Public Health Message Type: Alert.
Intended Audience: All public health partners, Healthcare providers, Infection preventionists, Local health departments, Schools/childcare centers.
Summary:
- The Philadelphia Department of Public Health is reporting that there is a cluster of measles
among unvaccinated individuals. - Providers should remain vigilant and consider measles in patients with a febrile rash illness
lasting three days or more, a fever of 101°F (38.3°C) or higher, and clinically compatible
symptoms (cough, coryza and/or conjunctivitis), particularly if the patient was potentially
exposed to a case of measles or has recently traveled internationally to an area with an on-going
measles. - Providers who are ordering measles testing should obtain samples from the following sites:
nasopharyngeal/throat swab (rRT-PCR), urine (rRT-PCR), and serum (measles IgM and IgG). - Providers should implement measles prevention measures by ensuring they and their staff are
up-to-date with immunizations, use appropriate precautions, and have access to and are trained
to use appropriate personal protective equipment (PPE) when interacting with patients. - Providers should ensure their patients are up to date on recommended immunizations including
MMR, especially prior to international travel. - Measles is an immediately reportable condition, and providers should immediately report
suspected cases of measles to local public health authorities where the patient resides, or if not
available, to the NJDOH at (609) 826-5964 during regular business hours or (609) 392-2020 after
business hours or on the weekend.
Background
The New Jersey Department of Health (NJDOH) would like to make you aware of a measles cluster occurring in Philadelphia among unvaccinated individuals. As of January 4, 204 there are 4 confirmed cases associated with this cluster, and the Philadelphia Department of Public Health is facilitating testing for at least 2 additional possible cases.
As of January 5, 2024, no cases of measles have been identified in NJ in 2024. The last confirmed case of measles in NJ was reported in March 2023 in a resident with recent international travel. The best way to prevent measles is to remain up to date on measles vaccinations.
The NJDOH has been notified by the Philadelphia Department of Public Health of NJ residents who may have been exposed to these cases. Local health departments with exposed residents were notified and are working to assess immune status and recommend quarantine, as appropriate, for these individuals. NJDOH will continue to work with local health officials if additional exposures are identified.
Therefore, the NJDOH requests healthcare providers maintain vigilance for measles among patients who meet the clinical criterion for measles (generalized maculopapular rash lasting 3 or more days, fever at least 101°F (38.3°C), and cough, coryza, or conjunctivitis). Take a detailed history to determine the individual’s travel history, contact with travelers or other possible exposures, vaccination status, and detailed history of present illness including symptoms, symptom onset dates and rash progression. Report all patients that are suspected of having measles IMMEDIATELY to local health department where the patient resides or, if not available, to the NJDOH.
Measles Specimen Collection and Testing
The NJDOH advises healthcare providers to collect specimens from patients suspected of having measles as early as possible in the course of illness. Efforts should be made to obtain specimens from suspected cases at first contact and testing should be expedited and coordinated with the local health department. When there is a high index of suspicion, measles RT-PCR testing is the preferred testing methodology, which is performed by CDC and Wadsworth (CDC viral reference laboratory). Approval is required by NJDOH prior to submission, and upon approval specimens are generally submitted through the NJDOH Public Health and Environmental Laboratory (PHEL)
- The following specimens should be obtained:
Nasopharyngeal and/or throat swab for PCR testing – preferred (hold for NJDOH submission
approval) - Urine for PCR testing (hold for NJDOH submission approval)
- Serum for measles IgM and IgG testing (send to commercial laboratory)
o Acute phase serum as soon as possible and convalescent serum 2-3 weeks later
o Collect minimum of 5 mL of blood in a red-top or serum-separator tube (SST)
o PLEASE NOTE:
If serology is being ordered to determine measles immunity, commercial IgG
testing is recommended. Do NOT order measles IgM if the patient is
asymptomatic or recently vaccinated with MMR.
Serologic test results should be interpreted with caution, as false-positive and
false-negative results are possible with IgM tests.
Please see the NJDOH Quick Guide for Measles Specimen Collection and Testing and Measles Laboratory Testing FAQs for more information.
Infection control considerations for suspected cases of measles
The NJDOH requests that all healthcare providers maintain a high index of suspicion for measles in persons with a febrile rash illness, especially in those persons with recent international travel or visit to a community with an on-going measles outbreak. Because measles is highly infectious and the virus can remain airborne up to two hours, providers should take precautions to minimize exposure if one of their patients is suspected of having measles:
- Advise patients who call about a febrile rash illness to minimize exposure to others
- Should a suspected case present for care, place a mask on patient and isolate immediately
- Arrange for an exam in an isolated area. The exam room should not be used for at least 2 hours
after the measles suspect leaves - Review vaccine records or titer reports for your staff now, to ensure that only those with
evidence of immunity to measles provide care to a suspected case of measles.- People presumed to be immune to measles are those:
- Born in the US before 1957
- This is insufficient for healthcare workers.
- Have documentation of receipt of two doses of live measles-containing vaccine
(MMR). - Have documentation of a positive measles IgG titer
- Born in the US before 1957
- People presumed to be immune to measles are those:
- Remind providers/staff about the importance of receiving up-to-date immunizations and using
appropriate precautions and personal protective equipment (PPE) when interacting with
patients.
Prevention of Measles
- The best way to prevent measles is to remain up to date on all measles vaccinations especially
when considering traveling abroad. - The following people should be vaccinated against measles:
- All children over one year of age who have not yet been vaccinated
- Children between 6 months and 1 year of age who will be traveling internationally or
visiting a community with an on-going measles outbreak (This dose will not count
toward the primary series and two additional doses after one year of age will still be
required) - Adults who have not yet been vaccinated and were born after 1957 and not had
laboratory confirmation of a previous measles infection. - Adults of any age who will be traveling internationally or visiting a community with an
on-going measles outbreak who have not previously received two doses of MMR.
The NJDOH reminds healthcare providers that measles is immediately reportable upon suspicion, and to
report suspected cases of measles to the local health department where the patient resides, or if not
available to the NJDOH at (609) 826-5964 during regular business hours or (609) 392-2020 after business
hours or on the weekend Additional measles information and resources can be found on the New
Jersey Department of Health’s measles page: https://www.nj.gov/health/cd/topics/measles.shtml.