Measles, once relegated to the U.S. history books, is once more a part of current events, and cases may start to become routine at medical practices around the country.
As of Monday, May 13, the CDC reported a total of 839 measles cases in 23 states across the country, with 75 new cases from the previous week, for the greatest number reported in the U.S. since 1994.
Aaron Glatt, MD, spokesperson for the Infectious Diseases Society of America (IDSA) and chairman of medicine at South Nassau Communities Hospital in Oceanside, New York, said that physicians should have "heightened suspicions" for illness, especially from patients coming from endemic areas -- even without a rash.
"As a physician, we should be worried about patients coming in with a rash, fevers, conjunctivitis, sore throat. But if you haven't had cases in your area, they're going to surprise you unless they come in with a rash," he told MedPage Today.
Because importation of measles from abroad has played a major role in this outbreak, Glatt also recommended that clinicians do a thorough travel history for any patient who they suspect has been exposed to the illness.
Glatt added that the CDC now recommends that infants as young as 6 months receive the measles, mumps, and rubella (MMR) vaccine prior to international travel. He said that it would be "worthwhile" for older patients who were vaccinated in 1963-1968 to get their titers checked.
Steven Goldstein, MD, is a pediatrician in New York City, and chair of the American Academy of Pediatrics (AAP) New York chapter. When he spoke with MedPage Today, he had just been speaking about a patient who may have been exposed to measles, and had 2-3 days of fever.
But because rash is a relatively late symptom of measles, patients could be showing up at doctor's offices and unknowingly expose not only the patients, but also the office staff.
"Every single doctor's office in the country should make sure their staff has had their measles titers checked, because you don't want the staff coming down with measles," Goldstein said. "And you have to be careful about bringing patients into the office during the time that they don't have a rash -- it could put everyone else at risk."
Goldstein said that measles in his area has had a "dampening effect" on families coming in for well child visits, fearing unintended exposure.
Glatt said that physicians have been going out to patients' cars to examine them rather than bringing them into an area with lots of other kids.
"Ideally, there should be a room [in the doctor's office] where [patients] can quickly be segregated into a special area," he noted.
Goldstein said that pediatricians should pre-screen patients beforehand -- asking them over the phone if they have a fever, rash, or if they were exposed to measles. If the doctor suspects measles exposure, patients should either be seen in an "abbreviated visit" outside the office or as the very last patient of the day. Due to how contagious measles is, Goldstein said he has had to close his office for 2 hours after a patient comes in with measles exposure.
"We've [seen patients] in the office, after the office was closed. I'll ask them to come in at the end of the day if I think measles is a possibility," Goldstein said.
This is of particular concern for patients too young to get the MMR vaccine. Goldstein said that he has been cognizant of the fact that when young babies have come in to an office with measles exposure, they have to get an immunoglobulin shot and be isolated for 28 days.
Goldstein also called the resurgence of measles in the U.S. is a "real game-changer" for both pediatric and adult practices, because so many more patients are at risk now than the last time measles was commonplace in the U.S.
"This has the potential to create chaos in ERs and doctors' offices, because so many people are on immunosuppressive therapies and chemotherapy," he said. "It's not fair to them, and to the huge number of babies under 6 months in these communities that can't be vaccinated yet."
Above all, Glatt said that all doctors should be making sure their patients are up to date with their vaccines. And Goldstein reiterated the importance of staying vigilant for signs of measles in all patients, given its resurgence in the country.
"Even if you're not seeing it yet, remember that it's out there, and we don't know where it's going to show up next," he said.
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