!!! NM Dept of Health General Notification Message !!!

Message ID
1454 Sent 3/3/2011 2:59:17 PM Mountain Time

NEW MEXICO HEALTH ALERT NETWORK (HAN)

health.alert@cw.nmhealth.org

SUBJECT: Measles Case in New Mexico -- Surveillance for Secondary Cases

Status: Actual
Message Type: Alert
Message ID(s): 1454
Severity: Moderate
Sensitivity: Not Sensitive - Distribute Freely
Delivery Time: 1 Hour
Acknowledge: No
Originating Agency: NM Dept. of Health (NMDOH)

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TO: Infection preventionists; hospital contacts; physicians;
physician assistants; Doctors of Oriental Medicine; nurses; primary
and urgent care, student health, occupational medicine, and long-term
care contacts; tribal Community Health Representatives; Indian Health
Service contacts; border/bioenvironmental/environmental/public health
contacts; county/local/tribal/military emergency managers.

FROM: NMDOH

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Summary:

This is an measles alert from the New Mexico Department of Health's

Epidemiology and Response Division and Public Health Division. It
includes information on surveillance for secondary measles cases.

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Detailed Message:

An adult from Santa Fe County has been diagnosed with

laboratory-confirmed measles after returning from travel
overseas. This individual likely exposed others during her
infectious period while traveling on Southwest Airlines flight 2605
from Denver to Albuquerque on February 22, 2011 and while seeking
medical care at two facilities in Santa Fe and Rio Arriba
Counties. Both facilities have been notified of potential
exposures. The patient's period of communicability in New Mexico
included Feb 23-24, 2011. Secondary cases resulting from exposure to
this case would be expected to develop signs and symptoms of illness
March 2-17, 2011. This notice provides you with background
information about measles, potential exposures and to ask for your
help in the early identification of any secondary cases. All
suspected cases of measles should be immediately reported to New
Mexico Department of Health Epidemiology and Response Division at 505-827-0006.

SUSPECT CASES OF MEASLES NEED TO BE ISOLATED AT HOME OR IN A MEDICAL

FACILITY. ANY CLOSE CONTACTS SHOULD BE VACCINATED AGAINST MEASLES OR
HAVE HAD MEASLES.

SURVEILLANCE FOR SECONDARY CASES

Secondary cases resulting from exposure to this case would be

expected to develop signs and symptoms of illness March 2-17,
2011. A patient with potential exposure to the index measles case
and with signs and symptoms of measles should be evaluated away from
other patients to prevent exposure and appropriate diagnostic
specimens drawn for testing.

Laboratory tests should be restricted to patients most likely to have

measles, i.e., those with fever and generalized maculopapular
rash. Testing of suspect measles cases should be coordinated with
the NMDOH epidemiologist on call at 505-827-0006.
PLEASE BE SURE TO USE APPROPRIATE VIRAL SWABS AND VIRAL TRANSPORT MEDIA.

Serology:

- A serologic test for IgM antibody to measles virus in a single

serum specimen is the recommended method for diagnosing acute
measles, though measles-specific IgM antibodies may not be detectable
until 3-4 days after rash onset. A second serum specimen may need to
be taken if the first specimen is negative and was taken before day 4
of the rash.

- When a patient suspected of having measles has been recently

vaccinated (6-45 days prior to blood collection), neither IgM nor IgG
antibody responses can distinguish between measles disease and the
response to vaccination.

- If serum can be delivered to the NMDOH Scientific Laboratory

Division (SLD) within 4 hours of being drawn in can be sent in
refrigerated on ice packs. Otherwise, collect specimen by drawing
blood a double gel serum separator tube that does not contain
preservatives. After allowing clot to form, centrifuge specimen,
transfer serum to a sterile container. Specimen must be frozen at
-20 degrees C (-4 degrees F) and shipped on dry ice.

Virus detection:

- It is important to collect viral specimens if the person

suspected of having measles has been exposed to a confirmed measles
case or is part of an outbreak.

- Throat or nasopharyngeal swabs are generally the preferred

sample for virus isolation. Urine samples may also contain virus and
when feasible to do so, collection of both respiratory and urine
samples can increase the likelihood of detecting virus. Collect
samples as soon after rash as possible. The samples should be
collected at the first contact with a suspected case of measles when
the serum sample for diagnosis is drawn.

