Measles Outbreak 2019: What You Need To Know Now

In 2019, we have experienced the largest number of cases reported in the U.S. since measles was considered eliminated nearly 20 years ago.

This webinar provides insights about the current outbreak and how to address cases you may encounter.

Live webinar occured May 7, 2019.

Webinar Questions and Answers

Q: Are you screening all Transplant candidates for measles serology?

A: Some centers are doing this in face of the measles outbreaks. For HSCT patients, when sufficient engraftment has occurred, they do get MMR.

Q: Also, if non-immune for Pre-Tx are you recommending a single dose of MMR or 2 doses?

A: Due to timing, generally one MMR dosing.

Q: What’s the best diagnostic method in immunocomproized patients receiving IVIG regularly?

A: Good question. Measles IgM is fairly specific and should be valid as not likely positive in pooled immunoglobulin. Measles IgG is another story of course. Measles PCR on a respiratory sample with the State Health Dept. is another option.

Q: I know you mentioned that adults are also at risk. Does that mean vaccinated adults can still contract measles?

A: Yes, especially if they have waning immunity (e.g., got one MMR dose) or received an early generation vaccine in the 1960s.

Q: Would it be possible for those elderly patients (and I mean 80-95y, born before the introduction of the MMR vacine) to contract measles?

A: It is possible, but generally thought to be unlikely given the durable immunity was seen after native measles. That said, if infection again truly becomes widespread, I expect some with senescent immunity could be prone to developing infection.

Q: Describe the incubation period, and when a patient becomes contagious

A: The incubation period tends to be 7-10d, and the patient is contagious before onset of the rash.

Q: If a person had the less effective vaccine in the early ‘60s but their titer is positive, does that person have the same protection as someone with a positive titer from the newer MMR vaccine?

A: Probably. Atypical measles was a problem in the past with exposure to measles after receiving the killed vaccine which hasn’t been used since the late 1960s.

Q: I recently read that the meales DNA PCR is only available through State labs and not through commercial labs. Is this accurate? And, is this necessary? Should we not be able to order that more easily without having to go through State labs only?

A: There was little commercial need for such a test, hence it remained in the health department/CDC realm. Some centers may develop "home-brew" PCRs, but I expect little appetite for diagnostic companies to pursue FDA approval for measles PCR.

Q: Any advice for vaccination for adults at risk for measles on TNF blocker and other immunologic T cell moderating therapies?

A: If in contact with a measles case or suspected to have measles, they should seek expert ID advice ASAP. The MMR is contraindicated in these patients, as it is a live vaccine. If patients are severely immunocompromised and exposed, current recommendations Intramuscular IVIG: 0.5 mL/kg of body weight (maximum dose = 15 mL) Intravenous: 400 mg/kg

Q: Would you advise to take Vitamin A for prevention?

A: No, only use is in low-resource countries in children.

Q: Any correlation to MMR vaccine shortage in the early 2000’s and current outbreak?

A: No, this outbreak is due to those who have not been immunized.

Q: Should a healthcare facility run a report to check frontline provider titers? In VA, no outbreak here yet

A: Titers were often checked upon hire in many health systems. That said, if the Occupational Health offfice doesn’t have a record, it may be worth finding out this information and immunizing if people don’t have demonstrable titers.

Q: If a child under 5 has an incomplete or lost vaccination record, should you investigate with antibody titers or just administer potentially duplicate MMR boosters?

A: Repeated MMR administration is safe and probably easier in younger children than drawing blood for the sole purpose of an immunological check.

Q: Any special recommendations for healthcare providers who already received 2 doses of MMR?

A: None currently.

Details

Paul Auwaerter, MD, MBA – Professor of Medicine at Johns Hopkins University – will present details on measles and the current outbreak.

Topics covered:

• Myths and facts of this measles outbreak
• Why cases are rising in the U.S.
• Evidence-based clinical guidance including diagnosis, treatment, and prevention

About The Presenter

PAUL AUWAERTER, MD, MBA

Paul G. Auwaerter is the Sherrilyn and Ken Fisher Professor of Medicine at the Johns Hopkins University School of Medicine serving as the Clinical Director for the Division of Infectious Diseases and Director of the Sherrilyn and Ken Fisher Center for Environmental Infectious Diseases.

He serves as the Executive Director of the Johns Hopkins Point of Care-Information Technology (POC-IT) Center producing the Johns Hopkins ABX (Antibiotic), JH HIV, JH Osler, JH Psychiatry and JH Diabetes Guides. In 2018, Dr. Auwaerter served as President for the Infectious Diseases Society of America, the largest professional society worldwide related to infectious diseases.