A total of 288 confirmed measles cases have been reported to CDC from January 1 to May 23, with the majority of cases occurring in patients who were not vaccinated.1 This represents the highest number of cases since measles elimination was documented in the United States in 2000.
Pharmacists can play a significant role in helping to reduce the number of future measles cases by educating patients and caregivers about the importance of getting vaccinated, immunizing patients, and collaborating with other health care providers in the community to send consistent messages and form successful immunization neighborhoods.
What’s happening across the United States?
Measles cases have been reported in 18 states, with 15 outbreaks (i.e., defined as a chain of transmission of three or more confirmed cases) representing 79% of the reported cases.1 The largest outbreak to date—138 cases and ongoing—is occurring among the unvaccinated in Amish communities in Ohio. California has the second highest number of cases, with 60 cases reported as of May 23.
Most cases have occurred in patients who were not vaccinated and had traveled to other countries where measles outbreaks are more common. These travelers subsequently transmitted the disease to clusters of unvaccinated persons around them, as measles is a highly contagious disease. CDC identified importations from at least 18 countries, with a large number of cases occurring in travelers returning from the Philippines. CDC reported confirmed cases in patients aged 2 weeks to 65 years, with approximately one-half of cases occurring in patients younger than 20 years.1
A confirmed measles case is one confirmed by laboratory testing or one that meets the clinical case definition of the disease, which includes a generalized rash lasting 3 or more days, a temperature greater than or equal to 101°F, and cough, coryza, and/or conjunctivitis. In a minority of cases (15%), patients have been hospitalized with various complications ranging from pneumonia, hepatitis, pancytopenia, or thrombocytopenia. No cases of encephalitis or deaths have been reported as of May 23.
Addressing community needs
The record number of measles cases highlights the importance of increased collaboration, coordination, and communication among immunization stakeholders to meet the immunization needs of patients and help protect the community from vaccine-preventable diseases. Equally important is providing reliable, consistent, unbiased, and easily understood information to patients, especially those who may be hesitant or question the vaccine’s value.
Pharmacists should understand current recommendations for the measles–mumps–rubella (MMR) vaccine so they can identify which patients need the vaccine, educate patients and caregivers on the importance of obtaining the vaccine, administer the vaccine as allowed by state laws, and appropriately document and follow up with other providers to ensure continuity of care.
The vaccine is currently recommended for all children, with the first dose given at age 12 months to 15 months and a second dose given at age 4 years to 6 years.1 Catch-up vaccinations are recommended for children who have not received two properly spaced vaccinations. In addition, adults without immunity to the disease should receive at least one dose of the MMR vaccine, and two appropriately spaced doses of MMR are recommended for health care personnel, college students, and international travelers.
Pharmacists should determine if patients will be traveling internationally and educate them on their increased risk for measles and the importance of timely vaccination for those without evidence of measles immunity.1 CDC recommends that before traveling, infants aged 6 months to 11 months should receive one MMR dose, and those 12 months and older should be given two doses, with a minimum interval of 20 days between doses.
CDC noted that health professionals should continue to work toward maintaining high vaccination coverage rates in the United States to limit measles importations and spread of the disease.1 In addition, providers are encouraged to maintain a high level of awareness that measles cases are occurring more frequently in the United States, to implement appropriate infection control measures if measles is suspected, and to promptly report any suspected cases to local health departments.
Measles is characterized by fever (as high as 105°F) and malaise; cough, coryza, and/or conjunctivitis; and a pathognomonic enanthema (Koplik spots), followed by amaculopapular rash. The rash usually appears about 14 days after exposure; however, the incubation period ranges from 7 to 21 days. The rash spreads from the head to the trunk to the lower extremities (sometimes immunocompromised patients do not develop the rash). Patients are considered contagious from 4 days before to 4 days after the rash appears.