Posted March 7, 2023. Past health advisories and alerts are archived for historical purposes and are not maintained or updated.
Summary
The Centers for Disease Control and Prevention (CDC) is issuing this Health Alert Network (HAN) Health Advisory to notify clinicians about a confirmed measles case at a large gathering. On February 24, 2023, the Kentucky Department for Public Health (KDPH) identified a confirmed case of measles in an unvaccinated individual with a history of recent international travel. While infectious, the individual attended a large religious gathering on February 17–18, 2023, at Asbury University in Wilmore, Kentucky. An estimated 20,000 people attended the gathering, and an undetermined number of these people may have been exposed. CDC recommends that clinicians be on alert for cases of measles that meet the case definition.
Background
Measles is a highly contagious, acute viral illness that begins with a prodrome of fever, cough, coryza (runny nose), and conjunctivitis (pink eye), lasting 2–4 days prior to rash onset. The rash typically occurs 3–5 days after symptoms begin and usually appears on the face and spreads downward. Measles can cause severe health complications, including pneumonia, encephalitis, and death. The virus is transmitted by direct contact with infectious droplets or by airborne spread when an infected person breathes, coughs, or sneezes. Measles virus can remain infectious in the air and on surfaces for up to two hours after an infected person leaves an area. Infected people are contagious from 4 days before the rash starts through 4 days afterwards. The incubation period for measles from exposure to fever is usually about 10 days (range, 7 to 12 days), and from exposure to rash onset is usually about 14 days (range, 7 to 21 days).
With declines in measles vaccination rates globally during the COVID-19 pandemic, measles outbreaks are occurring in all World Health Organization (WHO) Regions. Large outbreaks (≥20 reported measles cases per million population over a period of 12 months) have been reported in the European, African, Eastern Mediterranean, and Southeast Asian Regions. The United States has seen an increase in measles cases from 49 in 2021 to 121 in 2022, all among children who weren’t fully vaccinated, including outbreaks in Minnesota and Ohio.
Recommendations for Healthcare Professionals
- Consider measles as a diagnosis in anyone with a febrile illness and clinically compatible symptoms (e.g., rash, cough, coryza, or conjunctivitis) who:
- attended the Kentucky event during the exposure dates of February 17 or 18 or has had contact with an attendee.
- has recently traveled abroad, especially to countries with ongoing outbreaks.
- Immediately notify Spokane Regional Health District at 509-869-3133 about any suspected case of measles to ensure rapid testing and investigation.
- Recommend MMR vaccine for patients who are unvaccinated or not fully vaccinated.
- Do not allow patients with suspected measles to remain in the waiting room or other common areas of the healthcare facility; isolate patients with suspected measles immediately, ideally in a single-patient airborne infection isolation room (AIIR) if available.
- Follow CDC’s testing recommendations and collect either a nasopharyngeal swab, throat swab, or urine specimen for RT-PCR as well as a blood specimen for serology from all patients with clinical features compatible with measles.
- Contact SRHD at 509-869-3133 to coordinate testing of suspect cases through WA Public Health Laboratory.
- Collect the first (acute-phase) serum specimen (IgM and IgG) as soon as possible upon suspicion of measles disease. If the acute-phase serum specimen collected ≤3 days after rash onset is negative and the case has a negative result for real-time RT-PCR (rRT-PCR), or one was not done, a second serum specimen collected 3–10 days after symptom onset is recommended because the IgM response may not be detectable until 3 days after symptom onset.
- HCP should use respiratory protection (i.e., a respirator) regardless of presumptive evidence of immunity upon entry to the room or care area of a patient with known or suspected measles.
- Ensure all patients are up to date on MMR vaccine and other recommended vaccines.
- For people traveling abroad, CDC recommends that all U.S. residents older than 6 months be protected from measles and receive MMR vaccine, if needed, prior to departure.
- To potentially provide protection or modify the clinical course of disease among susceptible people, either administer MMR vaccine within 72 hours of initial measles exposure, or immunoglobulin (IG) within six days of exposure.
- For vaccine eligible people aged ≥12 months exposed to measles, administration of MMR vaccine is preferable to using IG, if administered within 72 hours of initial exposure.
- The following patient groups are at risk for severe disease and complications from measles and should receive IG: infants aged <12 months, pregnant women without evidence of measles immunity, and severely immunocompromised people. IG can be administered to other people who do not have evidence of measles immunity, but priority should be given to people exposed in settings with intense, prolonged, close contact (e.g., household, daycare, and classroom). Do not administer MMR vaccine and IG simultaneously, as this practice invalidates the vaccine.
Recommendations for the Public (including children) and Those Who Attended the Gathering
- If you attended the Asbury University gathering on February 17 or 18 and you are unvaccinated or not fully vaccinated against measles, you should quarantine for 21 days after your last exposure and monitor yourself for symptoms of measles so that you do not spread measles to others.
- If you attended the gathering and are not up to date on your measles vaccinations, talk to your healthcare provider right away about getting vaccinated after completing your quarantine.
- If you think that you have measles or have been exposed to someone with measles, isolate yourself from others and call your healthcare provider, urgent care, or emergency room before arriving to be tested. Do not arrive at a health care facility without giving advance notice.
- Measles is extremely contagious and can cause life-threatening illness. Anyone who is not protected against measles is at risk. An unvaccinated person can get measles when traveling abroad or in the U.S.
- Two doses of MMR vaccine provide better protection against measles than one dose.
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