On February 19, 2014, the Allegheny County Health Department (ACHD) was notified of a measles case in a fully vaccinated (two doses in childhood) 22-year-old Allegheny County resident who works in a research center, which is housed in a large cancer hospital, in Allegheny County. The case-patient was exposed on 1/31 to a confirmed measles case in New York State.
The case-patient developed a fever on 2/14 peaking at 102.5°F (39.2°C) on 2/16, a dry cough and sore throat on 2/15, and a facial maculopapular rash on 2/18. The rash resolved by 2/21. Measles infection was confirmed by positive IgM, positive IgG, and positive urine RT-PCR.
Times, dates and locations where people may have been exposed to the case include the following:
The 64 Port Authority bus on Friday, February 14, between 9 and 11 a.m.
Main entrance to the Hillman Cancer Center in Shadyside on Friday, February 14, between 9:30 a.m. and 3:30 p.m. and between 7 and 9 p.m.
Bridgeside Point II Building in the Pittsburgh Technology Center on Friday, February 14, between 12 and 3 p.m.
5215 Centre Avenue in Shadyside, the building that houses Stull, Jarvis and Spinola medical practice and the Shadyside Family Health Center, on Tuesday, February 18, between 11:00 a.m. and 2 p.m.
Based on the dates of exposure, it is possible that symptoms in infected contacts could develop between now and March 11.
Tracking of known contacts in all of these settings has been undertaken to reduce the potential for additional measles transmission. Media coverage has been promoted to notify the general public.
It is possible that members of the public were exposed to the ill person in other unrecognized settings. In light of this possibility and the overall increase in measles cases being seen in the United States in recent years, the Allegheny County Health Department and Pennsylvania Department of Health requests that all health care providers maintain a high index of suspicion for measles in persons with a febrile rash illness, especially in those with no history of measles vaccination.
Consider measles as a diagnosis in anyone with a febrile rash illness lasting three days or more, a temperature of 101ºF (38.3ºC) or higher, and clinically compatible symptoms (cough, coryza and/or conjunctivitis) who has recently traveled abroad or who has had contact with someone with a febrile rash illness. Immunocompromised patients may not exhibit rash or may exhibit an atypical rash. The incubation period for measles from exposure to fever is usually about 10 days (range, seven to 12 days) and from exposure to rash onset is usually 14 days (range, seven to 21 days).
While most people are not at risk because they have been immunized or have had measles, the following groups of individuals are susceptible to becoming infected with measles:
Anyone born since 1957 who has not received two doses of effective measles vaccine known as MMR, which would include infants too young to have been immunized; persons who were vaccinated with an inactivated vaccine, which was used from 1963 through 1967, and have not been re-vaccinated; and those who refused vaccination.
Persons whose immune systems are compromised due to disease or medication.
If measles is suspected, the illness should be immediately reported to the Allegheny County Health Department at 412-687-2243 or the Pennsylvania Department of Health at 877-724-3258 to facilitate consultation and to assist with diagnosis, tracking of contacts and initiation of control measures.
Providers suspecting measles should do the following:
Advise patients who call not to expose others. Arrange for exam in isolated area if indicated
Should a suspected case present for care, place a mask on patient and isolate immediately
Obtain specimens for testing, including viral specimens for confirmation and genotyping.
Contact the Allegheny County Health Department or the PA Department of Health at the numbers above
The Pennsylvania Department of Health urges all health care providers to assure their patients are vaccinated against measles and other vaccine-preventable diseases.
Categories of Health Alert messages:
Health Alert: conveys the highest level of importance; warrants immediate action or attention.
Health Advisory: provides important information for a specific incident or situation; may not require immediate action.
Health Update: provides updated information regarding an incident or situation; no immediate action necessary.
Michael Wolf, Secretary of Health