COMMENTARY

Measles: Down but Definitely Not Out

Sandra Adamson Fryhofer, MD

Disclosures

May 28, 2014

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Editor's Note: On May 29, 2014, the Centers for Disease Control and Prevention announced that the number of measles cases in 2014, recorded through May 23, was the highest year-to-date total since 1994, creating a concern that the virus may become endemic again on US soil as it spreads from overseas travelers to pockets of vaccine refusers.

Hello. I'm Dr. Sandra Fryhofer. Welcome to Medicine Matters. The topic: Measles is making a comeback; outbreak warnings from the CDC[1] and a reminder in the Annals of Internal Medicine.[2] Here's why it matters.

Measles is a vaccine-preventable disease. Worldwide, there are about 20 million cases each year.[3] Before we had a vaccine, there were half a million measles cases, 500 deaths, and 48,000 hospitalizations in the United States each year.[4] Now we have a measles vaccine, and measles was deemed to be eliminated in the US in the year 2000, which brought US measles cases down to 60 each year.

But since 2010, the number started increasing to 155 cases a year. With recent measles outbreaks in New York City and California in the first 3 months of 2014, 106 cases of measles were already reported.

What does this mean? Some people are not getting vaccinated. Some parents are refusing to vaccinate their kids. Here's what we're forgetting: Measles is contagious. Very contagious. It's one of the most contagious infectious diseases. You get it from direct contact with infectious droplets, and because the virus can live up to 2 hours in an aerosol, you don't even have to have face-to-face contact with an infected person to become infected. The incubation period ranges from 7 to 21 days.

People with measles are sick: high fever, cough, coryza, conjunctivitis. Remember the pathognomonic Koplik spots. Patients with measles get a red, blotchy rash that begins on the face and spreads. The rash is easily confused with other viral exanthems, especially if you don't think about it. Febrile rash in a recent traveler should raise your suspicion. However, remember that patients are contagious 4 days before to 4 days after the rash appears. So wherever they are, they're spreading infection to those around them. These patients are sick, so they seek medical attention. They go to the doctor, your office, the emergency room.

If you suspect that a patient has measles, begin airborne precautions immediately. Get them out of the waiting room. Give the patient a surgical mask to wear. Put them in a private room.

Measles is making a comeback. Think about it. Tell your patients. Make sure your patients have been vaccinated and are protected. The CDC says all US residents born after 1956 should make sure they have received MMR vaccine or have serologic evidence of immunity.

For Medicine Matters, I'm Dr. Sandra Fryhofer.

Update from Dr. Fryhofer:
On May 29, 2014, the CDC announced 288 measles cases as of May 23, 2014, the highest year-to-date total since 1994. Most travel-related cases were linked to the Philippines and India. Nearly half of measles cases have occurred in an Amish community in Ohio that refuses vaccination because of religious and philosophical objections. The full details can be read online in an MMWR report.

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