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March 12, 2024
 In March 2024, the Chicago Department of Public Health (CDPH) reported several measles cases. Illinois had five cases in 2023, the first since 2019. Lake County currently has no cases, but we urge healthcare providers to prevent further spread of this highly contagious disease.
What You Need to Know
- There is no need to screen adult patients for measles immunity in non-outbreak areas due to high population immunity and low disease risk.
- Ensure your patient is vaccinated against measles before international travel to prevent acquisition abroad and transmission to susceptible individuals upon return.
- If a patient’s measles immunity is unknown before international travel, vaccinate unless contraindicated; avoid serologic testing.
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Consult Lake County Health Department for community-specific recommendations; report suspected cases to the Lake County Health Department, Communicable Disease program, at (847) 377-8130, option #1. If you cannot reach us, please call IDPH at (217) 782-2016.
- If you suspect measles, immediately place the patient in airborne isolation, and notify infection control. Please refer to CDC’s infection control guidance for measles.
- Post-exposure prophylaxis (MMR vaccine or immunoglobulin (IG)) may be indicated within a time-sensitive period for exposed individuals (close contacts) who are not immune, infants, pregnant, or immunocompromised.
Reporting a Suspected Case
We rely on your prompt reporting of suspected and confirmed cases to prevent the further spread of this contagious disease.
- Call our 24/7 reporting hotline at (847) 377-8130, selecting option #1, for the Lake County Health Department, Communicable Disease program. Our staff is available to assist with recommendations.
- Include in the report:
- Disease or condition clinical presentation
- Vaccination status (if known)
- Exposure history
- Patient's name, parents' name (if a minor), address, telephone number, e-mail address
- Date of birth and age
- Gender
- Physician's name, address, and telephone number
- Always adhere to proper airborne infection prevention measures. Notify the hospital infection preventionist immediately.
- Post-exposure prophylaxis (MMR vaccine or immunoglobulin) may be indicated within a time-sensitive period for exposed individuals who are not immune, infants, pregnant, or immunocompromised. Otherwise, staying home for up to 21 days may be indicated for those who attend, work, or live in congregate settings.
- Exposed healthcare personnel who are non-immune should be excluded from work from Day 5 of first day of exposure till day 21 from last (not first) day of exposure.
Signs and Symptoms
Measles is a highly contagious viral respiratory illness. Transmission occurs through respiratory droplets and contact with contaminated surfaces. Patients present with fever, malaise, cough, coryza, and conjunctivitis (the three "C"s) followed by a maculopapular rash and possibly Koplik spots appearing about 14 days post-exposure. Rash spreads from head to trunk to lower extremities. Patients are contagious from 4 days before to 4 days after rash onset, but immunocompromised patients may not develop rash.
Common complications include ear infections and diarrhea. Severe complications include hospitalization, pneumonia (most common cause of death in young children), encephalitis, complications during pregnancy, and death. People at high risk for severe illness include infants, young children under 5, adults over 20, pregnant women, and immunocompromised individuals.
Healthcare providers should consider measles in febrile rash illnesses, especially in recent travelers or those exposed to infected individuals, and report suspected cases to the Lake County Health Department Communicable Disease program at (847) 377-8130, option #1.
Diagnosis
Laboratory confirmation is crucial, involving measles-specific IgM antibody in serum AND measles RNA detection by RT-PCR in respiratory specimens. Both serum and throat/nasopharyngeal swabs should be obtained along with blood draw for serum. For rapid turnaround of results, contact the Lake County Health Department to coordinate shipment of specimens for PCR testing at the Illinois Department of Public Health (IDPH) lab. Molecular analysis can differentiate between wild-type measles infection and vaccine-related rash.
Vaccination is the Key to Prevention
The MMR vaccine is the primary defense against measles. Children receive their first dose between 12-15 months old and a second dose between 4-6 years old. If a child is younger than 12 months and traveling internationally or had exposure to a person with measles, MMR vaccine may be given at 6-11 months with follow up using the childhood vaccine schedule (2 additional doses). Unvaccinated teenagers and adults should promptly receive their vaccinations. Additionally, the MMRV (measles, mumps, rubella, and varicella) vaccine is available for children aged 12 months to 12 years. If a patient's measles immunity status is uncertain, healthcare providers should administer the MMR vaccine unless contraindications exist. Contraindications include severe allergic reactions to any vaccine component, pregnancy, and immunosuppression. Importantly, the MMR vaccine is safe for individuals previously vaccinated or with a history of prior disease.
Treatment
There is no specific antiviral therapy for measles. Medical care is supportive and helps relieve symptoms and address complications such as bacterial infections.
Isolation
Infected people should be isolated for four days after they develop a rash, and airborne precautions should be followed in healthcare settings. People with immunocompromising conditions with measles may require more prolonged isolation.
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