Recommendations for Providers in Response to Multi-State Measles Outbreak

On Jan. 26, the Pennsylvania Department of Health (DOH) forwarded a Centers for Disease Control and Prevention (CDC) alert on the U.S. multi-state measles outbreak to Pennsylvania physicians subscribed to receive alerts through its Pennsylvania Health Alert Network (PA-HAN). Read the DOH alert.

The CDC and several state health departments are investigating a multi-state measles outbreak associated with travel to Disneyland Resort Theme Parks, which includes Disneyland and Disney California Adventure.

The purpose of the alert was to notify public health departments and health care facilities about the outbreak and provide guidance to health care providers.  The alert said that providers should:

  • Ensure all patients are up to date on the MMR vaccine and other vaccines.
    • Children one through 12 years of age may receive MMRV vaccine for protection against measles, mumps, rubella, and varicella.
    • Infants who receive a dose of MMR vaccine before their first birthday should receive two more doses of the MMR vaccine, the first of which should be administered when the child is 12 through 15 months of age and the second at least 28 days later.
  • For those who travel abroad, the CDC recommends that all U.S. residents older than six months be protected from measles and receive the MMR vaccine, if needed, prior to departure.
    •  Infants six through 11 months old should receive one dose of the MMR vaccine before departure.
    • Children 12 months of age or older should have documentation of two doses of the MMR vaccine, separated by at least 28 days.
    • Teenagers and adults without evidence of measles immunity should have documentation of two appropriately spaced doses of the MMR vaccine. One of the following is considered evidence of measles immunity for international travelers: 1) birth before 1957, 2) documented administration of two doses of the live measles virus vaccine (MMR, MMRV, or measles vaccines), 3) laboratory (serologic) proof of immunity or laboratory confirmation of disease.
  • Consider measles as a diagnosis in anyone with a febrile rash illness and clinically compatible symptoms (cough, coryza, and/or conjunctivitis) who has recently traveled abroad or who has had contact with someone with a febrile rash illness. Immunocompromised patients may not exhibit rash or may exhibit an atypical rash. The incubation period for measles from exposure to fever is usually about 10 days (range, seven to 12 days) and from exposure to rash onset is usually 14 days (range, seven to 21 days).
  • Isolate suspect measles case-patients and immediately report cases to local health departments to ensure a prompt public health response.
  • Obtain specimens for testing, including viral specimens for confirmation and genotyping. Contact the local health department for assistance with submitting specimens for testing.

To receive alerts such as this from DOH, subscribe to the PA-HAN.

The Pennsylvania Medical Society (PAMED) will continue to keep its members informed. PAMED will be holding a media call-in on Tuesday, Feb. 3. Among the panelists will be PAMED President Karen Rizzo, MD; Rachel Levine, MD, the state’s new physician general; and John Goldman, MD, an infectious disease expert at PinnacleHealth in Harrisburg. Stay tuned for more information.