Category: International EM
Posted: 6/4/2014 by Walid Hammad, MD, MBChB
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General Information:
This year there have been over 280 cases of measles in the US, spanning 18 states; early recognition is key to preventing transmission.
Remember the 3 c's for recognition:
Cough, Coryza (runny nose), Conjunctivitis + febrile rash
-Incubation period is 10-12 days
-Symptoms usually start with fever, followed by rash 2-3 days later starting from the hairline and spreading to the trunk and extremities
-Completion of the first series of vaccines provides 90-95% immunity from measles
Relevance to the EM Physician:
-Immediately place any patient suspected of having measles on airborne precautions
-Look for koplik spots on the oral mucosa (commonly described as appearing like small grains of salt)
-Complications include diarrhea, otitis media, “measles croup,” pneumonia, encephalitis (1/1000 cases), and death (2-3/1000 cases)
-Post exposure prophylaxis (PEP) is recommended for unvaccinated exposed individuals and is effective up to 72 hours after exposure; however, vaccination is contraindicated in pregnant women
Bottom Line:
-The incidence of measles is rising sharply in the US. Vaccination, early detection, and post exposure prophylaxis for exposed individuals is key to reversing this trend.
University of Maryland Section of Global Emergency Health
Author: Bradford Schwartz, MD
1. CDC. Measles-January 1-May 23, 2014. MMWR 2014; 63;(1-4).
2. CDC. Prevention of Measles, Rubella, Congenital Rubella Syndrome, and Mumps, 2013: Summary Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 2013;62(RR04);1-34.
3. CDC. Measles Questions and answers. http://www.immunize.org/catg.d/p4209.pdf
4. CDC. Measles-Rubeola. http://www.cdc.gov/measles/index.html
5. Perry and Halsey. Clinical Significance of Measles: A Review. J Infect Dis. 2004 May 1;189 Suppl 1:S4-16.
