Measles

Disclaimer

These guidelines have been produced to guide clinical decision making for the medical, nursing and allied health staff of Perth Children’s Hospital. They are not strict protocols, and they do not replace the judgement of a senior clinician. Clinical common-sense should be applied at all times. These clinical guidelines should never be relied on as a substitute for proper assessment with respect to the particular circumstances of each case and the needs of each patient. Clinicians should also consider the local skill level available and their local area policies before following any guideline. 

Read the full PCH Emergency Department disclaimer.

Aim

The guide staff with the assessment and management of measles.

Background 

Transmission and Epidemiology

  • Highly infectious. Droplet spread or direct contact with secretions (the child is usually coughing).
  • The virus may be suspended in the air for up to an hour after an infected person leaves the room or waiting area.
  • Patients are infectious for 3-4 days prior to the rash developing and a further 4-6 days from onset of rash.
  • After exposure to measles, it is usually about 10 days (range 7-18 days) to the onset of fever and about 14 days until the onset of rash.

Assessment

Examination

  • The child appears miserable, febrile and unwell
  • The 3 C's
    • Cough
    • Coryza
    • Conjunctivitis
  • Coarse blotchy maculopapular rash (Morbilliform)
  • Koplik spots appear 1-4 days before the rash appears – white spots on the bright red buccal mucosa of the cheek opposite the premolar.

Investigations

At PCH: Contact on call microbiology to ensure rapid processing

  • Measles antibodies (IgM and IgG)
  • Measles IgM appears 1-2 days after the appearance of the rash and persists for 1 month
  • NPA – for viruses and urgent PCR
  • Urine for measles PCR.

Management

Public Health Management

  • Upon suspicion of measles, isolate immediately within the department. Refer to Rash management
  • Suspected measles cases should always be discussed with the PCH clinical microbiologist (to coordinate local response)
  • Laboratory confirmation is always required
  • Take a contact history
  • Susceptible contacts may be advised to be immunised by their GP (for up to 72 hours after the first exposure). Alternatively they may have normal Immunoglobulin from 72 hours to 7 days after the first exposure.
  • Advise isolation at home until results become available. If positive, the exclusion time is 6 days from the onset of the rash
  • If possible, avoid hospitalisation, because of the infectivity. Admit for clinical condition warranting interventions only.

Complications

  • Pneumonia - is the most common cause of death in measles and may progress onto bronchiolitis obliterans
  • Acute otitis media
  • Diarrhoea and vomiting
  • SSPE (Sub Acute Scelerosing Pan Encephalitis) – a rare late complication

Bibliography

  1. Dowse G. (2010) Epidemiology of vaccine preventable diseases in Western Australia. Australia. Department of Health
  2. Dowse G. (2010) Public health management of 200 key vaccine preventable diseases. Australia. Department of Health
  3. NSW Health. (2008) Measles response protocol for NSW public health units. NSW Australia
  4. Nelson Textbook of Pediatrics: 20th Edition Robert M. Kliegman, Bonita M.D. Stanton, Joseph St. Geme, Nina F Schor Publisher: Elsevier

Endorsed by:  Director, Emergency Department   Date:  Mar 2018


 Review date:   Mar 2021


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