Measles 2019 Updates: The Comeback Kid

The child with a fever and rash in your Emergency Department (ED) may actually have measles. This year, there have been 1,182 cases of measles in the U.S., and counting. This is the highest rate in the past 27 years [1]. Globally, measles kills over a hundred thousand children [2]. In the U.S., one child dies for about every 1,000 cases [3]. Emergency providers must be able to quickly detect short-term complications that can lead to death and distinguish measles from mimics like Kawasaki Disease. It’s no coincidence that this year’s outbreak is in the setting of lower vaccination rates. The CDC now has new vaccine recommendations, and it’s imperative that ED providers join forces with public health providers to prevent future measles cases and deaths (photo credit). Presentation Measles continues to present as we all learned in medical school: the “classic” prodrome of fever, conjunctivitis, and URI symptoms followed by a maculopapular rash 3 to 4 days later that spreads cephalocaudal and spares the palms and soles. The pathognomonic Koplik spots in the mouth only appear in about 5% of cases. Individuals are infectious 4 days before and 4 days after the onset of the rash, and the incubation period for the virus can last up to three weeks. The median age for measles is 5 years old, but it can also impact unvaccinated adults [4]. Some vaccinated adults may also be susceptible. In the late 1960s, children received a killed version of the vaccine that led to insufficient protection. Patients who received this vaccine had a modified measles presentation: the rash started in the extremities, affected the palms and soles, and was not contagious [2].​​ However, because the current vaccine is an attenuated … Continue reading Measles 2019 Updates: The Comeback Kid