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Two Cases of Measles Confirmed in NW Michigan

Please share the following with all primary care personnel, urgent/emergency care clinicians,
and infection control/prevention specialists.

Two cases of measles have been confirmed in northwest Michigan. Both cases lacked a vaccination history against measles and recently had traveled to the Philippines where they were exposed. These are the first measles cases in Michigan in 2014. The public health investigation and response is currently ongoing.

Since late 2013 the Philippines has been experiencing a measles outbreak, exceeding 50,000 cases and over 100 deaths. Other Western Pacific Region countries have also been reporting measles outbreaks. In addition measles is endemic in many other parts of the world. This year the U.S. has experienced considerably more measles cases than usual with over 600 confirmed measles cases, the most in the U.S since 1994.

Many healthcare providers in the United States have never seen a patient with measles and may not recognize the signs and symptoms.

Michigan healthcare providers should consider measles in the initial differential diagnosis of patients who
a. present with febrile rash illness and clinically compatible measles symptoms [cough, coryza (or runny nose) or conjunctivitis (pink eye)] b. recently traveled internationally or were exposed to someone who recently traveled
c. have not been vaccinated against measles

If you suspect measles in a patient, do the following immediately:

1.Promptly isolate patients to avoid disease transmission; measles is highly communicable.
2.Immediately report the suspect measles case to their health department.
3.Obtain specimens for testing from patients with suspected measles, including viral specimens - recommended specimens are 1) serum and 2) throat swab (place swab in viral transport media)

All international travelers should be protected against measles. Persons uncertain of their measles vaccination history or immunity status should receive measles-containing vaccine, such as MMR, preferably 2 or more weeks prior to start of travel.

CDC guidance for healthcare providers can be found at http://www.cdc.gov/measles/hcp/index.html and http://www.cdc.gov/vaccines/pubs/surv-manual/chpt07-measles.html.

Additional Michigan guidance (Key Facts about Measles) is available at
http://www.michigan.gov/documents/mdch/KeyFacts_Measles_392862_7.pdf

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