EM:RAP 2019 June SNACK - Measles

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No me gusta!

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Ian L. -

What of post exposure prophylaxis for unvaccinated contacts : Attentuated vaccine or Passive Immunisation with immunoglobin for Immunocomprimised or Pregnant after antibody titres taken if time avails ?

Emergency NP -


Emergency NP -

Ian see above the indication for immune globulin ,MMR should not be given with IG . Remember vit A

ilene c. -

Thank you Emergency NP- you beat me to it!!! Short answer: for anyone high risk (little, sick, pregnant) immunoglobulin (dosing differs). This may interfere with the immunogenicity of the vaccine, so vaccine best delayed or given again ~6 mo later (or titers checked later). Here is the 2019 post-exposure prophylaxis grid (https://www.cdph.ca.gov/Programs/CID/DCDC/CDPH%20Document%20Library/Immunization/Measles-Quicksheet.pdf) and here is the summary:

MMR vaccine can be given as PEP <72 hours of exposure to persons >6 months of age who do not have contraindications for MMR vaccine. However, IMIG is preferred as PEP for exposed infants <12 months of age <6 days of exposure. Persons >12 months of age who may have been vaccinated or had disease and receive MMR vaccine as PEP should have blood drawn and tested for measles IgG if measles IgG status is unknown at the time of MMR administration. Contacts at high risk of severe infection (severely immunocompromised people, unvaccinated infants, and susceptible pregnant
women) should receive IG PEP <6 days of last exposure to measles. If it can be done rapidly, it is recommended that pregnant women be tested for measles IgG prior to administering IGIV if it is likely that they have received vaccine or had disease.

Ken B. -

Thanks for the review...but it lacks one thing. In a "rashy" anxious world there is no pearl that can trigger our Gestalt because we lack the experience that triggers our inner red flag.
I graduated in '76 and my first patient on my ICU rotation was a 6 y/o who eventually died of measles pneumonia. In my internship high risk obs. rotation we had not one but two women with near term pregnancies who were brain dead with SSPE. We had them side by side with a crash section kit on the table between them.
My last case of active measles was 1989, red as a beet, temp of 104ยบ in labour (in our 20 bed hospital).
My pearl. I did all my undergrad peds training at Sick Kids in Toronto. Our ID rounds each morning was full of pearls. For measles, "Measles is a Cough NOT a Rash". We were taught that if you are confronted by a worried parent whos kid has a rash or a rash and fever but No Cough , measles is unlikely. In the days when I saw lots I could identify the "hard brassy cough" of measles across the room in ER as easily as I could a croupy one. Hope this is helpful to someone.
Ken Babey
Asst Chief of Staff Kitikmeot Region
Nunavut Canada

Melinda N. -

thank you

ilene c. -

Great pearl. There is nothing like experience with the illness and I appreciate your pearls

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EM:RAP 2019 June SNACK Full episode audio for MD edition 34:16 min - 65 MB - M4A