Health Alert: Confirmed case of measles

The Texas Department of State Health Services (DSHS) is reporting a confirmed case of measles in a resident of Hood County. The last confirmed measles case in Texas was in 2019.

Due to the highly contagious nature of this disease, additional cases may occur. We advise clinicians to follow the recommendations below and report any suspected cases to their local health department, preferably while the patient is present.

A young child who is a resident of Hood County was recently diagnosed with measles. The child had no history of travel to an area where measles is spreading and no known exposure to a person with measles. The child has been treated and is recovering.

This is the first confirmed case of measles in Texas since travel-related outbreaks in 2019, which led to 23 cases. Two doses of the measles vaccine are highly effective at preventing measles, however even vaccinated people can occasionally become infected.

Measles is a highly contagious respiratory illness. The virus is transmitted by direct contact with infectious droplets or by airborne spread when an infected person breathes, coughs, or sneezes. The measles virus can remain infectious in the air for up to two hours after an infected person leaves an area. The illness usually starts a week or two after someone is exposed, with symptoms like a high fever, cough, runny nose, and red, watery eyes. A few days later, the telltale rash breaks out as flat, red spots on the face and then spreads down the neck and trunk to the rest of the body. A person is contagious about four days before the rash appears to four days after. People with measles should stay home from work or school during that period.

The best way to prevent getting sick is to be immunized with two doses of the measles-containing vaccine, which is primarily administered as a combination of the measles-mumps-rubella (MMR) vaccine. DSHS and the Centers for Disease Control and Prevention recommend children receive one dose at 12 to 15 months of age and another at 4 to 6 years. Children too young to be vaccinated or who have only had one dose of vaccine are more likely to get infected and more likely to have severe complications if they do get sick.

Healthcare providers should consider measles in patients presenting with the following symptoms, particularly those who have traveled abroad or had contact with known measles cases:

• Fever ≥101°F (38.3°C) AND
• Generalized maculopapular rash lasting ≥3 days AND
• Rash begins at the hairline/scalp and progresses down the body
• Cough, runny nose, or conjunctivitis OR Koplik spots (bluish-white specks or a red-rose background appearing on the buccal and labial mucosa usually opposite the molars)

Immediately report any suspected cases of measles to your local health department (contacts by the county at dshs.texas.gov/idcu/investigation/conditions/contacts). If possible, please report while the patient is present to facilitate testing and the public health investigation, including follow-up of potential exposures.

• Airborne precautions should be followed to reduce possible exposures in healthcare settings.
• In urgent/emergency healthcare settings, suspected cases should be masked with a surgical mask and triaged quickly from waiting areas into a room with a closed door, airborne isolation precautions are recommended. In other outpatient settings, suspected cases should be scheduled at the end of the day, if possible. Healthcare workers caring for patients suspected of having measles should use airborne infection control precautions. (www.cdc.gov/hicpac/2007IP/2007isolationPrecautions.html)
• Since measles is so highly transmissible and can spread in healthcare settings, people who work in places like a doctor’s office or emergency room should have evidence of measles immunity to prevent any potential outbreak. (https://www.cdc.gov/vaccines/pubs/surv-manual/chpt07-measles.html#f21).

Testing for measles should be done for all suspected cases of measles at the time of the initial medical visit:

• Measles PCR and serology (IgM and IgG) testing is available at both the Texas DSHS Laboratory in Austin and at commercial laboratories.
• The Texas DSHS Laboratory can perform PCR testing on throat swabs (preferred) or nasopharyngeal swabs placed in viral transport media and serology on serum specimens.
• DSHS strongly encourages providers to submit PCR specimens to the DSHS Laboratory because genotyping will be performed on positive PCR specimens, which can be helpful during outbreaks.
• Providers should work with their local health department or DSHS regional office to coordinate testing at the DSHS laboratory to ensure specimens are submitted correctly and meet testing requirements. 
• Unless coordinated in advance, specimens may only be received during normal business hours Monday through Friday. 

• Measles vaccination may prevent disease in exposed people if given within 72 hours of exposure. People 6 months old and older who have not been fully vaccinated would be eligible for vaccination under those circumstances. It may provide some long-term protection but should be followed with a second vaccination at least one month later. Immune globulin (IG) may be indicated for some people but should not be used to control an outbreak.
• Pregnant women, people with severe immunosuppression, and anyone with a previous anaphylactic reaction to a vaccine component should not get a measles vaccine.

• People with confirmed or suspected measles should stay home from school, work, and other group settings until after the fourth day of rash onset.
• During an outbreak, people without documented immunity from vaccination or previous measles infection should be isolated from anyone with measles to protect those without immunity and control the outbreak. Additional information on school exclusion and readmission can be found at dshs.texas.gov/idps-home/school-communicable-disease-chart.

If you think you have measles or have been exposed to someone with measles, isolate yourself from others and call your healthcare provider before arriving to be tested so they can prepare for your arrival without exposing other people to the virus. Measles is extremely contagious and can cause life-threatening illness to anyone who is not protected against the virus.

• For Healthcare Professionals – Diagnosing and Treating Measles | CDC
• Interim Measles Infection Prevention Recommendations in Healthcare Settings | CDC
• Measles – Vaccine Preventable Diseases Surveillance Manual | CDC
• Plan for Travel – Measles | CDC
• Measles Lab Tools | CDC
• Measles Serology | CDC
• Measles Specimen Collection, Storage, and Shipment | CDC
• CDC Measles Toolkit for Health Departments
• Global Measles Outbreaks | CDC