Please distribute to all providers and relevant medical staff in your office.

DATE: March 8, 2024
TO: Healthcare Providers
FROM: Dr. Maggie Park, Public Health Officer

Situation:

Please be advised that a case of measles has recently been confirmed in San Joaquin County. The patient is a child who was exposed to measles overseas prior to arriving to the U.S. and presenting to a local urgent care. San Joaquin County Public Health Services (SJCPHS) is conducting contact investigations of exposure cases.

Background:

There were no cases of measles reported in California in 2022. In 2023, California had 4 cases of measles. Our case in San Joaquin is the 3rd measles case in California for 2024, and the first in our county since 2014. Measles is a highly contagious viral disease that can lead to serious complications, especially in unimmunized persons. About 9 out of 10 people who are not protected will become infected following exposure to the measles virus. Risk factors include international travel and contact with international visitors. The MMR (measles, mumps, rubella) vaccine is highly protective.

Clinical Presentation:

Measles is characterized by a prodrome of fever (as high as 105 F) that lasts for a couple of days, followed by a cough, coryza, and conjunctivitis-the three “C”s , a pathognomonic enanthema (Koplik spots) followed by a maculopapular rash that spreads from the head to the trunk to the lower extremities. Patients are contagious from 4 days before to 4 days after the rash appears. The incubation period is typically 10-12 days from exposure, with the rash usually appearing about 14 days after exposure.

Actions Requested of Clinicians:

• Suspect measles if there are compatible symptoms and risk factors.
• Isolate the patient immediately, ideally in a single-patient airborne infection isolation room (AIIR) if possible, or in a private room with a closed door until AIIR is available.
• Adhere to standard and airborne precautions
• Immediately notify the facility infection control program and SJCPHS Disease Control and Prevention Program (209) 468-3822. After hours, call (209) 468-6000 and ask to speak with the on-call public health nurse. SJCPHS will assist with laboratory testing guidance and proper isolation and quarantine procedures.

Resources:

Centers for Disease Control and Prevention (CDC) infection control recommendations, click here

California Department of Public Health (CDPH) infection control recommendations, click here

CDPH EZIZ Measles Resources, click here

CDPH’s Immunization Branch, click here

COCA Now measles message, click here