Measles Case in New Mexico -- Surveillance for Secondary Cases

8/7/2019 Measles Case in New Mexico -- Surveillance for Secondary Cases

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!!! NM Dept of Health General Notification Message !!! Message ID

1454 Sent 3/3/2011 2:59:17 PM Mountain Time

NEW MEXICO HEALTH ALERT NETWORK (HAN)

[email protected]

SUBJECT: Measles Case in New Mexico -- Surveillance for Secondary Cases

Status: Actual

Message Type: Alert

Message ID(s): 1454

Severity: Moderate

Sensitivity: Not Sensitive - Distribute Freely

Delivery Time: 1 Hour

Acknowledge: No

Originating Agency: NM Dept. of Health (NMDOH)

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TO: Infection preventionists; hospital contacts; physicians;

physician assistants; Doctors of Oriental Medicine; nurses; primary

and urgent care, student health, occupational medicine, and long-term

care contacts; tribal Community Health Representatives; Indian Health

Service contacts; border/bioenvironmental/environmental/public health

contacts; county/local/tribal/military emergency managers.

FROM: NMDOH

==============================================

Summary:

This is an measles alert from the New Mexico Department of Health's

Epidemiology and Response Division and Public Health Division. It

includes information on surveillance for secondary measles cases.

==============================================

Detailed Message:

An adult from Santa Fe County has been diagnosed with

laboratory-confirmed measles after returning from travel

overseas. This individual likely exposed others during her

infectious period while traveling on Southwest Airlines flight 2605

from Denver to Albuquerque on February 22, 2011 and while seeking

medical care at two facilities in Santa Fe and Rio Arriba

Counties. Both facilities have been notified of potential

exposures. The patient's period of communicability in New Mexico

included Feb 23-24, 2011. Secondary cases resulting from exposure to

this case would be expected to develop signs and symptoms of illness

March 2-17, 2011. This notice provides you with background

information about measles, potential exposures and to ask for your

help in the early identification of any secondary cases. All

suspected cases of measles should be immediately reported to New

Mexico Department of Health Epidemiology and Response Division at 505-827-0006.

SUSPECT CASES OF MEASLES NEED TO BE ISOLATED AT HOME OR IN A MEDICAL

FACILITY. ANY CLOSE CONTACTS SHOULD BE VACCINATED AGAINST MEASLES OR

HAVE HAD MEASLES.

SURVEILLANCE FOR SECONDARY CASES

Secondary cases resulting from exposure to this case would be

expected to develop signs and symptoms of illness March 2-17,

2011. A patient with potential exposure to the index measles case

and with signs and symptoms of measles should be evaluated away from

other patients to prevent exposure and appropriate diagnostic

specimens drawn for testing.

Laboratory tests should be restricted to patients most likely to have

measles, i.e., those with fever and generalized maculopapular

rash. Testing of suspect measles cases should be coordinated with

the NMDOH epidemiologist on call at 505-827-0006.



PLEASE BE SURE TO USE APPROPRIATE VIRAL SWABS AND VIRAL TRANSPORT MEDIA.

Serology:

- A serologic test for IgM antibody to measles virus in a single

serum specimen is the recommended method for diagnosing acute

measles, though measles-specific IgM antibodies may not be detectable

until 3-4 days after rash onset. A second serum specimen may need to

be taken if the first specimen is negative and was taken before day 4

of the rash.

- When a patient suspected of having measles has been recentlyvaccinated (6-45 days prior to blood collection), neither IgM nor IgG

antibody responses can distinguish between measles disease and the

response to vaccination.

- If serum can be delivered to the NMDOH Scientific Laboratory

Division (SLD) within 4 hours of being drawn in can be sent in

refrigerated on ice packs. Otherwise, collect specimen by drawing

blood a double gel serum separator tube that does not contain

preservatives. After allowing clot to form, centrifuge specimen,

transfer serum to a sterile container. Specimen must be frozen at

-20 degrees C (-4 degrees F) and shipped on dry ice.

Virus detection:

- It is important to collect viral specimens if the person

suspected of having measles has been exposed to a confirmed measlescase or is part of an outbreak.

- Throat or nasopharyngeal swabs are generally the preferred

sample for virus isolation. Urine samples may also contain virus and

when feasible to do so, collection of both respiratory and urine

samples can increase the likelihood of detecting virus. Collect

samples as soon after rash as possible. The samples should be

collected at the first contact with a suspected case of measles when

the serum sample for diagnosis is drawn.

- Measles virus isolation is most successful when samples are

collected on the first day of rash through 3 days following onset of

rash; however, it is possible to detect virus up to day 7 following rash onset.

