Two recent measles outbreaks should remind clinicians of the dangers of measles, a disease officially eradicated in the U.S. in 2000, but one that could still reoccur due to lack of vaccinations and the potential of secondary transmission at health care facilities, a commentary stated.
The success of the measles vaccine has led many clinicians have never seen measles and may not be able to recognize its features. Yet, the median annual number of cases has been rising steadily, with an average of 155 cases per year since 2010. Its eradication means that many clinicians might not recognize it, or might mistake its presentation for something else, the author noted.
The commentary appeared at Annals of Internal Medicine.
The recent outbreaks in New York City and Orange County, California, resulted from people traveling from overseas, and then spreading measles through communities with large numbers of unvaccinated people, the author noted. Most postelimination measles cases have been due to outbreaks, mostly in unvaccinated people.
Clinicians should have a high level of suspicion for measles in those with febrile rash illness who have recently traveled or have had contact with travelers and are able to recognize its clinical features: a prodrome of fever up to 40.6° C, cough, coryza, and conjunctivitis.
The rash is red, blotchy, morbilliform one that appears 2 to 4 days after symptom onset, beginning on the face and then spreading downward and becoming confluent. Pathognomonic Koplik spots appear 1 to 2 days before the rash and last 2 to 3 days; they are small, slightly raised, bluish-white spots on an erythematous base and have been reported in 60% to 70% of patients with measles. Confounding its dermatological presentation, measles rash may be confused with other viral exanthems such as fifth disease, roseola, Kawasaki disease, or scarlet fever.
“As measles incidence increases, clinicians have a vital role to play,” the author wrote. “We need to talk to our patients about measles vaccination and remind them what is at stake if imported measles cases continue to land in communities of unvaccinated persons, especially for those who are too young or ineligible to be vaccinated. Meanwhile, we must ensure that our facilities do not become centers for secondary measles transmission—prompt recognition of suspected cases and rapid implementation of control measures are critical to prevent further spread.”