Increase in global and domestic measles cases and outbreaks
Michigan Department of Health and Human Services (MDHHS) Division of Immunization
Measles is an extremely contagious vaccine-preventable virus that spreads via coughing and sneezing and can survive in the air for up to two hours. According to Centers for Disease Control and Prevention (CDC), approximately 90% of people within close quarters of an infected individual will become infected themselves if they are not immune.1 Europe experienced a rise in measles cases in 2023 with over 30,000 cases reported by 40 of the 53 countries, including 21,000 hospitalizations. As of March 21, a total of 64 cases were reported by 17 states, including Michigan, in the United States.
The CDC has issued an official Health Advisory regarding the potential for measles cases related to international travel. Globally, measles cases are increasing, and measles is one of the most highly contagious airborne diseases seen among children and adolescents. Travelers are at risk of measles if they have not been fully vaccinated at least two weeks prior to departure or if they have not had measles in the past and travel to areas where measles is spreading. All international travelers, including infants 6–11 months of age and preschool-aged children, should be fully vaccinated against measles with the measles-mumps-rubella (MMR) vaccine according to CDC’s measles recommendations for international travel. Travelers should seek medical care if they develop a rash, high fever, cough, runny nose, or red, watery eyes. Travelers with suspected measles should notify the healthcare facility before visiting so staff can implement precautions to prevent spread within the facility.
As we continue to see cases trend upward, we want to remind clinicians and public health officials to provide guidance for measles prevention to international travelers and to be on alert for any suspected cases of measles. It is essential to obtain complete travel history from any patient presenting with symptoms consistent with measles (high fever, cough, coryza, rash). Providers should use the Michigan Care Improvement Registry (MCIR) and obtain MMR vaccination status for all patients. If the patient does not have a complete MCIR record, ask the patient about MMR vaccination status. Documentation of evidence of immunity will be necessary for cases requiring exclusion or precautions if they meet the contact criteria for a confirmed case. To reduce exposure in the healthcare setting, proper precautions should be taken. Appropriate specimen collection is key to rapid laboratory confirmation. Never miss an opportunity to offer vaccine. Ensure that all patients without other evidence of immunity, especially those planning international travel, are up to date on MMR vaccine and other recommended vaccines before their international travel.
Key pieces of epidemiological data to collect during a case investigation include (but are not limited to):
- Vaccination status, including number of doses and dates of administration.
- Transmission setting (e.g., household, school, health care setting, event).
- Source of infection (e.g., age, vaccination status, relationship to case, contact with probable or confirmed case, or contact with immigrants or travelers, or international travel).
- Import status (indigenous/endemic, international import, or out-of-state import, linked or traceable to an international importation).
- Travel history in the three weeks prior to symptom onset, including flight or maritime information.
- Date of return to the United States.
- Number of contacts.
For suspect or probable cases of measles, it is important to pursue both serologic and virologic testing. Specimens should be collected at the same time.
- Collect a throat swab (nasopharyngeal swab is an acceptable alternate) for polymerase chain reaction (PCR) up to seven days after rash onset and ideally within three days.
- Collect a serum specimen for antibody testing 3-30 days after rash onset.
PCR specimen is being run at MDHHS Bureau of Laboratories (BOL); any positive PCR specimen tested at commercial labs should be forwarded to BOL for additional genotyping. BOL is currently encouraging immunoglobulin M (IgM) serum specimen to be sent to commercial labs, or BOL will forward them to the CDC for testing. Immunoglobulin G (IgG) is being run at BOL. All specimens sent to MDHHS BOL for testing must be labeled with the patient’s first name, last name, date of birth, date of specimen collection, and specimen source. In addition, they must be sent in on cold packs and received by the laboratory within 48 hours of collection unless frozen. Detailed information regarding the collection and submission of specimens for measles or mumps testing at the BOL can be found within the A-Z Test Listing (michigan.gov).
For More Information
- International Travelers
- Healthcare and Public Health Professionals
References:
- Centers for Disease Control and Prevention (CDC). (2020, November 5). Measles Vaccination. Retrieved from Measles (Rubeola) | CDC.
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