What you need to know
Information last updated on May 29, 2019
The New Jersey Department of Health (NJDOH) has declared the 2019 Ocean County measles outbreak to be over.
Between March 2019 and May 2019, the NJDOH confirmed 12 measles outbreak-associated cases in Ocean and Monmouth counties. As of May 16, two incubation periods (a total of 42 days) have passed from the last day the last known case was infectious. Because no new cases have been identified during this period, the New Jersey outbreak is considered over.
NJDOH is still urging providers to stay vigilant due to New York’s ongoing outbreaks. As of May 24, 535 measles cases have been confirmed in Brooklyn and Queens since September while New York’s Rockland County has confirmed more than 250 cases.
The United States is dealing with its largest number of measles cases on record since 1994 with 940 confirmed cases across 26 states.
N.J. Department of Health Resources
- Measles Outbreak Clinical Quick Guide
- 2019 Measles Outbreak—Information for Clinicians
- What You Need to Know: Ocean County’s 2019 Measles Outbreak
This recent outbreak could present the opportunity for you to discuss vaccinations with your patients. A reminder the measles vaccine should be considered in all exposed individuals who are vaccine-eligible and who have not been vaccinated or have received only 1 dose of vaccine. The second measles vaccine can be given as early as 28 days after the first measles vaccine dose.
- Children as young as 6 months may receive the vaccine, but a measles vaccine administered prior to 1 year of age will not count toward requirements for school later on.
- Children less than 6 months of age, pregnant women without evidence of measles immunity, and severely immunocompromised people are at high risk of complications from measles and should be offered intramuscular immunoglobulin within 6 days of the exposure.
Measles Clinical Presentation
The symptoms of measles generally appear in about seven to 14 days after a person is infected. Measles prodrome starts 3-4 days before rash onset. The prodrome includes high fever, cough, coryza and conjunctivitis. Koplik spots may appear inside the cheeks. The subsequent maculopapular rash begins on the forehead and spreads downward to the feet. There is no specific antiviral treatment for measles and care is supportive. Click here to see a CDC video describing measles clinical features.
Management of Pregnant and Reproductive-Aged Women
- Practice Advisory from the American College of Obstetricians and Gynecologists Released on April 26, 2019
- Measles & the MMR Vaccine: Recommendations Around Pregnancy, including the Periconception and Postpatrum Periods (University of Washington)
What To Do If You Have a Possible Case of Measles
If you suspect measles, you must act immediately to minimize the risk of transmission to others. Remember to isolate based on clinical suspicion. Do not wait for laboratory confirmation to isolate.
- Office-based Practices: Place a surgical mask on the patient and place the patient in an unoccupied exam room. Staff should wear an N95 respirator when in the same room as the patient. Notify your local Health Department immediately. The Health Department can advise on and facilitate approval for appropriate testing. If patients do not require hospitalization, management, including testing, should remain in the outpatient setting. If referring a patient to an emergency room or urgent care, you must call ahead and alert the facility so they can initiate the proper isolation procedures.
- Emergency Departments: Remove patient from waiting area and place patient in a negative-pressure isolation room and observe airborne precautions. Notify your hospital’s Infection Control Department immediately.
Measles Vaccine History
Before the use of measles vaccine in the U.S., measles occurred in an estimated 3 to 4 million people resulting in 48,000 hospitalizations, 4,000 cases of chronic disability from measles encephalitis and 400-500 deaths annually. The measles vaccine is 97% effective in preventing the infection after receiving two doses. Incorporation of the measles vaccine into the childhood immunization coverage resulted in widespread immunity and the near elimination of measles in the U.S. Unfortunately, there are number of communities who are oppose to vaccination resulting in an increasing number of children who are susceptible and at risk for acquiring measles and other vaccine preventable disease. In the U.S., more than 900 cases have been reported from January 1 to May 24, 2019 compared to 372 cases for all of 2018 (see chart above).