Waning immunization rates due to pandemic disruption of vaccine schedules and anti-vax misinformation has opened the door for a measles return in the United States, a highly infectious virus that once killed 500 kids a year.
Two doses of the measles-mumps-rubella (MMR) vaccine is highly effective against the virus. The vaccine was widely administered in the early 1970s and measles was declared eradicated in the United States in 2000. That did not last, as pockets of unimmunized people were but one measles introduction away from lighting up like dry tinder. Today, the problem is driven by pandemic disruption of the childhood immunization schedules and metastasizing misinformation about the COVID-19 shots and vaccines in general.
“During the 2021-2022 school year, national vaccination coverage among kindergarten children dropped to 93%,” Georgina Peacock, MD, the CDC’s director of Immunization Services Division, said at a press briefing. “[This marks] a 2% drop since the start of the pandemic. While this might not sound significant, it means nearly 250,000 kindergarteners are potentially not protected against measles. We know that measles, mumps, and rubella vaccination coverage for kindergarteners is the lowest it has been in over a decade.”
On Feb. 4, an outbreak in central Ohio was declared over after two 22-day immunization periods had passed. Of 85 children with measles, none of them were fully vaccinated. Four received one shot, and the status of one other was unknown. There were no deaths, but 42% of patients were hospitalized.1
Undiagnosed hospital measles introductions are notoriously labor-intensive, including tracking potential exposures to patients and healthcare workers and determining immune status as necessary.
“Unless you have worked in a hospital during a measles outbreak, you really can’t imagine how much it really means, ‘All hands on deck,’” Patricia Stinchfield, MS, RN, CPNP, president of the National Foundation for Infectious Diseases, noted at the CDC press briefing. “Everyone needs to focus. There is a lot of attention in emergency rooms looking for kids with rashes and runny noses. It is so contagious and spreads easily within a clinic, emergency room, or on an inpatient floor.”
Healthcare workers should ensure immunity to the airborne virus to protect themselves and patients. “Healthcare personnel without presumptive evidence of immunity should get two doses of MMR vaccine, separated by at least 28 days,” the CDC recommended. “Although birth before 1957 is considered acceptable evidence of immunity, in routine circumstances, healthcare facilities should consider vaccinating healthcare personnel born before 1957 who lack laboratory evidence of immunity.”2
Measles cases are considered infectious four days before rash appears, and another four days after its gone.
“One of the biggest things is exposures,” said Stinchfield, who went through several measles outbreaks as infection control director at Children’s Minnesota. “Anyone who walks through an area with an unmasked child with measles is considered exposed.”
Mass Exposure Prompts CDC Alert
What about a case of measles among a crowd of 20,000 people for two days?
That is what happened recently at a gathering at Asbury University in Wilmore, KY, Feb. 17-18. The CDC issued a health alert after confirming a case of infectious measles who was unvaccinated and recently traveled abroad. The people attending the event were from in-state, other states, and multiple countries.
“Large outbreaks of 20 cases or more are being reported in Europe, Africa, the Eastern Mediterranean, and Southeast Asia,” the CDC reported.3
Those who attended the gathering and are unvaccinated or not fully vaccinated should quarantine for 21 days and monitor themselves for symptoms, including fever, rash, cough, or conjunctivitis.
People who think they may have measles or were exposed should isolate and “call your healthcare provider, urgent care, or emergency room before arriving to be tested,” the CDC emphasized. “Do not arrive at a healthcare facility without giving advance notice.”
Measles can cause severe health complications, including pneumonia, encephalitis, and death. “Measles virus can remain infectious in the air and on surfaces for up to two hours after an infected person leaves an area,” the CDC stated. “Do not allow patients with suspected measles to remain in the waiting room or other common areas of the healthcare facility. Isolate patients with suspected measles immediately, ideally in a single-patient airborne infection isolation room if available.”
Regardless of presumptive evidence of immunity, healthcare workers should wear N95 respirators upon entry to the room of a patient with known or suspected measles, the CDC recommended.
According to the Minnesota Department of Health, susceptible healthcare workers who were exposed to measles can blunt infection with prompt administration of post-exposure prophylaxis (PEP).4
- PEP with the MMR vaccine should be administered within 72 hours following exposure.
- MMR should be offered unless medically contraindicated (e.g., if the healthcare worker is pregnant or immunocompromised).
- Immune globulin (IG) may prevent or modify measles when administered within six days following exposure. Typically, IG is reserved for children.
REFERENCES
- Howard J. Measles outbreak in central Ohio ends after 85 cases, all among children who weren’t fully vaccinated. CNN. Feb. 5, 2023.
- Centers for Disease Control and Prevention. Routine measles, mumps, and rubella vaccination. Page last reviewed Jan. 26, 2021.
- Centers for Disease Control and Prevention. Measles exposure at a large gathering in Kentucky, February 2023 and global measles outbreaks. March 3, 2023.
- Minnesota Department of Health. Managing measles exposures in health care workers. Feb. 16, 2023.
Waning immunization rates due to pandemic disruption of vaccine schedules and anti-vax misinformation has opened the door for a measles return in the United States, a highly infectious virus that once killed 500 kids a year.
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