Possible Alaska Case?

A 12-month-old infant who traveled to San Diego and Las Vegas (but NOT Disneyland, which had been incorrectly reported previously) during December 31 through January 12, developed a mild febrile illness on January 15, 3 days after returning to Alaska. The child then developed a rash on January 16 on the right lower extremity. A nasopharyngeal swab was obtained on January 21, and tested positive via polymerase chain reaction (PCR) for measles virus on January 23. However, the child had received measles vaccine on January 13, which can cause the PCR test to be positive (and can cause a mild febrile illness). Thus, there is a high potential that this was not a true case of measles.

Additional testing is being performed to determine if this positive PCR result was caused by the vaccination; the results of this additional testing should be available late next week. Measles can be a serious illness, especially for high-risk persons (i.e., infants, pregnant women, and immunocompromised persons). As such, out of an abundance of caution, the Alaska Section of Epidemiology is notifying high-risk persons who were in close contact to this infant and might be eligible for post-exposure prophylaxis.  No further public health action is currently indicated due to the low likelihood of this being a true measles case. However, the Section of Epidemiology encourages all Alaskans to ensure they (and their children) are up-to-date on their immunization status.

Disneyland Outbreak Background

Measles has been confirmed in 68 California residents in 2015. Of the confirmed cases, 42 have been linked to Disneyland or Disney California Adventure Park in Anaheim, California. Related cases have occurred in three Utah residents, two Washington residents, one Colorado resident, one Oregon resident, and one resident of Mexico. A number of additional suspect cases are under investigation and many large contact investigations are ongoing. The confirmed cases include five Disney employees; four of whom worked at the parks and one who is believed to have been infected as a guest. Initial exposures occurred in December, but additional confirmed cases visited Disney parks while infectious in January.

Measles Basics

Measles is a highly contagious respiratory disease caused by a virus. It spreads through the air through coughing and sneezing. Measles starts with a fever, runny nose, cough, red eyes, and sore throat, and is followed by a rash that spreads all over the body. About three out of 10 people who get measles will develop one or more complications including pneumonia, ear infections, or diarrhea. Complications are more common in adults and young children.

Incubation period:       Typically prodrome symptoms at 8-12 days after exposure, rash onset at 14 days (range 7-21 days)

Infectious period:        4 days before rash onset through 4 days after rash onset

Lab diagnosis:             Contact the Section of Epidemiology to facilitate testing

• Obtain a throat or nasopharyngeal swab; use a viral culturette and place into viral transport media (other media types can inhibit viral growth).
• Draw 7-10 ml of blood in a red-top or serum separator tube; spin down serum if possible. NOTE: capillary blood (approximately 3 capillary tubes to yield 100 μl of serum) may be collected in situations where venipuncture is not preferred (e.g., in children aged <1 year).
• Collect 50-100 ml of urine in a sterile centrifuge tube or urine specimen container.

(See Alaska Section of Laboratories Test Directory, Rubeola (Measles) on page 43:https://dhss.alaska.gov/dph/Labs/Documents/LaboratoryTests.pdf.)

Surveillance and Reporting

Measles is a serious disease. Healthcare providers in Alaska should consider measles in patients with febrile rash illness and clinically compatible measles symptoms (conjunctivitis, cough, coryza), especially if the person recently traveled internationally or was exposed to a person with febrile rash illness. Suspected cases should be promptly isolated. Healthcare providers should report suspected measles cases within 24 hours by calling the State of Alaska, Section of Epidemiology at (907) 269-8000 or (800) 478-0084 after hours.

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