- Specimens for viral culture must be refrigerated and received

at the NMDOH Scientific Laboratory Division (SLD) within 3 days ofcollection. Specimens should be shipped to the NMDOH Scientific

Laboratory Division under the direction of the epidemiologist on-call

for the NMDOH who can be reached at 505-827-0006 (24 hours a day, 7

days a week).

Scientific Laboratory Division

New Mexico Scientific Laboratories

1101 Camino de Salud NE

Albuquerque, NM 87102

Phone: (505) 383-9000

BACKGROUND

Transmission and case definition:

Measles is a highly contagious disease that is transmitted by

respiratory droplets and airborne spread. The incubation period for

measles ranges from 7 to 21 days. Anyone who shared airspace with a

person infectious with measles, or were in the same area up to two

hours after the infectious person was present, may have been

exposed. The virus can be transmitted from 4 days prior to the onset

of the rash to 4 days after the onset. The secondary attack rate is

extremely high: up to 90 percent of susceptible close contacts will

become infected with the measles virus. A diagnosis of measles

should be considered in any person with a generalized maculopapular

rash lasting 3 or more days, a temperature of 101 degrees F (38.3

degrees C) or higher and cough, coryza, or

conjunctivitis. Immunocompromised patients may not exhibit rash or

may exhibit an atypical rash.



Clinical course:

Measles typically begins with a mild to moderate fever, which is

accompanied by cough, coryza, and conjunctivitis. Two or three days

later, Koplik's spots, a characteristic sign of measles, may

appear. At this time the fever spikes, often as high as 104 degrees

or 105 degrees F. At the same time, a red blotchy maculopapular rash

appears, usually first on the face, along the hairline and behind the

ears. This slightly itchy rash rapidly spreads downward to the chest

and back and, finally, to the thighs and feet. In approximately one

week, the rash fades in the same sequence that it

appeared. Immunocompromised patients may not exhibit rash or may

exhibit an atypical rash.

Preventing transmission in healthcare settings:

To prevent transmission of measles in healthcare settings, airborne

infection control precautions should be followed

stringently. Suspected measles patients (i.e., persons with febrile

rash illness) should be removed from emergency department and clinic

waiting areas as soon as they are identified, placed in a private

room with the door closed, and asked to wear a surgical mask, if

tolerated. In hospital settings, patients with suspected measles

should be placed immediately in an airborne infection

(negative-pressure) isolation room if one is available and, if

possible, should not be sent to other parts of the hospital for

examination or testing purposes. All healthcare personnel should

have documented evidence of measles immunity on file.

Measles immunity:

Persons are considered immune to measles if:

- They were born before 1957.

- They have received two doses of a measles-containing vaccine

after 1968, at least 28 days apart, with the first dose on or after

the 1st birthday.

- They have a positive antibody (IgG) test for measles.

- They have a medical record documenting measles infection.

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==============================================STATUS

Actual: Refers to a live event.

Exercise: Designated recipients must respond to the notification.

Test: Tests the alerting system or the ability to reach the

intended recipients.

MESSAGE TYPE

Alert: Indicates information that warrants immediate action or attention.

Advisory: Indicates information that may not require immediate action.

Update: Indicates prior alert or advisory has been updated and superseded.

Cancellation: Indicates prior alert or advisory has been cancelled.

Error: Indicates prior alert or advisory has been retracted.

SEVERITY

Extreme: Extraordinary threat to life or property.

Severe: Significant threat to life or property.Moderate: Possible threat to life or property.

Minor: Minimal threat to life or property.

Unknown: Unknown threat to life or property.

SENSITIVITY

Sensitive: Indicates information contains sensitive content.

Not Sensitive: Indicates non-sensitive content.

MESSAGE IDENTIFIER: The notification ID number.

DELIVERY TIME: Indicates timeframe for delivery of the notification.

ACKNOWLEDGEMENT: Indicates recipient must confirm receipt of the

notification and the timeframe in which the confirmation is required.



ORIGINATING AGENCY: Identifies the agency sending the notification.

ALERTING PROGRAM: The program sending the notification or engaging

in communications using the PHIN Communication and Alerting (PCA) as

the delivery vehicle.

You have received this notification based upon the information

contained in our HAN database. If you have a different email address

or fax number that you prefer to be used or you have a new job title

or emergency response role, please send an email to

[email protected]. If you do not have email, you can send

a fax to the HAN administrator at 505-473-2050.

PLEASE ADD [email protected] TO YOUR SAFE SENDERS LIST SO

THAT YOU CAN RECEIVE HEALTH ALERTS AND EMERGENCY INFORMATION PROMPTLY.

Measles Case in New Mexico -- Surveillance for Secondary Cases

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