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IMMUNIZATIONS

HOW TO
IDENTIFY
MEASLES

Measles is an acute viral
respiratory illness
characterized by a pro-
drome of fever (as high as
105°F) and malaise; cough,
coryza, and conjunctivitis –
the “three C’s”; and a
pathognomonic
enanthema (Koplik spots),
followed by a macu-
lopapular rash. In some
immunocompromised
patients the rash is
not evident.

Organization (WHO) was making good inroads into that region with What is our role in the current global outbreak in measles as
the polio vaccine. It was the very need for the cold chain that impacted providers in Bexar County? Our first and foremost role is to “do
the ability to provide that sub-Saharan region with the measles vac- no harm” by ensuring our staff are aware of the measles outbreak
cine. Further, over the next decade, we the faculty in the Military Med- and are appropriately immunized or have evidence of immunity (re-
ical Humanitarian Assistance Course stressed the measles vaccine as member the daycare worker above). Review and post in our offices,
the primary emergent immunization intervention to be seriously con- for staff and patients, the Texas Health and Human Services 2019
sidered in a refugee crisis. This intervention is necessary because Measles Health Advisory and the Texas Medical Association Notice
measles is so highly infectious, especially when associated with camp found in the references. Our second intervention is active surveil-
overcrowding and even higher rates of morbidity and mortality in lance to ensure our patients are immunized appropriately for
malnourished children. Measles-associated encephalitis can be partic- measles according to CDC guidelines (Table 1). Ensure patients are
ularly devastating. According to the WHO, there were 110,000 receiving the second dosage and consider immunization between 6
measles deaths globally in 2017; most were children under 5 years of and 12 months if planning to travel internationally. Third, we should
age. This is despite the measles vaccine resulting in an 80% drop in use this outbreak to capitalize on the opportunity to further educate
measles deaths since 2000. our patients and their families on the effectiveness of immuniza-
Fast forward 27 years to 2019, we are in the middle of another tions. Each year prior to the initiation of the measles vaccine in
measles outbreak with more cases this year than we have seen since 1963, measles led to; three-to-four million infected people, resulting
the outbreak in 1992 that launched my interest in immunizations. in 48,000 hospitalizations, 400-500 deaths and 1000 cases of en-
There have been over 1200 cases in 31 states. We have had one con- cephalitis. The year after licensure, measles decreased by 95% and
firmed case in Bexar County which is among the 21 cases in Texas the episodic outbreaks ceased. The measles vaccine has a long his-
in 2019. Similar to the 1992 measles outbreak, this outbreak in the tory of being highly effective.
United States is associated with a global outbreak due to under-im- We need to redouble our efforts to educate families on vaccine
munization with over 360,000 confirmed cases, triple the number safety. While this outbreak has created significant stress in some
from the previous year families, in others it has perhaps not created enough anxiety. In fam-
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