Measles

Background

Consider the diagnosis of measles in all children (and adult) presenting with: fever, rash, cough, conjunctivitis

Prodromal 3Cs
- Malaise, Conjunctivitis, Cough (tracheobronchitis), Coryza
Initial fever (usually high) x4/7
Koplik spots (salt grain or bluish by 2nd molar) day 5-7
Rash day 7 (lasts 5 days)
- Starts on face ears, spreads centrifugally
- Maculopapular then confluent
- Involves palms and soles
Generalised lymphadenopathy
Hepatomegaly
Abdo. pain (appendicitis or mesenteric adenitis)
Cough often late (and last to resolve)
Resolution by day 14

Approach, Mx and Ix similar to measles (rubeola).

Isolate patient (plus infection control)
An “oracol” oral fluid swab should be sent to the Micro. lab. Swabs are available in the treatment room CUH CED. Please record the date of rash onset and the vaccination history on the form when sending a swab
In addition to the above PCR testing, Serum based testing for measles IgM, for serum collected 4 days after rash onset, and measles IgG are available 7 days a week in the NVRL
Ensure staff are protected (MMR, previous exposure, born before 1978)
Unimmunised children requiring admission should be immunised if no contraindications
Opportunistic MMR immunisation is encouraged in other children who attend the ED
Measles is a notifiable disease. If in the HSE South please inform on 066 7184548 of any suspect case as soon as possible. Outside of normal working hours the Public Health Doctor on call for emergencies can be contacted through the Ambulance Services at 021-4209848
For those unfortunate enough not to live in Cork, here is a list of regional medical officer contact details
Please complete a Measles - Surveillance form

If possible, assess the patient an a room which can remain vacant for two hours post consultation with suspected cases
Suspected cases of measles should be placed in an airborne isolation room with controlled ventilation where possible
Provide persons with signs or symptoms of measles with information on all infection prevention and control precautions
Staff should use appropriate PPE (to include FFP2 mask) and standard and transmission based precautions
Use standard and airborne precautions and contact with discharges from respiratory and mucous membranes with known or suspected measles
Adhere to respiratory hygiene, cough etiquette and hand hygiene
Adhere to environmental and equipment cleaning and disinfection