One Measly Outbreak

Granddaughter visiting grandmother in a long-term care facility

In the year 2000, the United States officially declared measles to have been eradicated. Today, 19 years later, the country is seeing the biggest increase in new cases in more than 25 years. The current spike in measles cases has been largely attributed to international travel, but the influence of the anti-vaccine movement has also been a factor. Of the more than 700 new measles cases seen this year, 500 have been in people, mostly children, who have never been vaccinated.

Dr. Anne Schuchat, director of the CDC’s National Center for Immunization and Respiratory Diseases, has said, “Measles is so contagious that if one person has it, 90 percent of the people close to that person, who aren’t immune, will also be infected. You can catch it just by being in the same room as a person with measles, even if that person left the room, because the virus can hang around for a couple of hours.”

So what is the impact of all this on the nation’s elderly, and especially those in LTC facilities? Well, there is good news.

According to William Schaffner of the National Foundation for Infectious Diseases, U.S. citizens born prior to 1957 are generally considered immune to measles, since most in that age group were exposed to the virus before a vaccine was available.

That leaves only a small percentage of older adults who may be susceptible. It is important that LTC facilities determine the measles status of all their residents. The CDC recommends obtaining acceptable evidence of immunity against measles, which includes at least one of the following:

1)   Written documentation of adequate vaccination:

a)   one or more doses of a measles-containing vaccine administered on or after the first birthday for preschool-age children and adults not at high risk

b)   two doses of measles-containing vaccine for school-age children and adults at high risk, including college students, healthcare personnel, and international travelers

2)   Laboratory evidence of immunity

3)   Laboratory confirmation of measles

4)   Birth certificate showing pre-1957 birthdate

It is important healthcare providers do not accept verbal reports of vaccination as presumptive evidence of immunity without accompanying written documentation.

For patients born after 1957, who were neither vaccinated nor had measles, an LTC should check with the patient’s primary health care provider and arrange to administer a vaccine.

“The measles, mumps, and rubella (MMR) vaccine is about 97% effective when people get it in two doses as intended,” Dr. Schuchat said.

Another step LTC facilities can take is to familiarize caregivers with the signs and symptoms of measles and what to do if they spot them. Many caregivers may not have seen a case of measles in their lifetime because of the low prevalence of the disease since the measles vaccine has been widely administered.

The symptoms of measles typically appear within 14 days of infection and usually first manifest as:

  • high fever
  • cough
  • runny nose (coryza)
  • red, watery eyes

Two or three days later, small white spots called Koplik spots appear inside the mouth.

Within five days after symptoms begin, a rash breaks out. It usually begins as flat, red spots that appear on the face at the hairline and spread downward to the neck, trunk, arms, legs, and feet. Small bumps may also appear on top of the red spots. The spots may join together as they spread from the head to the rest of the body. At this point, the patient’s fever may spike to more than 104° F.

“I’m urging all health professionals to ‘think measles,’” Dr. Schuchat said. “Healthcare professionals do need to know the guidelines for infection control and reporting of measles, and they should make sure their patients are getting the best protection possible.”

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