Camden County Health Dept. staff will answer questions on Saturday from 8:30 a.m.-4:30 p.m. at 1-800-999-9045 regarding a Public Health Alert about measles. The New Jersey Department of Health and Senior Services has identified a Camden County man with probable measles who may have exposed an unknown number of people at public locations in South Jersey between April 21 and 24. On 4/12/11, a passenger arriving in the United States from Milan, Italy was subsequently diagnosed with laboratory confirmed measles. A NJ resident had multiple exposures to the index case in Rhode Island between 4/12 and 4/15.
NJDHSS was first made aware of the NJ contact when public health authorities in Rhode Island called to inform us that the NJ contact is now symptomatic with fever onset 4/22 and rash onset 4/24. The person had an unknown vaccination history: he received an MMR as post-exposure prophylaxis while in RI. Laboratory tests are pending but may be difficult to interpret given recent MMR vaccine post-exposure.
He has been on multiple flights and to multiple places of business during the period he would be considered infectious. DGMQ has been notified. Since there are multiple public exposures, NJDHSS will be issuing a press release to inform individuals of possible exposure to measles. Public health authorities are also working with the businesses to ensure immunity of workers who might have had contact with this individual. The exposures may have occurred at the following locations during the noted times and dates. This incident is unrelated to the previously reported exposures at Eppes Essen restaurant in Livingston which occurred on April 10 when 2 French women with laboratory-confirmed measles attended a private party.
4/21/2011
6:30 – 9:30 pm Pop Shop
729 Haddon Avenue, Collingswood, NJ
4/22/2011
8 am -12 pm Home Depot
2160 Route 70, West Cherry Hill, NJ
4/23/2011
6 – 9pm Kohl’s
2133 Route 38, Cherry Hill, NJ 08002
4/24/2011
11 am – 4 pm Magnolia Nursery
405 S. White Horse Pike, Magnolia, NJ 08049
11 am – 4 pm Toys R Us
500 New Jersey 38, Cherry Hill, NJ 08034
11 am – 4 pm Walmart
500 New Jersey 38, Cherry Hill, NJ 08002
11 am – 4 pm Home Depot
2160 Route 70, West Cherry Hill, NJ
11 am – 4 pm Lowe’s
122 West Oak Avenue, Lawnside, NJ
There is ongoing measles transmission in Europe with more than 6,500 reported cases in 33 countries since 2011. In the United States, there have been several recently identified cases and outbreaks of measles in international travelers due to ongoing measles transmission in other countries. Since April 13, NJDHSS has received a total of five unique notifications of laboratory-confirmed cases with multiple NJ contacts. Public health authorities are requesting health care providers remain extremely vigilant for anyone presenting with signs and symptoms of measles. Please contact public health authorities immediately to discuss appropriate specimen collection and submission.
Measles is an immediately reportable disease as per N.J.A.C 8:57 which can be accessed at: http://nj.gov/health/cd/
Measles Overview
Measles is a highly contagious disease that is transmitted by respiratory droplets and airborne spread. The disease can result in severe complications, including pneumonia and encephalitis. The incubation period for measles ranges from 7 to 18 days. Contacts can be infectious from day 5 through day 21 following exposure. The diagnosis of measles should be considered in any person with a generalized maculopapular rash lasting = 3 days, a temperature = 101ºF (38.3ºC), and cough, coryza, or conjunctivitis. Immunocompromised patients may not exhibit rash or may exhibit an atypical rash.
Recommendations
Health care providers should maintain vigilance for measles importations and have a high index of suspicion for measles in persons with a clinically compatible illness who have traveled abroad or who have been in contact with travelers. They should assess measles immunity in U.S. residents who travel abroad and vaccinate if necessary. Measles is endemic in many countries, including popular travel destinations. Suspected measles cases should be reported immediately to the local health department, and serologic and virologic specimens (serum and throat or nasopharyngeal swabs) should be obtained for measles virus detection and genotyping. A culture is preferable to serology in vaccinated individuals. Laboratory testing should be conducted in the most expeditious manner possible.
Preventing Transmission in Health Care Settings
To prevent transmission of measles in health care settings, airborne infection control precautions (available at http://www.cdc.gov/hicpac/
All health care personnel should have documented evidence of measles immunity on file at their work location. Having high levels of measles immunity among health care personnel and such documentation on file minimizes the work needed in response to measles exposures, which cannot be anticipated.
As an added precaution, hospital Emergency Departments are encouraged to provide signage which directs staff and/or patients to identify anyone presenting with fever and rash.
In Summary
1) Report all suspect measles cases (febrile illness accompanied by generalized maculopapular rash) immediately (DO NOT WAIT FOR LABORATORY CONFIRMATION) to the local health department. If unable to reach the local health department, notify the NJDHSS Vaccine Preventable Disease Program during regular business hours at (609) 826-4860. After business hours, or on the weekend, call NJDHSS at (609) 392-2020.
2) Place all patients with suspected measles in airborne isolation immediately.
3) Obtain clinical specimens for diagnostic testing from blood (for both IgM and IgG to measles), urine, nasopharyngeal aspirates, or throat swabs.
4) Determine the immune status of contacts. Offer measles vaccine or immune globulin to susceptible exposed contacts. Quarantine contacts who cannot produce documentation of immunity from day 5 through day 21 following exposure.
5) Assure that all those eligible for MMR vaccine receive appropriate and timely vaccination.
Resources
http://www.cdc.gov/measles/
http://www.cdc.gov/vaccines/
http://www.cdc.gov/measles/
http://www.nj.gov/health/cd/
