Measles surrounds Iowa
May 18, 2010
The Iowa Department of Public Health reports that during April and May, Minnesota, Missouri and Nebraska have reported confirmed cases of measles. The most recent nearby case occurred in Nebraska with potential exposures occurring on May 6 and 7, 2010. On May 7, the patient, an unvaccinated 8-year-old, visited Henry Doorly Zoo in Omaha for the grand opening of the Madagascar exhibit while infectious. The child developed fever on May 7, cough and coryza on May 8; and conjunctivitis, photophobia, diarrhea, and rash on May 11. The child had traveled in Hawaii and California during the incubation period. Secondary cases are expected to have onset of illness between May 13 and May 25. (Letters are being sent to the parents of the groups of Iowa children who are known to have been at the Zoo at this time, thus potentially exposed).
Missouri reported on May 10 two cases of measles in southwest Missouri in one family who had recently traveled to Venezuela. The ill child had not been vaccinated for measles and the vaccination status of the ill adult is being investigated.
Minnesota reported an adult with measles in a Hennepin County man, who was potentially infectious between April 21 and 29. The man had traveled to Chicago during his incubation period where he was likely exposed to measles. His measles vaccination status is unknown.
Any individual suspected of having measles (generalized rash lasting greater than or equal to three days, temperature >101o Fahrenheit, and cough or coryza or conjunctivitis) or any fever in a person who has been recently exposed to measles, should:
- Have serology for IgM drawn immediately and sent to the University Hygienic Laboratory (testing is performed at no cost to the patient and on an emergency basis if approved by public health). The specimen and a completed specimen request form should be sent to UHL (request form available at www.uhl.uiowa.edu/kitsquotesforms/vdvbpcrrequestform.pdf).
- Be immediately reported to the Iowa Department of Public Health Department at 800-362-2736 (24 hours a day, 7 days a week) and the local health department. This is considered a public health emergency.
- Be told to go home and stay home until measles can be excluded from the diagnosis. This and other control activities should not be delayed pending the return of laboratory results from persons suspected of having measles.
Health care providers: Do not rule out the possibility of measles based on a history of measles immunization (measles vaccine is 99 percent effective, but measles can occur even in persons with two documented doses of MMR).
Patients with possible measles should be seen safely. Do not have these patients wait in waiting rooms and do not use examination rooms for three hours after a measles patient has left, since the virus can stay in the air for that time. Some health care providers elect to see patients while in their cars in parking lots. Note: In the first 72 hours after rash onset, up to 20 percent of tests for immunoglobulin M antibody (IgM) can be falsely negative; thus, these negative tests may need to be repeated (consult with public health).
Persons with measles are contagious from one to two days prior to onset of symptoms (about four days before rash onset) to four days after the appearance of the rash. The incubation period is 7 to 18 days, and averages 10 days to onset of fever and 14 days to the onset of rash.
To prevent measles, children (and some adults) should be vaccinated with two doses of the measles, mumps, and rubella (MMR) vaccine. Children should be given the first dose of MMR vaccine at 12 to 15 months of age. The second dose can be given four weeks later, but is usually given before the start of kindergarten at 4 to 6 years of age. "Recommended Immunization Schedules" can be obtained at: www.cdc.gov/vaccines/recs/schedules/default.htm.
For more information on measles, please visit www.idph.state.ia.us/adper/measles.asp