time as a case and for two hours after the visit. These people are considered to be exposed to the measles virus.
    • to prevent measles in susceptible contacts give EITHER:
      • MMR
        • if within 72 hours of first contact with the patient, and no known prior vaccination or measles infection, and not pregnant and normal immunity and age > 9 months old
      • NIHG Immunoglobulin
        • 0.2ml/kg to max 15ml by deep IM; or 0.5ml/kg if impaired immunity to max 15ml
        • if either:
          • longer than 72 hours but within 7 days from contact
          • within 72hrs if never has had a measles vaccine and has not been given MMR
          • C/I to MMR such as:
            • pregnant, non-immune
            • age 6 to 9 months
            • age 0 to 5 months if mother non-immune or is the index case
            • impaired immune system
            • allergy
        • NB. MMR should not be given within 5 months of NIHG injection
  • check your staff vaccination records:
measles.txt · Last modified: 2018/12/23 05:02 by wh