Measles in Texas – Provider Guidance - Community First Health Plans

Confirmed cases of measles have been reported in the South Plains and Panhandle regions of Texas, with the outbreak linked to community transmission and exposure from international travel. There is an urgent need for awareness and proactive steps to prevent further spread.

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Clinical Overview of Measles:

Measles is a highly contagious respiratory illness, which can cause life-threatening illness to anyone who is not protected against the virus. It can be transmitted by direct contact with infectious droplets or by airborne spread when an infected person breathes, coughs, or sneezes.
People who are infected will begin to have symptoms within a week or two after being exposed. Early symptoms include high fever, cough, runny nose, and red, watery eyes. A few days later, the telltale rash breaks out as flat, red spots on the face and then spreads down the neck and trunk to the rest of the body. A person is contagious about four days before the rash appears to four days after. People who could have measles should stay home during that period.
The best method of prevention is immunization with two doses of a measles-containing vaccine, which is primarily administered as the combination measles-mumps-rubella or MMR vaccine. Two doses of the MMR vaccine prevent more than 97% of measles infections. A small number of vaccinated people can occasionally develop measles. In these cases, the symptoms are generally milder, and they are less likely to spread the disease to other people.
Suspected measles cases should be roomed immediately upon arrival at the clinic. Providers and staff should wear appropriate PPE when assessing a suspected measles infected patient. Isolate infected patients for 4 days after they develop a rash and follow airborne precautions in health care settings. Laboratory confirmation is essential for all sporadic measles cases and all outbreaks.
Providers should report any suspected cases to their local health department immediately, preferably while the patient is still with the provider. 24/7 number for immediately reportable: 1-800-705-8868
Health care providers can find recommendations for infection control and diagnostic testing through DSHS health alerts. DSHS posts additional information about outbreak cases on Tuesdays and Fridays online at DSHS.Texas.gov/news-alerts.

Clinical Features:

Measles is an acute viral respiratory illness. It is characterized by:

A prodrome of fever (as high as 105°F), malaise, and cough, coryza, and conjunctivitis (three “C”s)
A pathognomonic enanthema (Koplik spots)
Followed by a maculopapular rash

The rash usually appears about 14 days after a person is exposed. The rash spreads from the head to the trunk to the lower extremities.

Measles Vaccine Recommendations:

Measles vaccine is included in MMR vaccine and MMRV vaccine; MMRV is only licensed for children 1–12 years old. CDC recommends children receive 2 doses of MMR vaccine.
Adults and teens should also be up to date on MMR vaccinations with either 1 or 2 doses (depending on risk factors); unless they have other presumptive evidence of immunity to measles, mumps, and rubella.
Measles vaccine is recommended for vaccinating people in specific groups who do not have evidence of immunity against measles, including college students, international travelers, health care personnel, close contacts of immunocompromised people, people with HIV infection, adults who got inactivated measles vaccine, groups at increased risk during measles outbreak

Post-exposure Prophylaxis for Measles

To potentially provide protection or modify the clinical course of disease among susceptible persons, administer one of these:

MMR vaccine, if administered within 72 hours of initial measles exposure.
Immunoglobulin (IG), if administered within 6 days of exposure. The recommended dose for intramuscular immunoglobulin (IMIG) is 0.5mL/kg, regardless of the contact’s immune status.

Please review CDC Measles Vaccine Recommendations for additional information about routine recommendations, post-exposure prophylaxis for measles, considerations for specific groups, and MMR and MMRV contraindications and precautions.

CDC Resources for Providers:

Interim Infection Prevention and Control Recommendations for Measles in Healthcare Settings
Vaccine Safety (MMR | MMRV)
Vaccine Information Statements (MMR | MMRV)
Immunization schedules (Child and adolescent | Adult)
Vaccines For Children Program Information for Providers
Ask the Experts: MMR | Immunize.org
Surveillance Manuals (Measles | Mumps | Rubella)
Pink Book (Measles | Mumps | Rubella)
Clinical overview (Measles | Mumps | Rubella)

Action:

Providers are encouraged to share this information with their staff. If you have any questions about this notice, please email Provider Relations at ProviderRelations@cfhp.com or call 210-358-6294. You can also contact your Provider Relations Representative directly.

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