By Kaylyn Wayman, ARNP
Given recent measles cases in Washington, we at Summit Pacific Medical Center thought it would be helpful to provide a brief overview on preventative measures as well as warning signs to be aware of as measles is a highly contagious disease.
Background: Rubeola, or more commonly known as measles, is an acute respiratory viral illness. In 2000, measles was declared eliminated in the United States. Recently since 2014, measles has been on the rise as vaccination rates continue to decline in areas across the United States.
What to look for:
Stage 1: Measles signs and symptoms generally appear about 10-14 days after an exposure. Patients are generally contagious from 5 days before a rash to 4 days after.
Stage 2: Stage 2 of the illness generally lasts 2-4 days (can persist up to 8) and include; fever (up to 104 degrees F), decreased appetite, inflammation and draining of the eyes (conjunctivitis), as well as a runny nose & cough.
Stage 3: Approximately 2-4 days after onset of fever a red, bumpy rash appears. The rash usually begins on the face and spreads downward. The palms and soles of the feet will rarely be involved.
Stage 4: Recovery of symptoms normally follows with resolution of the rash and fever. However, a cough may persist up to two weeks after rash has cleared.
Patients at highest risk for contracting measles are those that have not been immunized with the Measles, Mumps & Rubella (MMR) vaccine series. The first MMR vaccine dose is normally given at 12-15 months followed by the second dose at 4-6yrs. However, the MMR vaccine series can be initiated at any age.
The diagnosis of measles is not based on the rash, symptoms, fever, or physical findings but requires confirmation tests. The Center for Disease Control (CDC) recommends antibody blood tests (Rubeola IgG and IgM) and a viral nasal-pharyngeal swab to confirm the diagnosis of measles. If your provider suspects measles you can anticipate these labs to be ordered.
The Rubeola IgG and IgM are blood samples that can help distinguish immunity vs. active infection. The nasal-pharyngeal swab can be useful in distinguishing active disease in the first 1-3 days of the onset of rash.
Unfortunately, these tests can take up to 3-7 days to complete. While awaiting results, it is important to keep the patient isolated to limit the potential spread of measles to others, including vulnerable populations (immunocompromised & unvaccinated patients).
Treatment: There is no specific treatment or medication for the measles virus. Some recommendations for supportive care include high doses of Vitamin A (consult your provider). It is most important that patients be kept isolated, well hydrated, and fever managed with antipyretic medications (acetaminophen and/or ibuprofen).
Prevention: Vaccination is the most effective in prevention of the measles.
Major Complications: Measles can be a very serious disease that can lead to hospitalization or even death in some patients. If patients develop uncontrolled fever, difficulty breathing, or confusion it is important that they are seen by a healthcare provider as soon as possible.
For more information about measles please visit these sites: