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Previous story "Exquisitely contagious" Measles Case Infects Small Child In Clark County Next story


Story by Sandy Kromeir - The Oregon Herald
Published on Wednesday February 16, 2011 - 1:05 AM
 
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An infant who recently returned from India with his family has been diagnosed with measles, a serious disease that can lead to pneumonia and encephalitis, an inflammation and swelling of the brain.

The health department said the baby was taken Evergreen Pediatrics and Southwest Medical Center outpatient laboratory.

Health officials say people who visited Evergreen Pediatrics in Vancouver on Monday, Feb. 14 between 1:30 p.m. and 6 p.m. are considered exposed to measles.

Measles, also called rubeola, is no longer considered endemic in the United States. However, continued success depends upon maintaining high vaccination rates, because 80% of the cases of measles continue to be imported into the United States. Measles disease can occur anytime of the year, but is most frequently seen during late winter and spring.

Worldwide, an estimated 30 million cases and 700,000 deaths occur each year. More than half of the deaths occur in Africa. During 1997-1998, approximately 100 deaths were attributed to a large outbreak of measles in Argentina and Brazil.

Measles is an acute viral illness characterized by:

A prodrome of fever and malaise, Cough, coryza, and conjunctivitis, A maculopapular rash, Koplik's spots (enanthem present on mucous membranes) are considered to be indicative of measles and occur 1–2 days before the rash and persist for to 1–2 days after the rash. Other rash-causing diseases often confused with measles include roseola (Roseola infantum) and rubella (German measles), among others.

Atypical measles occurs only in persons who received inactivated ("killed") measles vaccine (KMV) and are subsequently exposed to wild type measles virus. Modified measles occurs primarily in patients who received immune globulin (IG) as post-exposure prophylaxis and in young infants who have some residual maternal antibody.

Measles is usually a mild or moderately severe illness; however, complications can occur.

Residual neurological impairment occurs from encephalitis in approximately 5–10 cases per 10,000 reported cases.

Hospitalization occurs in 19% of measles cases in the United States.

Pneumonia occurs in 6% of measles cases. Death occurs in approximately 1–3 cases per 1,000 reported cases. Rash illnesses are difficult to distinguish without laboratory testing. In diagnosing measles, clinicians should consider:

Including both rubella and measles in the differential diagnosis of patients presenting with an acute generalized rash and fever. Ordering serology tests only if the clinical case definition is met; otherwise, false positive results may be detected. Collecting specimens for both culture and serology. Acute measles infection is lab confirmed by the presence of one or more of the following:

A positive measles-specific IgM antibody, A significant rise in IgG antibody from paired acute and convalescent sera, A positive viral culture for measles, or Detection of the virus by reverse transcription-polymerase chain reaction (RT-PCR). For more information about the lab tests that can be done for measles, when they should be used, and how to submit specimens for Lab Testing for Measles.

Treatment is supportive and focused on relieving symptoms and or treating complications.

Measles is highly communicable. Secondary attack rates exceed 90% among susceptible persons.

Measles is infectious from 4 days prior to 4 days after rash onset. Maximum infectiousness occurs between onset of prodrome through the first 3-4 days of rash. Immunocompromised persons may shed virus for several weeks after the acute illness. There are no asymptomatic infectious carriers.

The incubation period for measles averages 10-12 days from exposure to prodrome and 14 days (range 7-18) from exposure to rash onset.