To: Health Care Providers
From: Patsy Kelso, PhD, State Epidemiologist for Infectious Disease
Date: April 21, 2011
– Please Distribute Widely –
On April 14, the World Health Organization (WHO) posted information regarding the international increase in measles cases. To date in 2011, 24 countries in the European Region are experiencing large measles outbreaks that are spreading between countries and to other regions of the world. France has had the largest outbreak, with 3,749 measles cases officially reported in January and February 2011. This included eight people who suffered neurological complications, and one person who died due to measles-related pneumonia.
CDC reports that in January and February 2011, a total of 29 cases of measles were identified in the U.S. – 28 of these were associated with importation. As of April 9, 2011 there have been 42 cases reported for 2011, compared to a total of 61 cases reported in 2010. Outbreaks are currently occurring in Minnesota and Utah. In New England, cases have been reported in Massachusetts and Rhode Island. No cases of measles have been reported in Vermont since 2001.
Measles is a highly communicable viral respiratory disease that causes an estimated 10 million cases and 164,000 deaths worldwide each year. Due to widespread immunization starting in the late 1960s, measles was declared eliminated from the United States in 2000. Importation of measles from other countries still occurs. Lower rates of vaccine acceptance associated with parental concerns regarding the MMR vaccine allows for continued transmission of sporadic cases of measles. The greatest risk is for infants under 1 year of age, still too young to receive MMR immunization.
- Watch for possible cases of measles imported into Vermont
A suspected case of measles requires prompt public health intervention to decrease the risk of transmission. Measles presents with prodromal fever, cough, coryza and conjunctivitis. An erythematous maculopapulor rash appears on the third to seventh day, starting at the hairline and descending in a centrifugal pattern.
- Report suspect measles cases promptly to confirm diagnosis
Contact the Health Department’s Epidemiology Unit to report suspect cases and to arrange for measles testing available through the Vermont Department of Health Laboratory. Call 802-863-7240 (800-640-4374 in Vermont).
- Serologic testing is required to confirm measles diagnosis
Obtain 2 mL of serum when the patient presents for medical evaluation. If the specimen is collected < 3 days after rash onset, repeat testing may be requested if the IgM is negative. Vaccine status can affect results – please discuss with Epidemiology. Throat or nasopharyngeal swabs are generally the preferred sample for virus isolation or RT-PCR detection. A first void urine specimen for measles viral culture should also be obtained. Testing will be arranged through the CDC.
- Review immunization records for your patients
Make certain they have received age-appropriate vaccines. International travelers should also be urged to receive appropriate immunizations, including a measles-containing vaccine.
For questions related to this alert, call 802-863-7240 (800-640-4374 in Vermont).
For more information on measles, see: