Due to routine childhood immunization with the MMR vaccine, measles was declared eliminated from the United States in 2000. That disease elimination success story is currently in jeopardy as, according to CDC, from January 1 to May 10, 2019, 839 individual cases of measles have been confirmed in 23 states. This was an increase of 75 cases from the previous week and is the greatest number of cases reported in the U.S. since 1994. Measles has received extensive media attention, in Massachusetts and nationally, during the first few months of 2019.
In Massachusetts there has been one confirmed case to date in 2019, out of 87 cases investigated. Last year, in contrast, 24 suspected measles cases were investigated during the same time period (with zero confirmed cases).
The recent confirmed case in Massachusetts received quite a bit of publicity following an MDPH press release on 4/1/19 describing possible public exposures throughout the state. Individual towns where exposures took place were notified by MDPH epidemiologists. Forty of the 85 suspected cases of measles in MA in 2019 have been reported since 4/1/19. Clearly, healthcare providers are suspecting measles in patients with compatible illness. There were no secondary cases identified.
There have also been measles exposures on airlines involving Massachusetts passengers, a traveler with measles who went through Boston by bus in February, and several rumors about measles in Massachusetts that have turned out to be false.
MDPH issued a Clinical Measles Alert on 4/17/19, urging healthcare providers to do the following:
- Assess staff and patient immunity to measles today, and vaccinate those without evidence of immunity**
- Consider measles in patients who:
· Present with febrile rash illness and clinically compatible measles symptoms (cough, coryza [runny nose] or conjunctivitis)
· Recently traveled internationally or were exposed to someone who recently traveled
· Have not been vaccinated against measles
- If you suspect measles, do the following immediately:
- Promptly isolate patients to minimize disease transmission.
- Immediately report a suspect measles case to your local board of health and to the MDPH Divisions of Epidemiology and Immunization at 617-983-6800. Cases diagnosed in Boston should be reported to the Boston Public Health Commission at 617-534-5611.
- Obtain specimens for testing from patients with suspected measles, including serum and an NP swab or throat swab. Call 617-983-6800 to arrange testing at the MA State Public Health Laboratory.
A press release recommending MMR vaccination entitled “Public Health Officials Urge Massachusetts Residents to Get Vaccinated Against Measles Now” was posted on the MDPH website on 4/30/19.
Upcoming measles-related training: A CDC Clinician Outreach and Communication Activity (COCA) conference call is scheduled on Tuesday, May 21, from 2-3 PM, entitled Most Measles Cases in 25 Years: Is This the End of Measles Elimination in the United States? For more information go to https://emergency.cdc.gov/coca/calls/2019/callinfo_052119.asp.
MDPH Immunization Updates: Measles is also discussed by MDPH epidemiologists at the regional Immunization Updates taking place this spring. There are still in-person trainings and webinars available: https://www.cvent.com/c/calendar/00ec68b6-9d14-4d2b-879b-70c63e3aac96.
CDC Measles Toolkit and Other Resources for Healthcare Providers
CDC Measles Toolkits for healthcare providers and state/local health departments: CDC has recently developed web-based tools (posters, fact sheets, FAQs) for measles education and control. They are available at https://www.cdc.gov/measles/toolkit/index.html and will have items added to them as they are developed. For up-to-date answers to questions, visit Frequently Asked Questions (FAQs) about Measles in the U.S. at https://www.cdc.gov/measles/about/faqs.html
CDC Measles Website: https://www.cdc.gov/measles/index.html
CDC MMR FAQs for Healthcare Providers: https://www.cdc.gov/vaccines/vpd/mmr/hcp/index.html
CDC Measles FAQs: https://www.cdc.gov/measles/about/faqs.html
CDC measles fact sheet for parents (available in English and Spanish):
MDPH Measles Chapter: https://www.mass.gov/doc/measles-2016/download
- Appendix A and B of the measles chapter contain measles specimen collection instructions, and a one-page document describing initial steps to take when measles is suspected in a provider office.
MDPH Measles Fact Sheets:
Have questions about immunizations? Contact us!Immunization Division | 617-983-6800Vaccine Unit | 617-983-6828MIIS Help Desk | 617-983-4335
MMR Vaccination and Int’l Travel,
Evidence of Immunity
MMR Vaccination Before International Travel
Before any international travel—
- Infants 6—11 months old need 1 dose of measles vaccine. Infants who get one dose of MMR vaccine before their first birthday should get two more doses according to the routinely recommended schedule (one dose at 12 through 15 months of age and another dose at 4 through 6 years of age or at least 28 days later).
- Children 12 months and older need 2 doses separated by at least 28 days
- Teenagers and adults who do not have evidence of immunity** against measles should get 2 doses separated by at least 28 days
**Evidence of Immunity
Acceptable presumptive evidence of immunity against measles includes at least one of the following:
- Written documentation of adequate vaccination: one or more doses of a measles-containing vaccine administered on or after the first birthday for preschool-age children and adults not at high risk; two doses of measles-containing vaccine for school-age children and adults at high risk, including college students, healthcare personnel, and international travelers
- Laboratory evidence of immunity
- Laboratory confirmation of measles
- Birth before 1957 (year of birth is not acceptable evidence of immunity for healthcare providers)
Please call MDPH at 617-983-6800 if you have questions and concerns about measles.
Divisions of Epidemiology and Immunization
Bureau of Infectious Disease and Laboratory Sciences
Massachusetts Department of Public Health (MDPH)
305 South Street, Jamaica Plain, MA 02130