Be Alert for Measles in Louisiana

Measles (Rubeola) is a highly contagious febrile rash illness caused by a paramyxovirus transmitted via the respiratory route.  The incubation period averages 10-12 days, and 14 days from exposure to rash onset (range 7-18 days).  The prodrome generally lasts 2-4 days and is characterized by fever, increasing in stepwise fashion and often peaking at 103°-105°F. Fever is followed by the onset of one or more of cough, coryza, and/or conjunctivitis.  Koplik spots, if present, are considered to be pathognomonic for measles and appear as punctate blue-white spots on the bright red background of the buccal mucosa, occurring 1-2 days before the onset of the rash to 1-2 days afterwards.  The measles rash is a maculopapular eruption that begins at the hairline and gradually proceeds to face and upper neck and from there downwards and outward.  The maculapapular lesions are generally discreet, but may become confluent.  Other symptoms of measles may include anorexia, diarrhea (especially in infants), and generalized lymphadenopathy.  Common complications from measles can include otitis media, pneumonia, encephalitis, seizures and/ death.

The Centers for Disease Control and Prevention (CDC) recommends that infants aged 6-11 months should receive one (1) dose of MMR vaccine before departure from the United States for international travel.  These children should then be re-vaccinated with 2 (two) additional doses of MMR vaccine (first dose at age 12-15 months [12 months if the child is in an area where disease risk is high] and the second dose at least 4 weeks later.)  Students at post-high school educational institutions who do not have evidence of immunity against measles need 2 (two) doses of MMR vaccine, separated by at least 28 days. Adults who do not have evidence of immunity against measles should receive at least 1 (one) does of MMR vaccine. Healthcare personnel should have documented evidence of immunity against measles, according to the recommendations of the Advisory Committee on Immunization Practices. Healthcare personnel without evidence of immunity should receive two doses of MMR vaccine, separated by at least 28 days.

All healthcare facilities should ensure that they have updated documentation of immunity status for all staff.  Documentation of immunity status includes birth prior to 1957, written record of receipt of two MMRs, or positive serologic titers.

Additional information about measles can be found on the CDC’s website.

If you have a question on how to submit suspected measles specimens, please contact the Louisiana OPH Virology Laboratory at 504-219-4776.To report any suspected cases
of measles, please contact the DHH- OPH Immunization Program Office during working hours at 504-838-5300 or the Louisiana Epidemiology Hotline after hours at 1-800-256-2748.

By Louisiana statute, measles is to be reported immediately upon suspicion.

The clinical symptoms of measles are:

  • Fever of 101° or more;
  • Generalized maculopapular rash, usually beginning on the face and spreading to the trunk, with the presence of one or more of the following:
    • Cough
    • Coryza
    • Conjunctivitis

If a patient presents with any of these symptoms, take the following steps:

  1. Isolate the patient.  In a hospital setting, negative air pressure rooms are recommended.
  2. All visitors and staff working with the patient should use airborne precautions.
  3. Obtain diagnostic specimens.
  4. Report the patient to the health department.

Testing for confirmation may include the following:

  • Serology on a single specimen for IgM testing
  • Isolation and/or positive PCR of measles virus from a clinical specimen
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