Given the disease was declared eradicated more than 20 years ago in the United States, it's something many young doctors have never seen.
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"If they have not seen measles, they have heard about it, they have talked about it, they have thought about it and certainly now as the alerts are going out for people to be a little more attuned to the signs and symptoms, they're going to be very focused," said said Dr. Salwa Suleiman, a pediatric infectious disease physician at Nemours Children's Health.
The CDC has now issued an alert to healthcare providers across the country about the illness as cases are on the rise.
"Even before the CDC alert, healthcare providers and families within Philadelphia had a heightened level of concern for measles because the first case was identified in December. This CDC alert draws attention that the outbreak in Philadelphia is not an isolated phenomenon," said Dr. Lori Handy, MD, associate director of the Vaccine Education Center at the Children's Hospital of Philadelphia.
According to the CDC, there have been 23 cases nationwide since December 1st, most of them in children and adolescents who had not been vaccinated, even if eligible.
In the Delaware Valley, we've seen 10 cases.
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Nine are in Southeastern Pennsylvania, including eight in Philadelphia and one outside the city. New Jersey has seen one case in Camden and there have been no cases in Delaware, but there was a case of exposure earlier this month in Wilmington.
The CDC alert issued January 25 reads in part, "Due to the recent cases, healthcare providers should be on alert for patients who have: (1) febrile rash illness and symptoms consistent with measles (e.g., cough, coryza, or conjunctivitis), and (2) have recently traveled abroad, especially to countries with ongoing measles outbreaks. Infected people are contagious from 4 days before the rash starts through 4 days afterward."
"I know that all of our providers, our primary care offices, and the EDs are certainly aware that there has been a measles outbreak in this area and are paying very close attention to both symptoms and vaccination status," said Suleiman.
Advocare Pediatrician Dr. Charles Scott says even though the number of cases seems small, this should be taken seriously, as measles is highly contagious.
"Measles is not a benign disease, the kids are pretty sick-appearing. There can also be complications, you can get pneumonia with it, you can get encephalitis, which is inflammation of the brain," Scott said.
Doctors say vaccination remains the most effective defense against the measles virus.
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The CDC says one dose of the measles vaccine is 93% effective. Two doses are 97% effective. While vaccination rates remain fairly high, there has been a slight decline among children being vaccinated.
"Due to those who have chosen not to vaccinate their children, they're still that possibility that a case may spread," said Scott.
"People don't see the illnesses and therefore they believe them eradicated, but as we see with periodic outbreaks, not completely eradicated, that's the problem," Scott added.
According to the CDC, the increased number of measles importations seen in recent weeks is reflective of a rise in global measles cases and a growing global threat from the disease. Healthcare workers say it's of the utmost importance to follow proper protocol if diagnosed or exposed.
The federal agency offers the following recommendations to healthcare providers:
- Isolate: Do not allow patients with suspected measles to remain in the waiting room or other common areas of the healthcare facility; isolate patients with suspected measles immediately, ideally in a single-patient airborne infection isolation room (AIIR) if available, or in a private room with a closed door until an AIIR is available. Healthcare providers should be adequately protected against measles and should adhere to standard and airborne precautions when evaluating suspect cases regardless of their vaccination status.
- Notify: Immediately notify local or state health departments about any suspected case of measles to ensure rapid testing and investigation. Measles cases are reported by states to the CDC through the National Notifiable Diseases Surveillance System (NNDSS) and can also be reported directly to the CDC at measlesreport@cdc.gov.
- Test: Follow the CDC's testing recommendations and collect either a nasopharyngeal swab or throat swab for reverse transcription polymerase chain reaction (RT-PCR), as well as a blood specimen for serology from all patients with clinical features compatible with measles. RT-PCR is available at CDC, at many state public health laboratories, and through the APHL/CDC Vaccine Preventable Disease Reference Centers.
- Manage: In coordination with local or state health departments, provide appropriate measles post-exposure prophylaxis (PEP) to close contacts without evidence of immunity, either MMR or immunoglobulin. The choice of PEP is based on elapsed time from exposure or medical contraindications to vaccination.
- Vaccinate: Make sure all your patients are up-to-date on the measles vaccine, especially before international travel. People 6 months of age or older who will be traveling internationally should be protected against measles.