All reports of suspected measles cases should be investigated immediately. In the measles post-elimination era, a single case of measles is considered a public health priority that requires rapid evaluation for likelihood of measles and appropriate public health response. Extra effort by public health departments is required to ensure that appropriate and timely diagnosis of rash illnesses and reporting of suspected cases continues in order to prevent outbreaks and re-establishment of endemic disease transmission.
Prompt recognition, reporting, and investigation of measles is important because the spread of the disease can be limited with early case identification and public health response including vaccination and quarantine of susceptible contacts without presumptive evidence of immunity.
As measles continues to be endemic in many regions of the world, importation (exposure outside of the United States) of measles occur every year in the United States. Each imported measles case could result in transmission of measles to susceptible individuals if exposed. Surveillance and prompt investigation of cases and their susceptible contacts help to halt the spread of disease.
Establish a diagnosis
Suspected cases of measles should have laboratory confirmation. Efforts should be made to obtain clinical specimens for viral testing. Health care providers should maintain a high index of suspicion for measles in clinically compatible cases, especially among unvaccinated persons and among persons who recently traveled abroad or who have had contact with persons such as travelers or international visitors. In addition, not every sporadic measles case is linked to a known importation, so cases that raise high suspicion of measles, irrespective of associated risk factors, should be investigated for measles unless an alternative diagnosis is likely.
Obtain accurate and complete immunization histories
Measles case investigations should include complete immunization histories that document all doses of measles-containing vaccine. Acceptable proof of vaccination is documented administration of live measles virus-containing vaccine. Written or electronic records with dates of vaccine administration are the only acceptable evidence of vaccination.
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Identify the source of infection
Efforts should be made to identify the source of infection for every confirmed case of measles. Case-patients or their caregivers should be asked about contact with other known cases. When no history of contact with a known case can be found, opportunities for exposure to unknown cases should be sought. Such exposures may occur in schools (especially high schools with foreign exchange students), during air travel, through other contact with foreign visitors, while visiting tourist locations (casinos, resorts, theme parks), in healthcare settings, or in churches.
Assess potential for transmission and identify contacts without presumptive evidence of immunity
In the event of a confirmed measles case, local or state health departments should contact health care providers in their areas to inform them of the confirmed case and request immediate reporting of any suspected cases. Previously unreported cases may be identified by reviewing emergency room logs, electronic medical records, or laboratory records.
Presumptive Evidence of Immunity
Acceptable presumptive evidence of measles immunity includes at least one of the following:
- written documentation of adequate vaccination: receipt of one or more doses of a measles-containing vaccine administered on or after the first birthday for preschool-age children and adults not at high risk, and two doses of measles-containing vaccine for school-age children and adults at high risk for exposure transmission (i.e., health care personnel, international travelers, and students at post-high school educational institutions)
- laboratory evidence of immunity
- birth before 1957
- laboratory confirmation of disease
Source:
https://www.cdc.gov/vaccines/pubs/surv-manual/chpt07-measles.html
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