Q&A: What to know about the CDC’s measles alert
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Key takeaways:
- The CDC issued an alert to health care providers to be on the lookout for measles cases.
- An outbreak of nine cases in Philadelphia was linked to a daycare.
The CDC issued an alert to health care providers in the United States last week to be on the lookout for measles after receiving reports of 23 confirmed cases between Dec. 1 and Jan. 23.
The Philadelphia health department has reported nine confirmed cases in an ongoing measles outbreak linked to a daycare, although no new cases have been reported in 2 weeks. Elsewhere, the Washington, D.C., health department warned residents recently that someone with measles had traveled through two local airports.
Globally, cases of measles rose by nearly 20% and nearly 33 million children missed a measles vaccine dose in 2022, according to data reported by the CDC and WHO last fall.
WHO recently attributed the rapid rise of measles cases in Kazakhstan to unvaccinated children and warned of continued spread of measles in Europe, which reported more than 42,000 cases last year.
In the U.S., the CDC reported in November that routine vaccine coverage among kindergarteners fell from 95% to 93% as the number of vaccine exemptions climbed to an all-time high.
We checked in with three experts about the recent measles alerts and for advice on what clinicians should be looking for: Lori Handy, MD, MSCE, attending physician and associate director of the Vaccine Education Center at The Children’s Hospital of Philadelphia; Robert W. Frenck Jr., MD, director of the Vaccine Research Center at Cincinnati Children’s Hospital; and Anita K. Patel, MD, critical care specialist at Children’s National Hospital in Washington, D.C.
Healio: Are pediatricians aware of the CDC alert?
Frenck: The CDC and the AAP have programs to notify practitioners of disease outbreaks, including measles. I think most health care professionals are aware that, whenever vaccination rates drop, we are at risk of having outbreaks of measles.
Healio: What is the level of concern around the alert in Philadelphia?
Handy: Even before the CDC alert, health care providers and families within Philadelphia had a heightened level of concern for measles because the first case was identified in December. This CDC alert draws attention to the fact that the outbreak in Philadelphia is not an isolated phenomenon.
Although a rare, imported case in an international traveler is expected, spread within the U.S. population should be preventable when we maintain herd immunity — that is, vaccination levels around 95%. Many secondary cases are seen in individuals not vaccinated for measles, some of whom were eligible for vaccine but have declined vaccination.
Healio: Was there a level of concern around the alert in D.C.?
Patel: With any report of measles in our area, we have a high level of concern. Measles is not only extremely virulent, but one out of every five children who contract measles will be hospitalized; one out of every 20 children who contract measles will get pneumonia, the most common cause of death from measles in children; one out of every 1,000 will develop encephalitis, which can lead to intellectual disability and/or deafness; and one to three out of every 1,000 children will die from either respiratory or neurologic complications.
Healio: Are pediatricians’ offices and hospitals exercising caution when it comes to measles?
Frenck: Because infections are one of the leading reasons that parents seek medical attention for their children, pediatricians have a long history of trying to minimize risk of transmission of any infection in their offices.
Handy: Regionally, health care settings do have increased caution related to measles. Health care settings often increase messaging to families, create awareness through signs and communications and increase screening by phone or on arrival. Awareness by families is important because they can call ahead and have the health care setting prepare to safely evaluate the child in an isolation room.
Healio: What should physicians be on the lookout for?
Patel: The most important part of having a high level of suspicion for measles is a history of vaccinations and a good history of sick contacts and recent travel and locations visited. This will allow the physician to understand if measles is on the differential.
Handy: Physicians should be familiar with the presenting symptoms of measles, including the initial symptoms of cough, runny nose, conjunctivitis and high fever, followed within 3 to 5 days with a red rash that typically spreads from the hairline down the face and body. The order of appearance of rash is quite typical, and most children look miserable with the infection. Measles has many complications — ear infections, pneumonia, diarrhea, encephalitis, among others, so it’s a very scary infection to spread through a group of children.
Physicians should have a high index of suspicion in children who are unvaccinated and have had an exposure — for this reason, they should pay attention to local public health alerts that share locations of prior exposures so that they can review these with families. Physicians should also take the opportunity to recommend vaccination to anyone eligible in light of the increase in cases to keep their patients safe from infection. Two doses of vaccine is highly effective — around 97%, so it’s a highly reliable vaccine to receive.
Frenck: The rash goes away in the same order as it started. At the end of the infection, patients often have flaking/peeling of the skin.
Healio: What should providers do if they suspect a measles case?
Frenck: If a provider suspects a case of measles, they should immediately isolate the child from the other patients in the office. A diagnostic test should be performed, which is a PCR swab of the nose, similar to the technique done for COVID-19 testing. The provider also needs to contact the local health department so the case can be investigated. Also, the provider should obtain a history of measles vaccination in the family, and any unvaccinated person should be highly encouraged to be vaccinated.
Healio: What else would you like physicians and parents to know?
Patel: Measles is highly preventable with vaccines we have in our toolbox. If you have a suspected exposure and have not yet been vaccinated, contact your pediatrician immediately so they can determine if postexposure vaccination is indicated. Additionally, if you are traveling to a location that has suspected measles cases, pediatricians can administer the vaccine earlier than the normal vaccine schedule in certain circumstances. Please talk to your doctor before any travel to determine if this is an option for you.
Frenck: As is common, many of the cases in the current outbreak are from people who contracted the infection outside the U.S. It’s worth noting that these days people can get basically anywhere in the world in 24 hours or less and can contract measles, among other infections, and return to the United States before they know they are ill — which increases the likelihood of spreading the infection here. This is another reason why vaccination is so important.
Vaccines are over 95% effective in preventing people from getting the infection, and they are safe. The measles vaccines do not cause autism.
Handy: Measles is airborne, meaning that anyone who shares the airspace with someone who is infected is exposed. The virus can linger in the air for up to 2 hours, so people who move into that airspace after the infected person has left can also be exposed. It is so contagious that if 10 unvaccinated people were exposed, nine of them would develop infection.
Although measles in an occasional international traveler can occur, we can reduce spread within the United States by ensuring vaccination of all eligible people. Many families have questions about the vaccine and should talk with their health care providers as their primary source of information to understand the benefits of vaccination.
References:
CDC. Stay alert for measles cases. https://emergency.cdc.gov/newsletters/coca/2024/012524.html. Accessed Jan. 30, 2024.
City of Philadelphia. Health department update on measles outbreak – January 29. https://www.phila.gov/2024-01-30-health-department-update-on-measles-outbreak-january-29/. Accessed Jan. 30, 2024.
DC cautions residents of a potential measles exposure. https://dchealth.dc.gov/release/dc-cautions-residents-potential-measles-exposure. Published Jan. 16, 2024. Accessed Jan. 30, 2024.
Kazakhstan responds to rapid escalation of measles cases. https://www.who.int/europe/news/item/23-01-2024-kazakhstan-responds-to-rapid-escalation-of-measles-cases. Published Jan. 23 2024. Accessed Jan. 31, 2024.
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