- Measles virus isolation is most successful when samples are

collected on the first day of rash through 3 days following onset of
rash; however, it is possible to detect virus up to day 7 following rash onset.

- Specimens for viral culture must be refrigerated and received

at the NMDOH Scientific Laboratory Division (SLD) within 3 days of
collection. Specimens should be shipped to the NMDOH Scientific
Laboratory Division under the direction of the epidemiologist on-call
for the NMDOH who can be reached at 505-827-0006 (24 hours a day, 7
days a week).

Scientific Laboratory Division

New Mexico Scientific Laboratories
1101 Camino de Salud NE
Albuquerque, NM 87102
Phone: (505) 383-9000

BACKGROUND

Transmission and case definition:

Measles is a highly contagious disease that is transmitted by

respiratory droplets and airborne spread. The incubation period for
measles ranges from 7 to 21 days. Anyone who shared airspace with a
person infectious with measles, or were in the same area up to two
hours after the infectious person was present, may have been
exposed. The virus can be transmitted from 4 days prior to the onset
of the rash to 4 days after the onset. The secondary attack rate is
extremely high: up to 90 percent of susceptible close contacts will
become infected with the measles virus. A diagnosis of measles
should be considered in any person with a generalized maculopapular
rash lasting 3 or more days, a temperature of 101 degrees F (38.3
degrees C) or higher and cough, coryza, or
conjunctivitis. Immunocompromised patients may not exhibit rash or
may exhibit an atypical rash.
Clinical course:

Measles typically begins with a mild to moderate fever, which is

accompanied by cough, coryza, and conjunctivitis. Two or three days
later, Koplik's spots, a characteristic sign of measles, may
appear. At this time the fever spikes, often as high as 104 degrees
or 105 degrees F. At the same time, a red blotchy maculopapular rash
appears, usually first on the face, along the hairline and behind the
ears. This slightly itchy rash rapidly spreads downward to the chest
and back and, finally, to the thighs and feet. In approximately one
week, the rash fades in the same sequence that it
appeared. Immunocompromised patients may not exhibit rash or may
exhibit an atypical rash.

Preventing transmission in healthcare settings:

To prevent transmission of measles in healthcare settings, airborne

infection control precautions should be followed
stringently. Suspected measles patients (i.e., persons with febrile
rash illness) should be removed from emergency department and clinic
waiting areas as soon as they are identified, placed in a private
room with the door closed, and asked to wear a surgical mask, if
tolerated. In hospital settings, patients with suspected measles
should be placed immediately in an airborne infection
(negative-pressure) isolation room if one is available and, if
possible, should not be sent to other parts of the hospital for
examination or testing purposes. All healthcare personnel should
have documented evidence of measles immunity on file.

Measles immunity:

Persons are considered immune to measles if:

- They were born before 1957.

- They have received two doses of a measles-containing vaccine

after 1968, at least 28 days apart, with the first dose on or after
the 1st birthday.

- They have a positive antibody (IgG) test for measles.

- They have a medical record documenting measles infection.

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STATUS
Actual: Refers to a live event.
Exercise: Designated recipients must respond to the notification.
Test: Tests the alerting system or the ability to reach the
intended recipients.

MESSAGE TYPE
Alert: Indicates information that warrants immediate action or attention.
Advisory: Indicates information that may not require immediate action.
Update: Indicates prior alert or advisory has been updated and superseded.
Cancellation: Indicates prior alert or advisory has been cancelled.
Error: Indicates prior alert or advisory has been retracted.

SEVERITY
Extreme: Extraordinary threat to life or property.
Severe: Significant threat to life or property.
Moderate: Possible threat to life or property.
Minor: Minimal threat to life or property.
Unknown: Unknown threat to life or property.

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ACKNOWLEDGEMENT: Indicates recipient must confirm receipt of the

notification and the timeframe in which the confirmation is required.
ORIGINATING AGENCY: Identifies the agency sending the notification.

ALERTING PROGRAM: The program sending the notification or engaging

in communications using the PHIN Communication and Alerting (PCA) as
the delivery vehicle.

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