Home Medizin Der Masernausbruch in Illinois unterstreicht die dringende Notwendigkeit einer Impfung

Der Masernausbruch in Illinois unterstreicht die dringende Notwendigkeit einer Impfung

von NFI Redaktion

In a recent study published in the Morbidity and Mortality Weekly Report (MMWR), researchers from Illinois, United States of America (USA), reported on the occurrence of five cases of measles in unvaccinated children living in the same building but with no contact between them.

Measles outbreak in Illinois underscores critical need for vaccination

Notizen aus der Praxis: Masernausbruch – Cook County, Illinois, Oktober–November 2023. Bildquelle: adriaticfoto / Shutterstock

Background

Measles is a vaccine-preventable infectious disease and poses a significant health risk. In the USA, it is recommended that children receive two doses of the measles, mumps, and rubella (MMR) vaccine, typically at ages 12-15 months and 4-6 years. This study describes a concerning case of a measles outbreak in five unvaccinated children from two families living in the same building without contact with each other.

The Case

On October 5, 2023, Patient A, a 2-year-old immigrant from Yemen, was diagnosed with an unspecified viral illness in the emergency department (ED) of Hospital A after testing negative for influenza, COVID-19, and respiratory syncytial virus. Patient A had not received the MMR vaccine and had symptoms of fever, cough, and runny nose. On October 8, Patient A visited the emergency department of Hospital B for worsening respiratory symptoms and tested positive for rhinovirus/enterovirus. Patient A was then re-admitted to Hospital A for difficulty breathing.

Remarkably, the next day in the hospital, Patient A developed a maculopapular rash. On October 10, the family disclosed that they had contact with a person diagnosed with measles before entering the USA. Measles were confirmed using real-time reverse transcription polymerase chain reaction (RT-PCR), and the patient was discharged.

Investigations

Between October 5 and 11, the child potentially exposed 247 healthcare workers, 177 patients and visitors, including 13 infants under one year, five immunocompromised children, and one unvaccinated child over one year. Two of these children received the MMR vaccine within three days of exposure, while 13 received immunoglobulin as a precaution.

Among the household contacts of Patient A were two siblings, both unvaccinated for MMR and found susceptible to measles through serologic testing. The siblings were Patient B, aged four, and Patient C, aged nine. The siblings developed measles with varying symptoms during quarantine. Although Patient B required an emergency department visit for supportive care, neither child was hospitalized. All building residents were alerted on October 17.

On October 30, Patient D, another 2-year-old child, visited the emergency department with symptoms and lived on a different floor in the same building as Patient A. The child had not received the MMR vaccine due to parental concerns about vaccine side effects. Measles were confirmed by RT-PCR.

Interestingly, the families of both patient groups had different cultural backgrounds and languages, although they lived in the same building. While their living units did not share ventilation systems, they did share the laundry room and building entrances.

On October 31, Patient E, the unvaccinated one-year-old brother of Patient D, was tested for isolated runny nose. The child attended a childcare facility on October 30 while symptomatic and tested positive for measles by RT-PCR. Post-exposure prophylaxis was administered to susceptible individuals, including immunoglobulin for one child and an early second dose of MMR vaccine for others. Patient E only developed a fever on November 6 and a rash on November 9, nine days after the positive test result and notification to the childcare facility.

While measles testing is usually done when prodromal symptoms like cough, fever, runny nose, or conjunctivitis occur, the isolated runny nose experienced by Patient E may not have been associated with measles. Since measles testing before the onset of fever is rare, determining the exact infectious period for this patient was a challenge. Patient E did not require hospitalization.

Discussion

Five children became ill in this outbreak of measles. They were unvaccinated, despite cultural barriers, restricted access to healthcare, and vaccine refusal for the MMR vaccine being factors. While outbreaks have been observed in closely connected communities before, the current families were not part of such networks. Public health measures typically involve tailored approaches such as culturally appropriate educational materials and translation services. However, these efforts are costly and time-consuming. This outbreak emphasizes the high contagion risk of measles, even among children with no contact with each other.

Conclusion

In conclusion, the study highlights the need for all children and vulnerable individuals to receive two doses of the MMR vaccine at appropriate intervals. Physicians should suspect measles in patients with febrile rash and ensure vaccination to prevent future outbreaks.

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