Measles Outbreak—California, December 2014-February 2015
Zipprich J, Winter K, Hacker J, Xia D, Watt J, Harriman K
MMWR Morb Mortal Wkly Rep. 2015;64:1-2
Theme Park Measles Outbreak
The California Department of Public Health received its first notification about a suspected measles case on January 5, 2015. The index case was an unvaccinated 11-year-old child. Also on January 5, the California Department of Public Health received reports about four additional suspected measles cases, along with two reports from Utah; all of the persons had visited a California theme park complex during the period of December 17 through December 20, 2015. By February 11, 2015, there were 125 confirmed cases of measles in the United States, and 110 of those children (88%) were from California.
Approximately one third of the children had visited one of the theme parks, 31% were secondary cases, and 34% had measles from an unknown exposure. Of the secondary cases, 76% were household or close contacts of known cases. Eight additional children were exposed in community settings. Cases related to theme park exposure were found in seven other states; in addition, there was one case in Mexico and 10 cases in Canada.
Among the 110 children from California, 45% were not vaccinated, but 12 were infants and too young to be vaccinated. This meant that 34% of the California patients were unvaccinated but eligible for vaccine. An additional 5% had received only one dose of the vaccine. Two thirds of those eligible California children were unvaccinated owing to personal beliefs. Approximately 20% of the children for whom complete healthcare data could be verified were hospitalized.
Only a pediatric provider who had been on some sort of extended leave without electronic communication would find this article to be "news," but it is still very interesting to read the actual figures and appreciate the extent of the epidemic. It's worth noting that the United States experienced more confirmed measles cases in in 2014 (> 600) than in 2011-2013 combined. In fact, the yearly frequency of measles cases was generally < 100 and has only been in the range of 200 cases for 3 years, from 2001 to 2013. Obviously, the large California outbreak occurring so early in the year has raised concerns that 2015 will be another very active year for measles in the United States.
However, I chose this article to review the resources that have been put forth by various organizations to help pediatric primary care providers navigate this epidemic in the office. One of the first resources is the update on measles recommendations from the American Academy of Pediatrics 2015 Red Book. It updates the required evidence that can serve to document immunity to measles.
Two sections deal with options for postexposure prophylaxis. First, unvaccinated individuals should be given the measles vaccine within 72 hours of measles exposure, as postexposure prophylaxis to modify the disease course. Although infants aged 6-12 months may receive the vaccine as part of efforts to control outbreaks, they will still need to receive a dose at 12 months and another at 48 months or later. Individuals who cannot receive measles vaccine owing to immune issues can be given immune globulin within 6 days of exposure as postexposure prophylaxis.
There is a nice table (Table 3.38) in the Red Book update that lists measles vaccine recommendations for various scenarios, including unimmunized children, partially immunized children, and those with egg allergy, among others. It might be a good table to post on the wall in your office.
The Centers for Disease Control and Prevention (CDC) has an excellent Frequently Asked Questions page on measles and measles vaccination. There are photos of patients with measles and other very helpful clinical information at another CDC page on measles for providers. Finally, a patient information page was published by the JAMA network of journals.
I don't think we have heard the end of the public discussion about measles and measles vaccination the United States. In fact, I have quite honestly been surprised at the backlash directed at parents who choose not to vaccinate and practices that support delayed vaccinations. Although it is overdue that vaccine proponents are as vocal in the public discourse as are vaccine objectors, it is unfortunate that it required children contracting measles to get us to this point.
Medscape Pediatrics © 2015 WebMD, LLC
Cite this: William T. Basco. Measles: A One-Stop Shop of Resources for Pediatric PCPs - Medscape - Feb 23, 2015.