Issue link: https://viewer.e-digitaledition.com/i/332636
ON APRIL 21, 2014, the Ohio Department of Health (ODH) w a s not i f ie d b y the Knox County Health Department about a suspected measles outbreak. The index case-patients were unvaccinated travelers returning from the Philippines, a country experiencing a large outbreak of measles. As of April 30, 2014, there are 30 confirmed measles cases in six Ohio counties (Ashland, Coshocton, Holmes, Knox, Richland, and Wayne). Since many healthcare providers have not seen a case of measles, the following information is provided as a reminder of the signs and symptoms of measles. This guidance was adapted from materials from the Centers for Disease Control and Prevention (CDC) and the Immunization Action Coalition. Key Information Measles is common in many parts of the world. (The Philippines is currently experiencing an explosive outbreak, but importations can occur after any interna- tional travel, including to Europe.) It can be misdiagnosed as other rash illnesses (e.g. Kawasaki Disease, Dengue). Given the recent increase in cases in Ohio, be on the lookout for measles. Prompt isolation of patients suspected of hav ing measles is critica l, a s a ny airborne exposure to a case (up to 2 hours after the infected person leaves an airspace) can result in transmission of measles. Viral specimens should be obtained on suspected case-patients (not just serology). Q How long does it take to show signs of measles after being exposed? A: It takes an average of 10–12 days (range 7–21 days) from expo- sure to the first symptom, which is usually fever. The measles rash doesn't usually appear until approxi- mately 14 days after exposure, two to three days after the fever begins. Q What are the symptoms of measles? A: Symptoms include fever, runny nose, cough, loss of appetite, conjunctivitis, and a rash. The rash usually lasts five to six days and begins at the hairline, moves to the face and upper neck, and proceeds down the body. Q How serious is measles? A: Measles can be a serious dis- ease, with 30 percent of reported cases experiencing one or more compli- cations. Death from measles occurs in two to three per 1,000 reported cases in the United States. Complications from measles are more common among very young children (younger than 5 years) and adults (older than 20 years). Q What lab testing should be done? A: Laboratory testing of suspect cases of measles is recommended. Both serology and respiratory samples (oro- pharyngeal, nasal, or nasopharyngeal) EXCERPTS FROM A LETTER BY MARY DIORIO, MD, MPH Q&A: Measles The measles rash on a toddler's face Koplik spots are small, white spots (often on a reddened background) that occur on the inside of the cheeks early in the course of measles PHOTOS COURTESY OF THE CDC PUBLIC HEALTH IMAGE LIBRARY ++++++++++++++++++++ + +++ + +++ ++++++++++++++++++++ FROM THE ODH 2 8 | Cleveland/Akron/Canton MD NEWS ■ M D N E W S . CO M ■ J U LY/AU G U S T 2 0 1 4