Stay alert for measles cases
Between December 1, 2023 and January 23, 2024, the Centers for Disease Control and Prevention (CDC) was notified of 23 confirmed U.S. cases of measles, including seven direct importations of measles by international travelers and two outbreaks with more than five cases each. Most of these cases were among children and adolescents who had not received a measles-containing vaccine (MMR or MMRV), even if age eligible. In Washington State, Clark County Public Health (CCPH) and Wahkiakum County Health and Human Services are investigating six confirmed cases of measles among unvaccinated adults. CCPH is not aware of any public exposures for these confirmed cases. However, out of an abundance of caution, health officers are alerting providers to the presence of measles in Southwest Washington and asking providers to consider measles in patients who present with compatible symptoms.
What can you do?
- Consider measles infection in patients with compatible symptoms, including:
- Prodrome of fever, cough, coryza and conjunctivitis for 2-4 days.
- Generalized maculopapular rash that usually begins on the face at the hairline and then spreads to the neck, trunk, and extremities.
- Koplik spots may appear on buccal mucosa 1-2 days prior to rash.
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Be prepared for possible measles cases at your facility:
- Patients with suspected measles should wear a mask covering the nose, mouth and chin that fits tightly with no gaps.
- In urgent/emergency healthcare settings:
- Suspected patients should be triaged immediately away from waiting rooms
- Room patient in airborne isolation if available
- In outpatient clinic settings:
- Schedule suspected patients to be seen at end of day, if possible, and keep them out of waiting rooms.
- Use standard and airborne infection control precautions.
- Only staff with documented immunity to measles should enter patient’s room.
- After patient is discharged, do not use or have staff enter the room for 2 hours.
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Assess immunization status of patients at every visit and strongly recommend vaccination based on recommended schedule, health condition, occupation, and other risk factors such as travel; Under-vaccinated individuals may be at risk for measles infection due to outbreaks that occur in the US or anywhere else in the world.
- Report suspected cases of measles to Public Health at (206) 296-4774 immediately before discharging or transferring patients.
Read the full PHSKC Healthcare Advisory, including information on testing.
Increased supply of RSV immunization to protect babies: updated guidance for healthcare providers
Nirsevimab (Beyfortus) is an RSV antibody immunization recommended for preventing severe RSV in infants and some young children. Supply of nirsevimab was limited earlier in the season, and the CDC provided guidance to healthcare providers on how to prioritize the limited supply. But with recent increases in supply, the CDC now advises healthcare providers to return to recommendations put forward by the CDC and the Advisory Committee on Immunization Practices (ACIP) on the use of nirsevimab. Most infants whose birth parent received an RSV vaccine do not need to also get nirsevimab. Infants and children recommended to receive nirsevimab should be immunized as quickly as possible.
RSV antibody immunization is recommended for:
- All infants younger than 8 months of age born during RSV season or entering their first RSV season. Except in rare circumstances, most infants younger than 8 months of age do not need nirsevimab if they were born 14 or more days after their birth parent got RSV vaccine.
- Some children aged 8 through 19 months who are at increased risk for severe RSV and entering their second RSV season.
Neither RSV vaccine (Pfizer Abrysvo, GSK Arexvy) is approved for use in infants or young children. Healthcare providers should take care to use the correct product for the correct population.
Although supply of nirsevimab is expected to increase, availability may continue to vary locally and by healthcare facility. Healthcare providers with limited supply should prioritize nirsevimab for infants at highest risk for severe RSV disease using the following principles: first by high-risk conditions and then by age, prioritizing the youngest infants first.
Read more here.
Additional doses of nirsevimab remain available for ordering in WAIIS. All providers should have the RSV order set available in the IIS and have the ability to place orders. DOH reviews and approves orders every week and accepts orders until 11:00 AM on Wednesdays. Ordering will remain open so long as product is available. Use the vaccine advertisement tool in the WAIIS to advertise doses you aren't using, or to search for available doses for transfer.
Learn more: RSV and Nirsevimab Recommendations Webinar
- 12:00 - 1:00 PM PT Thursday, February 1, 2024
- Hosted by DOH
- Register here
Abrysvo recommended for pregnant people from September through January
The Advisory Committee on Immunization Practices (ACIP) recommends Abrysvo RSV vaccine for pregnant people during September–January in most states. The Childhood Vaccine Program (serving those under 19) will follow the ACIP recommendations and will no longer offer Abrysvo for pregnant teens in Washington State after January 31, 2024.
According to the CDC, Abrysvo vaccination can be considered valid if given inadvertently to a pregnant person after January 31, though insurance coverage may vary.
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Pregnant people 32 through 36 weeks gestation should receive RSV vaccination through January.
- Pfizer Abrysvo is the only RSV vaccine recommended for use in pregnant people. GSK Arexvy is not recommended for use in pregnant people.
- Except in rare circumstances, most infants younger than 8 months of age do not need nirsevimab if they were born 14 or more days after their mother got RSV vaccine.
RSV and Nirsevimab administration errors
RSV immunization products provide invaluable protection for infants. However, it is important to be aware of vaccination errors that are more likely because three different RSV products were brought to market at the same time. These include:
- Error: pregnant person receives Arexvy RSV vaccine instead of Abrysvo.
- Arexvy has not been authorized for use in pregnant people.
- Do not give Abrysvo.
- Infant should receive nirsevimab shortly before or during their first RSV season (age less than 8 months).
- Error: Arexvy or Abrysvo is given to an infant instead of nirsevimab.
- The infant should receive nirsevimab as soon as the error is identified (no minimum interval), but it could be reasonable to consider waiting 48 to 72 hours between administration of the vaccine and nirsevimab.
- If both products are administered within 72 hours, doses should be given in different anatomical sites.
- Error: an infant weighing less than 5kg receives a 50mg nirsevimab dose, rather than the recommended 100mg dose.
- Follow-up dose of 50mg should be given, regardless of interval from the lower-than-recommended dose.
- Please note: this is different from the general ACIP recommendation, which advises that a full dose be repeated if more than one day passes from the error.
Health care providers are encouraged to report these administration errors to VAERS even if there is no adverse health event related to the error. Inform the recipient of the error, determine how the error occurred, and implement strategies to prevent it from happening again.
Resources
Order laminated 2024 immunization schedules
On January 11, CDC published two articles in MMWR summarizing the 2024 revisions to the U.S. immunization schedules:
The updated schedules include multiple made by ACIP during 2023. Download a copy of the full-color, 15-page PDF of the child/adolescent schedule.
The updated schedules for adults include multiple new vaccine recommendations for adults made by ACIP during 2023. Download a copy of the full-color, 13-page PDF of the adult schedule.
Laminated Schedules Available for Order
Sturdy, laminated versions of the 2024 U.S. child and adolescent immunization schedule and the 2024 U.S. adult immunization schedule are now available for order in the Immunize.org shop. The schedules are being printed now and will ship by early February.
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