Measles Outbreak Offers Springboard for Immunization Discussions

February 03, 2015 04:02 pm Chris Crawford

So far, 2015 is turning out to be a banner year for measles: The number of cases reported in January alone was more than the total seen in a typical year.

This 2014 image shows a child in the Philippines with measles.

According to widespread media reports, most of the cases have been traced to Disneyland in Orange County, Calif. That fact led AAFP President Robert Wergin, M.D, to observe that the elevated media exposure of this outbreak offers a perfect opportunity for family physicians to identify unimmunized patients in their practices and reach out to them to explain the importance of getting the measles, mumps and rubella (MMR) vaccine.

"(With unimmunized patients,) I would emphasize the contagiousness; you have a 90 percent chance of getting measles (after having been exposed) if you aren't immune," Wergin told AAFP News. He also stressed explaining to patients the sometimes severe consequences of measles, including death.

Wergin has a personal connection with measles; the disease took the life of his uncle at age 4. Wergin's parents gave him the middle name Leland to honor his mother's brother, whom he never got to meet.

Breakdown of the Current Outbreak

From Jan. 1 to Jan. 30, 102 people in 14 states were reported as having measles, according to the CDC.(www.cdc.gov)

Story highlights
  • From Jan. 1 to Jan. 30, 102 people in 14 states were reported as having measles.
  • Last year, the CDC received the most measles case reports the agency had seen in 20 years -- more than 600.
  • On Jan. 23, the CDC issued a Health Alert Network advisory about the measles outbreak that included recommendations for health care professionals to use in their practices.

Anne Schuchat, M.D., director of the CDC's National Center for Immunization and Respiratory Diseases, explained during a Jan. 29 CDC press briefing(www.cdc.gov) that the agency is working with state and local health departments to control the outbreak, which started in late December.

"Although we aren't sure exactly how this year's outbreak began, we assume that someone got infected overseas, visited the Disneyland parks and spread the disease to others," she said.

Infected people in this outbreak have exposed others in settings such as schools, daycare facilities, emergency departments, outpatient clinics and airplanes, Schuchat added.

Although children account for many of the reported cases, the outbreak includes more cases in adults than is typically seen. Overall, the majority of the cases that have been reported to the CDC were among people who had not been vaccinated or who didn't know whether they had been vaccinated.

"This is not a problem with the measles vaccine not working; this is a problem of the measles vaccine not being used," Schuchat said.

Last year, the CDC received the most measles case reports the agency had seen in 20 years -- more than 600. According to Schuchat, many of those cases were linked to travelers who had brought the disease from the Philippines, where an outbreak of more than 50,000 cases was occurring.

Between 2001 and 2010, the United States saw a median of 60 reported cases of measles each year. Just 15 years ago, the CDC declared measles eradicated in the country.

Family Physician at Ground Zero

AAFP member William Woo, M.D., can see Disneyland from his office window in Anaheim, Calif. Another department at his medical facility saw one of the Disneyland measles cases, he said.

"For my generation of physicians, to actually see a case is rare," Woo told AAFP News.

Even so, he said the outbreak that began in his backyard has generated a lot of phone calls and emails from people worried about their kids. He's also seen an increase in the number of patients trying to find out whether they are immune and, if not, seeking to update their vaccines.

[Measles Cases and Oubreaks infographic]

"We've been using (the outbreak) as a springboard to get more information out there and more people vaccinated so we can prevent outbreaks like this again in the future," Woo said. "When patients and parents come in, I tell them how important the vaccines are, how devastating the diseases can be if their children get them, and also how low the risks are that are associated with the vaccine.

"If it takes me pointing out Disneyland or other recent unfortunate events, I do it. Whatever it takes to makes sure my patients are safe."

Office Recommendations

On Jan. 23, the CDC issued a Health Alert Network advisory(emergency.cdc.gov) about the measles outbreak that included recommendations for health care professionals to use in their practices.

One of those recommendations is to consider measles in the differential diagnosis of anyone with a febrile rash illness and clinically compatible symptoms who has traveled abroad recently or who has come in contact with someone who also has a febrile rash illness.

Given that it's the middle of flu season, Woo said lots of people are coming in with fevers, chills and coughs. Although fever with rash can also indicate strep throat, he noted, measles should be added to the list of possible causes of febrile rash.

The CDC also recommended isolating suspected measles patients and immediately reporting cases to local health departments to ensure a prompt public health response.

In keeping with that advice, Woo suggested having a staff member meet patients who might have measles at their cars, giving them masks and enacting proper isolation techniques so others in the waiting room are not exposed to the infection.

Starting with the Ebola outbreak last summer, Woo said his Anaheim office began asking patients concerned that they had contracted a disease whether they had a fever and had traveled internationally within the past 21 days. This same protocol is now being used for measles, he noted.

As for exposure history, Woo said that because of the office's proximity to Disneyland, he also asks patients with suspected measles whether they have been to the amusement park recently.

Woo said family physicians need to have an increased level of suspicion, especially during an outbreak or if a patient has traveled to areas of increased disease activity.

"For MMR and other vaccines, make sure you are broaching the topic with your patients every visit, every time, to ensure the health and safety of your patient population," he said.

Related AAFP News Coverage
Family Physicians Enlist in Fight Against Measles
Family Medicine Residents Get Rare Learning Opportunity

(6/9/2014)

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