By now, we’ve all heard: Measles is back.
As of May 31, 2019, 7,981 cases of measles had been reported in the U.S in 26 states. Approximately 20% of these are in adults ≥20 years of age. In 1973, prior to the elimination of measles, it was generally considered a disease of childhood, with an incidence of 3% in adults.
Most clinicians practicing today have not seen a measles case in their training, simply because it was declared eliminated in the U.S. in the year 2000. That means there was no continuous disease transmission in this country for longer than 12 months. The current outbreak is due to either to foreign travelers bringing measles cases into the U.S. or from U.S. travelers to other countries bringing it back. These cases can quickly spread in communities with large pockets of unvaccinated individuals.
With the resurgence of a disease thought to be eliminated, healthcare providers are being challenged with how to treat the (still relatively rare) cases of measles they might encounter and how to educate and assuage those who may concerned about their risk of exposure or the strength of their immunity.
Adults and vaccinations
While most of the focus during this new measles “epidemic” has been on the risk to children, healthcare professionals are also fielding many questions from adults who are uncertain if vaccinations from their youth will continue to protect them from potential exposure.
The Centers for Disease Control and Prevention (CDC) provides an online FAQ to help answer measles vaccine questions. The standard immunization schedule for MMR is as follows:
- Children: First dose at 12 to 16 months
- Second dose at 4 to 6 years
- Catch-up schedule:
- Children: 2 doses ≥ 28 days apart
- Adults: If no evidence of immunity: 1 dose
Adults born before 1957 are considered immune because they likely contracted measles as a child, which afterwards confers life-long immunity. Adults born after 1957 who can verify they were properly immunized as children are also considered immune. There is no harm in getting a vaccine even if you are already immune.
Adults who are immunocompromised are at higher risk if exposed to measles. One of the most important things that can be done for immunocompromised patients is to ensure that their close contacts are vaccinated against measles to try to limit exposure. If an immunocompromised patient has been exposed, immune globulin is given to reduce the risk of infection and associated complications.
Symptoms of measles
With measles in the news, healthcare professionals may encounter a certain degree of fear from patients in areas where there has been outbreak. Measles is often difficult to recognize in its early stages, and since many clinicians haven’t encountered the disease before, it is important to be aware of the symptoms.
Prodrome symptoms, occurring 10 to 12 days after exposure, include fever, cough, and runny nose, all lasting 2 to 4 days. These also mimic many other common illnesses, which is why it has been difficult for patients and clinicians to recognize measles early.
The more identifiable rash on skin and mucous membranes start about 14 days after exposure, first presenting on the hairline and moving downward over the body over the next few days. The rash typically lasts 5 to 6 days.
Patients are contagious from the prodrome through a few days after rash starts.
What should clinicians and pharmacists do?
There is no treatment for measles. It is all supportive and comfort care.
Any exposed patient should be encouraged to call their physician, who can access their medical records and help determine if they are immune to measles or need other treatment. Instruct patients to avoid urgent care centers to help limit the spread of measles. However, emergency care should always be sought as appropriate. If symptoms are severe and patients need immediate medical attention, they should be encouraged to call prior to arrival so the medical center can be prepared to keep them away from other patients. Anyone who has been positively diagnosed with measles should be isolated and told to avoid public places.
Healthcare workers, teachers, or anyone in the public sphere who is likely to come in contact with patients with measles should be fully vaccinated. While washing hands and general hygiene measures should be taken, measles is airborne and easily transmissible. Healthcare workers who are exposed may also require immune globulin.
The best way to prevent measles is to immunize. Many people have a fear of vaccinating that is not rooted in legitimate medical science. Healthcare professionals should help dissuade people’s fear with education. It is important to have readily available easy-to-understand, evidence-based patient education materials on measles and the importance and safety of immunizations.
Darcie Streetman, PharmD, is a clinical pediatric pharmacist and Senior Clinical Editor for Neonatal and Pediatric Drug Information, Clinical Effectiveness, at Wolters Kluwer, Health. She attended Ohio Northern University, where she received her pharmacy degree. She then completed both a general practice residency and pediatric specialty residency at the University of Michigan.
