CHEYENNE – There has been an increase in measles cases and outbreaks in 2024, both domestically and worldwide. Because of this, the Wyoming Department of Health (WDH) and the Centers for Disease Control and Prevention (CDC) advise healthcare providers to ensure that children have received the necessary measles vaccinations. In addition, U.S. residents over the age of six months who are traveling internationally should have up-to-date MMR vaccinations according to a recent press release from the WDH.
Most cases reported in 2024 have been among children aged 12 months and older who had not received measles-mumps-rubella (MMR) vaccine, according to the release. Many countries, including travel destinations such as Austria, the Philippines, Romania, and the United Kingdom, are experiencing measles outbreaks.
Declines in measles vaccination rates globally have increased the risk of measles outbreaks worldwide, including in the United States. Measles cases continue to be brought into the United States by travelers who are infected while in other countries. As a result, domestic measles outbreaks have been reported in most years, even following the declaration of U.S. measles elimination in 2000. Most importations come from unvaccinated U.S. residents, the release states.
Measles is a highly contagious viral illness that can cause severe health complications, including pneumonia, encephalitis, and death, especially in unvaccinated persons. Measles typically begins with a prodrome of fever, cough, coryza, and conjunctivitis, lasting 2-4 days before rash onset.
The erythematous, maculopapular, blanching rash typically begins on the face and spreads cephalocaudally and centrifugally to involve the neck, upper trunk, lower trunk, and extremities.
Koplik spots are a pathognomonic enanthema consisting of 1- 3 mm whitish, grayish, or bluish elevations with an erythematous base, typically seen on the buccal mucosa opposite the molar teeth, though they can spread to cover the buccal and labial mucosa and may coalesce. If Koplik spots are present, they usually appear approximately 48 hours prior to the onset of rash and begin to slough when the rash appears.
The virus is transmitted through direct contact with infectious droplets or by airborne spread when an infected person breathes, coughs, or sneezes, and can remain infectious in the air and on surfaces for up to two hours after an infected person leaves an area. Individuals infected with measles are contagious from four days before the rash starts through four days afterward.
WDH and CDC recommend that clinicians consider measles as a diagnosis in anyone with fever (<101°F or 38.3°C) and a generalized maculopapular rash with cough, coryza, or conjunctivitis who has recently been abroad, especially in countries with ongoing outbreaks, or who has had contact with individuals with similar symptoms.
WDH recommends that providers collect a nasopharyngeal swab or oropharyngeal swab for reverse transcription polymerase chain reaction (RT-PCR) and a blood specimen for serology from all patients with clinical features compatible with measles.
A urine specimen for RT-PCR should also be collected when possible. Serology alone can be inadequate for diagnosis.
WDH recommends that providers send specimens to a commercial laboratory to ensure timely results. Providers who suspect measles infection may submit specimens to commercial laboratories without seeking permission from WDH. However, WDH requests that providers notify them of suspect measles patients by calling the 24/7 public health emergency line.
Providers should follow specimen collection, storing, and shipping requirements from the commercial laboratory.
To prevent measles, healthcare providers need to ensure that their patients are up to date on measles vaccination. Children should receive their first dose of measles-containing vaccine at age 12-15 months and their second dose at 4-6 years.
Regardless of receiving post-exposure prophylaxis, healthcare providers should be excluded from work from the 5th day after the first exposure until the 21st day after the last exposure.
Healthcare providers who received the first dose of MMR vaccine before exposure may continue to work and should receive the second dose of the MMR vaccine at least 28 days after the first dose. They should be monitored daily for signs and symptoms of measles infection for 21 days after the last exposure, according to the release.
Healthcare providers with presumptive evidence of immunity to measles who have been exposed to measles do not require post-exposure prophylaxis or work restriction, but they should be monitored daily for signs and symptoms of measles infection for 21 days after the last exposure.
During a measles outbreak, healthcare facilities should recommend two doses of the MMR vaccine at the appropriate interval for unvaccinated healthcare personnel, regardless of their birth year.
Healthcare providers who received the first dose of MMR prior to exposure may remain at work and should receive the second dose of MMR vaccine, at least 28 days after the first dose. They should be monitored daily for signs and symptoms of measles infection for 21 days after the last exposure.
Healthcare providers with presumptive evidence of immunity to measles who have an exposure to measles do not require post-exposure prophylaxis or work restriction, though they should be monitored daily for signs and symptoms of measles infection for 21 days after the last exposure.
During a measles outbreak, healthcare facilities should recommend two doses of MMR vaccine at the appropriate interval for unvaccinated healthcare personnel regardless of birth year.
Measles is a reportable disease. Providers who suspect or confirm measles in a patient should call the WDH 24/7 Public Health Emergency line at 888-996-9104. For additional information or questions about this advisory, providers can call the daytime epidemiology hotline at 877-996-9000.Regardless of receipt of post-exposure prophylaxis, they should be excluded from work from the fifth day after the first exposure until the 21st day after the last exposure.
