Measles Outbreaks Are Increasing Worldwide

Measles outbreaks are on the rise globally, and it is considered a public health crisis. In the United States, there were 349 confirmed measles cases in 26 states and the District of Columbia in 2018, which is the second largest number since measles was eliminated in the US in 2000.¹

Measles is still common in some countries in Europe, Asia, the Pacific, and Africa. The rise in outbreaks is most likely due to an increase in the amount of travelers infected with measles and unvaccinated individuals in the US, who are spreading the disease.¹ New York has seen one of the largest measles outbreaks in decades, which is primarily occurring among unvaccinated people in Orthodox Jewish communities.^1,2 The outbreaks were associated with travelers who brought measles back from Israel, where a large outbreak is occurring.² The Los Angeles County Department of Public Health has also issued a recent warning regarding an individual infected with measles that visited various locations.³

Measles is an acute viral respiratory illness with symptoms that include high fever, cough, runny nose, and conjunctivitis. Two to 3 days after the symptoms begin, tiny white spots known as Koplik spots may appear inside the mouth, which is followed by a characteristic maculopapular rash that spreads from the head to the lower extremities.⁴ Complications include pneumonia, encephalitis, and death. Individuals are contagious from 4 days before to 4 days after the rash appears.⁴ Measles is highly contagious, and 90% of unvaccinated individuals that come in contact with an infected person on a plane will contract the disease.⁴

Vaccination with the measles-mumps-rubella (MMR) immunization is the best way to prevent measles.⁴ The CDC recommends a 2-dose series with the first at age 12-15 months, and the second dose at age 4-6 years or at least 28 days after the first dose.⁴ One dose is about 93% effective at preventing measles, and 2 doses are approximately 97% effective.⁴

Ensuring Children and Adolescents Are Up-to-Date on Vaccines

Individuals exposed to measles who do not have evidence of vaccination or immunity should be offered post-exposure prophylaxis. The MMR vaccine administered within 72 hours of initial measles exposure or immunoglobulin (IG) given within 6 days of exposure may offer some protection.⁴ During outbreaks, the MMR can be given to infants at age 6 months or older to prevent measles.

Pharmacists should educate parents that children receiving the MMR before their first birthday should be revaccinated when they are age 12-15 months and again at age 4-6 years.⁴ There is no specific antiviral medication for measles, so supportive care is used to relieve symptoms.

Over-the-counter medications such as acetaminophen (Tylenol) or ibuprofen (Motrin) can be used for fever, but aspirin should be avoided in children and teens due to the risk of Reye’s syndrome. Severe measles cases in children who require hospitalization should be treated with vitamin A.⁴

The antivaccine movement has sparked controversy and is contributing to the growing measles outbreaks by spreading inaccurate information about vaccines, fueled by social media. Pharmacists can play an important role in educating and vaccinating patients to help prevent future outbreaks. It is extremely important to counsel parents that the MMR vaccine is safe and effective, and not being immunized can cause serious health complications and even death. It is especially important to make sure patients traveling are up-to-date on their MMR.

References

• Measles cases in 2018. CDC website. https://www.cdc.gov/measles/cases-outbreaks.html?rel=0" ?rel=0" . Published January 10, 2019. Accessed January 15, 2019.
• Howard J. New York tackles ‘largest measles outbreak’ in state’s recent history as cases spike globally. CNN. https://www.cnn.com/2019/01/08/health/measles-outbreak-ny-bn/index.html?rel=0" ?rel=0" . Published January 9, 2019. Accessed January 15, 2019.
• Health officials identify locations for possible measles exposure [news release]. Los Angeles, CA: County of Los Angeles Public Health; January 11, 2019. http://publichealth.lacounty.gov/phcommon/public/media/mediapubhpdetail.cfm?prid=1974&rel=0" &rel=0" . Accessed January 15, 2019.
• Measles (rubeola) clinical features. CDC website. https://www.cdc.gov/measles/hcp/index.html?rel=0" ?rel=0" . Published May 8, 2018. Accessed January 15, 2019.