#Measles grand rounds this AM. Responding to an outbreak....@LBHealth #Sinai in conjunction with the Baltimore Health Department.

History: once ubiquitous and deadly disease nearly eliminated by the vaccine because #VaccinesWork but because of elimination pockets of people especially in Europe oppose vaccines.

Most US cases are imported. Most were unvaccinated- personal belief exemptions the reason.
Here is what to look for (for those of us who haven’t seen it yet):

Complications of measles can be severe. Most concerning is encephalitis. SSPE is a long term effect that can happen years later.

Why do we get epidemics? Diagnosis is delayed because we think it’s Kawasaki, scarlet fever or dengue. Has to be on our differential now (unfortunately). Kids are contagious 4 days prior to rash to 4 days after.

If a child shows up in ER - isolate immediately. Love the #GOT shout out! HODOR!

Diagnosis typically made by IgM or NP swab PCR. Call the health department immediately.
Treatment is supportive and may include extra vitamin A.
Then try to stop the spread!

Control measures:
Quarantine
Vaccinate
Immunoglobulin
Have up to 6d after exposure to get non immune vaccinated and/or immunoglobulin.

Correction. Vaccine within 72 hours post exposure. Immunoglobulin up to 6 day. Sorry everyone.
Note IMIG good for most, IVIG for pregnancy and immunocompromised.

Update from the Health Department.
Good news is there is no evidence of ongoing transmission in Baltimore. But we are being proactive to prevent spread.

Here is why we’re facing this: outbreaks going on in multiple communities. Hot spots near us are Brooklyn, Queens and Rockland County NY. Unfortunately our community travels there frequently....
Check with the @CDCgov for recommendations.

Who is your friend? The local Health Department. Call if you have a suspected case. They do testing at the State Lab. Get serum and and NP swab. Answer in 24 hours.

Prevention efforts = vaccine. If you are traveling to an ongoing transmission area make sure you have 2 doses or immunize the 6-12 month olds. This includes visitors coming to you from those areas. For older kids:

Most people don’t need 3 doses and you only need a post exposure MMR if you didn’t have 2 doses. If you can’t get vaccine then give immunoglobulin but don’t do both at same time!
Current recommendation is go to your doctor for the vaccine!

Final recommendations for providers:
Vaccinate
Tell parents to call ahead
Don’t send patients to the ER for vaccines
Have high suspicion and call