Question

• What public health and education measures have been taken during recent outbreaks to monitor and track the Measles in the community?

Answer 1

Measles - Infection prevention and control

Measles can be prevented by vaccination with the measles, mumps and rubella (MMR) vaccine. High uptake is vital in the control of measles, and for the prevention of outbreaks; to obtain herd immunity the WHO recommends 95% of the eligible population be vaccinated. Herd immunity occurs when a high proportion of individuals are immune to a contagious disease, especially through vaccination.

To ensure satisfactory protection, two doses of the vaccine are required; the first is usually offered at the age of 12 months and the second at three years and four months, although missed doses can be offered at any age including adulthood. Vaccination is especially recommended to individuals travelling to countries that have an ongoing measles outbreak or areas where measles is endemic.

It is vital that occupational health services ensure frontline healthcare staff have had two MMR vaccines to ensure they are protected and to prevent onwards transmission to vulnerable patients, such as those who are immunocompromised.

Control and management of measles is challenging, as the disease is highly contagious and can be transmitted by coughing and sneezing or direct face-to-face contact. People with measles are infectious from four days before their rash appears to four days after it has disappeared. There is a risk of contracting measles after only 15 minutes in a room with a contagious patient. In hospital, it is essential to isolate any suspected case of measles. People diagnosed with measles need to be excluded from school or work for four days after the onset of a measles rash. They should avoid public places and contact with unvaccinated people, immunocompromised people and pregnant women. Good hand hygiene is also important in preventing the spread of disease.

Health protection services

1. Assessment of close contacts

It is sometimes necessary to follow up measles exposure in a healthcare setting where patients have not been appropriately isolated. This involves contact tracing and identifying vulnerable contacts (such as pregnant women or immunocompromised people) and sending out warning and information letters. Local health protection teams will indicate whether this is necessary and support nurses in this process

2. Preventing measles virus while traveling

The best protection is to get vaccinated with MMR (measles, mumps and rubella) six weeks before travelling abroad. Health professionals can interpret age and vaccine history to determine the vaccines that the body needs, and this can be categorised as follows:

ü Travellers born before 1970 who are not immune to measles should get one dose of the MMR vaccine

ü Those who are born in or after 1970 and not immune to measles should get one dose of the MMR vaccine

Besides vaccination, travellers are advised to:

ü Keep hygiene habits and cleanliness by washing hands frequently especially after touching public installations and before touching your nose, eyes and mouth.

ü Cover the nose and mouth with a surgical mask when having respiratory symptoms.

ü Regularly disinfect surfaces that are touched frequently.

ü Check and get your MMR vaccine before travelling as vaccination protects you and those who are not vaccinated.

Public health activities in response to a measles outbreak.

• Assemble an outbreak control team or response committee

• Determine coverage in affected and surrounding areas

• Enhance surveillance, i.e., active case-finding for additional cases- You should have a high clinical suspicion of measles if your patient:

ü Is unvaccinated/partially vaccinated;

ü Recently travelled to an endemic area or one with an ongoing outbreak;

ü Has had contact with a person with measles;

ü Belongs to/has contact with communities likely to be unvaccinated.

• Inform the public and other appropriate health authorities

• Educate case-patients and their contacts about the mode of transmission and on measures to minimize measles spread

Create awareness regarding Measles symptoms- Measles usually begins with a high fever, runny nose, cough and sore red eyes, followed by uncomfortable rash starting behind the ears and spreading to the body. The rash makes itself known about three to five days after infection. Some may experience the symptoms after one or two weeks after coming in contact with the virus. Loss of appetite and malaise are common symptoms as well. Some people may develop complications such as ear infections, pneumonia, diarrhea or in rare cases inflammation of the brain. These complications mostly arise in people whose immune systems are already weakened due to age, pre-existing diseases or malnutrition.

• Proper case management, including administration of vitamin A as indicated

• Obtain specimens for laboratory confirmation and viral detection

• Implement control activities to limit virus transmission

ü ○ Provide measles vaccine to unvaccinated persons

ü ○ Assess immunity of contacts of cases, offer post-exposure prophylaxis (vaccine, immunoglobulin) to those susceptible

ü ○ Implement isolation, quarantine, exclusion in households as needed

• Collect detailed data on cases and outbreak response

• Analyze and summarize outbreak, including other available surveillance and measles vaccine coverage data, to determine whether there is evidence of population immunity gaps that require public health action; disseminate these findings to pertinent stakeholders