Measles exposure in La Crosse and Trempealeau Counties
On 4/21/18 the Wisconsin Immunization Program was notified that an individual from out of state with confirmed measles visited La Crosse and Trempealeau counties. The rash onset was 4/14/18 and the patient visited the Wisconsin counties April 13-16, 2018 which falls within the contagious period.
The individual visited the following establishments on the dates and times listed:
- Comfort Inn: 1223 Crossing Meadows Drive, Onalaska 4/13/2018-4/16/2018
-
Beedle's
Bar and Restaurant W24966 State Rd 5493 Galesville, WI 4/13/18
7:30 p.m. - 10:30 p.m.
- Dollar Tree: 2910 Market Place, Onalaska 4/14/2018
- St. Mary's Catholic Church: 20344 West Ridge Ave, Galesville 4/15/2018 from 10:00 a.m.-1:30 p.m.
- Fairfield Inn 434 3rd Street South, La Cross 4/15/19 6:30 p.m.-12:00 midnight
- Texas Roadhouse: 4310 WI-16, La Crosse 4/15/18 9:00 p.m.-11:15 p.m.
The La Crosse and Trempealeau county health departments are contacting the identified establishments to provide recommendations to their employees, and to obtain contacts lists of patrons who visited the establishments. The average interval between appearance of rash after being exposed is 14 days.
Local health departments (LHDs) and
tribal clinics should work with health care providers in their jurisdiction to
raise awareness about the disease and take immediate steps if there is a
suspected or confirmed case.
Please note that patients who may have been exposed to the contagious individual are past the 72 hour time frame for using MMR vaccine as prophylaxis. Patients who cannot demonstrate immunity should still be vaccinated to prevent future disease occurrence.
Reporting Measles Cases
All measles cases-suspected
or confirmed- must be reported to the Wisconsin Division of Public Health.
Measles is a Wisconsin Disease Surveillance Category I disease. Health care providers
who have patients with suspected or confirmed measles should report immediately
by telephone to the patient’s local health department. The local health
department shall then notify the state epidemiologist immediately calling 608-258-0099.
In addition to calling within 24 hours, LHDs should submit a complete case
report electronically through the Wisconsin Electronic Disease Surveillance System (WEDSS).
For additional details and reporting forms, please visit the Wisconsin Division of Public Health Measles’s webpage, under the tab labeled "For Healthcare Professionals."
Measles Symptoms
Symptoms include a rash with
flat, red spots and fever and cough or runny nose or watering/mattering eyes.
Symptoms appear about eight to 12 days after a person is exposed to measles.
The first symptom is usually fever and the rash usually appears two to three
days after the fever begins. The rash begins at the hairline, moves to the face
and upper neck, and then down the body. For photos of the rash, please
visit the CDC website (warning-some of the photos
may be disturbing to some viewers).
Measles can be a serious
disease that can lead to hospitalizations and even death, especially for immunocompromised
patients. Many people infected with measles have complications such as
diarrhea, ear infections, pneumonia or acute encephalitis. Measles during
pregnancy increases the risk of complications such as premature labor and
miscarriages. For additional information on symptoms or complications, please
visit the Centers for Disease Control and Prevention (CDC) website.
Measles Transmission
Measles is a highly
infectious virus that is spread when an infected person coughs or sneezes. The
virus can live for up to two hours in the airspace where the infected person
coughed or sneezed. Measles is so contagious that if one person has it, 90% of
the people close to that person who are not immune will also be infected. The
CDC website has additional information on measles transmission.
Specimen Collection and
Laboratory Testing
The Wisconsin State
Laboratory of Hygiene (WSLH) Measles Specimen and Laboratory Testing Customer
Service phone number is 1-800-862-1013.
For specimen collection, please use the following information:
Both specimens listed below
should be collected for testing on a symptomatic individual:
-
Combined
Throat and Nasopharyngeal Swab: As soon as measles is
suspected (preferably within the first 3 days of illness, but no later than 10
days after rash onset), collect a throat swab AND a nasopharyngeal swab, combined
in the same vial of virus transport medium. Synthetic swabs (e.g., Dacron) are
required for specimen collection. Do not use cotton or calcium alginate swabs
as they may be inhibitory to enzymes used in PCR. Place both swabs in a single
tube of virus transport medium is acceptable. Maintain specimen at refrigerator
temperature prior to and during transport. The test to order: PCR
-
Acute
Serum: As soon after onset as possible, collect 7-10 mL of blood in a red
top or serum separator tube (SST). Store specimens at refrigerator
temperatures. Transport at refrigerator temperatures using cool-packs. A repeat
serum specimen should be collected and tested if IgM serology testing is
negative for specimens collected within 72 hours of rash onset. The test to order: IgM serology.
WSLH typically does not test
over the weekend. The State Immunization Program can request testing be done if
it is determined to be critical for case surveillance. The local health
department should be in communication with the State regarding feasibility.
This is also dependent upon the specimen arriving in a timely manner which is
paramount to ensure timely testing.
Resources for patients and
the public
MMR vaccine: What you should know. A resource
for parents on routine MMR vaccine administration.
Parents and patients may
view their vaccine record through the Wisconsin Immunization Registry. For more
information, visit the Immunization Program website.
The Immunization Action
Coalition (IAC) has multiple language translations, of the
MMR and MMRV vaccine information statements.
The Wisconsin Immunization
Program recently updated the measles disease
fact sheet to be more visually appealing and uses patient-friendly
language. The fact sheet is available in Hmong and Spanish.
For parents/patients who
have concerns around the disproven idea that MMR vaccine causes autism, the
Autism Science foundation has information to help address parents’ concerns: http://autismsciencefoundation.org/
and the link to autism/immunizations page: http://autismsciencefoundation.org/what-is-autism/autism-and-vaccines/.
Action Steps for Clinicians
- Due to the large number of potential exposures, health care providers should be aware of and test for potential measles cases.
- Health
care providers should ensure that all personnel (including non-clinical
staff and volunteers) have documented immunity to measles.
- Immunity
for health care personnel consists of laboratory evidence of immunity or
vaccination with two doses of live measles vaccine. Birth before 1957 is
not considered acceptable proof for health care personnel.
- Reinforce
the importance of MMR vaccination by giving a strong recommendation to all
patients.
- Use
reminder/recall.
- Generate reports in the Wisconsin Immunization
Registry (WIR) or your electronic health record system to determine which
patients are due or overdue for MMR and reach out to them to schedule an
appointment for immunization.
- Do
not miss opportunities to vaccinate patients. Use every clinical encounter
to assess and offer MMR.
Place educational material in waiting and exam
rooms, or add a pre-recorded message to the phone system. The CDC has many
resources, such as MMR vaccine: What
you should know.
Thank you for your
attention to this matter. If you have any additional questions or concerns,
please visit the Wisconsin Immunization Program measles website or call your Regional Office
Staff (click on the grey tab).
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