Measles Redux FEBRUARY 26, 2015 Karen Holbrook, MD MPH Deputy Health Officer
What is Measles? Severe Viral Infection: Rubeola ~ 1 in 4 hospitalized ~ 1 in 20 pneumonia ~ 1 in 1,000 encephalitis ~ 1 or 2 in 1,000 die In 1950 s/early 1960 s every year: 3-4 million cases 48,000 hospitalizations 4,000 cases of encephalitis 400-500 deaths Common Symptoms Fever Runny nose Red eyes Cough Rash: face downward Treatment: Supportive Immunity: Develops after disease 2
Is Measles Contagious? Spread through the air when an infected person coughs or sneezes. Incubation period: 21 days -symptoms typically begin 8 to 12 days after exposure (day 0) and rash onset is typically14 days after exposure (range is 7 to 21 days) Contagious period: 4 days before and 4 days after rash onset Contact: someone who shares the same airspace with an infectious person Measles is very contagious. 9 out of 10 susceptible contacts will get measles. Measles Rₒ is 18. In the past, 98% of people got measles before age 20. 3
Measles Transmissibility Source: Adam Cole/NPR 4
Is Measles Preventable? The measles vaccine (MMR) is very effective. One dose: 95% Two doses: 97-99% Measles vaccine licensed in 1963. Two doses recommended in 1989. 1 st dose: age 12 to 15 months 2 nd dose: age 4 to 6 years By 2000, measles eliminated from US. 5
Measles in Sonoma County
Who In Sonoma is Susceptible? 7
Who Is at Risk for Severe Disease? Children < 5 Pregnant women Immune compromised individuals 8
What is Happening Now? Currently in CA:126 cases (as of Wed, February 25, 2015) 39 visited Disneyland between December 17 20, 2014 28 household or close contacts to a confirmed case 10 exposed in a community setting (e.g., ED) with known confirmed case present 47 with unknown exposure source but presumed linked based on combination of descriptive epidemiology or strain type. 2 cases with different genotype Geographic spread Hospitalized: 19% 57% age 20 years or older Most cases unvaccinated (~77%) Reasons: 60% PBE, 36% too young, 4% missed/alt schedule 9
Measles in the US 10
What is Health Department Doing? Following outbreak closely Informing clinicians Health Advisories Sharing Educational Opportunities Health Officer/ Deputy Health Officer 24/7 Conducting laboratory testing Informing schools Letter to Superintendents, Principals &template letter for Families Informing Pre-school/Day Cares/Early Learning Orgs Same as above Informing DHS employees & assessing Iz status All staff letter Cal-OSHA ATD standard trainings, assessments of Iz status and offering vaccinations through Occ Health Provider Media 11
What Happens When There Is a Case of Measles? Case is isolated until no longer infectious Review infectious period Contacts are identified Review definition of contact Immunity of contacts is determined Review criteria for immunity Susceptible contacts requested to stay home Review incubation period Susceptible contacts may be candidates for MMR Ig 12
What Should I Do? Check to see if you are immune Review criteria If you do not have documentation, get it Ask your parent Ask your health care provider For documentation For assessment: vaccinate or check serology (blood test for measles IgG) If you are not immune, get vaccinated Advisory Committee on Immunization Practices Sonoma County Health Advisory Cal OSHA Aerosol Transmissible Disease (ATD) Standard Share proof of immunity with your employer OR have it immediately available upon request 14
Health Advisory http://www.sonoma-county.org/health/announcements/index_provider.asp 15
Vaccination Recommendations? Vaccinate Susceptible Patients - Updated All patients born after 1956 should be vaccinated with 2 doses of MMR unless they have laboratory evidence of immunity by measles IgG. Due to the evolution of vaccination recommendations over time, some adults may have had only one dose of MMR. Currently the Advisory Committee on Immunization Practices (ACIP) recommends 2 doses of MMR for adults who are health care workers, international travelers, college or trade school students and adults who received measles vaccine of unknown type which was possible during 1963 through 1967. In addition, during times of increased risk of exposure, as is currently occurring in the Bay Area (although not specifically Sonoma County), Bay Area and California Health Officials encourage clinicians to provide a second dose of MMR vaccine to all adults previously vaccinated only once. Clinicians should prioritize second doses of vaccine for adults in the above categories and those who work or are present in settings where unimmunized persons may be or where persons at risk for severe disease may be (e.g., childcare, pre-school and school settings where infants or many unvaccinated children are present, events/venues with pregnant women and children < 2 years of age, events /venues with immunocompromised persons). Although the MMR vaccine is routinely given at 12 months of age and 4-6 years of age; infants traveling to countries where measles is circulating can be vaccinated as early as 6 months of age. For more information see: http://www.cdc.gov/vaccines/hcp/acip-recs/vacc-specific/mmr.html. 16
Questions
H&S codes Examination Order H&S 121365(a) Treatment Order H&S 121365(b) Directly Observed Therapy Order H&S 121365(c) Isolation Order H&S 121365(g) Exclusion Order H&S 121365(f) Detention for Isolation H&S 121365(d) Detention for Completion of Treatment H&S 121365(e) Additional Orders (specify) H&S 121365
MMR Adverse Reaction Fever Rash Joint pain/swelling Thrombocytopenia Parotitis Deafness Encephalopathy 5 15% 5% 25% <1/30,000 doses Rare Rare <1/1,000,000 doses
Measles in Sonoma County