A case of measles has been confirmed in an adult who traveled to Orange County. The person began having symptoms prior to arrival. Potential exposures may have occurred at several locations in Anaheim:

• July 26 – Denny’s Restaurant (1168 W Katella Ave, Anaheim, CA 92802) from 7:00 p.m. – 9:00 p.m.
• July 27 – CVS Pharmacy (1803 S Harbor Blvd, Anaheim, CA 92802) from 12:45 p.m. – 2:00 p.m.
• July 27 – Walmart (1120 S Anaheim Blvd, Anaheim, CA 92805) from 1:00 p.m. – 3:30 p.m. 
• July 28 – Anaheim Global Medical Center Emergency Department (1025 S Anaheim Blvd, Anaheim, CA 92805) from 2:00 p.m. – 5:00 p.m.
• July 28 – CVS Pharmacy (1676 W Katella Ave, Anaheim CA 92802) from 4:00 p.m. – 5:30 p.m.

Measles is an acute viral illness typically presenting with fever, cough, coryza, and conjunctivitis, followed 3-5 days later by a rash. The maculopapular rash typically begins on the face and spreads down the torso and out to the extremities. The incubation period for measles ranges from 7-21 days after exposure and individuals are infectious from 4 days prior to rash onset until 4 days after rash onset. Measles is highly contagious and spreads via airborne transmission.

Individuals can be presumed to be immune to measles if they were 1) born prior to 1957 OR 2) have received two doses of measles containing vaccine OR 3) have documented positive IgG titer OR 4) have documentation of prior disease.

Management of Suspect Cases

• Providers seeing a suspect case of measles should contact OCHCA Communicable Disease Control Division (CDCD) immediately at 714-834-8180 (staffed 24 hours per day).
• Suspect cases of measles should be placed immediately in standard and airborne isolation and evaluated wearing personal protective equipment including N-95 respirator, eye protection, gown and gloves.
• Settings without respiratory isolation rooms should consider deferring having the patient seen until the end of the day when other patients are gone. If a suspect case is seen in a non-respiratory isolation room, the room should be left empty for at least one hour.

Testing

• The recommended test is PCR of throat (preferred) or nasopharyngeal swab specimens for detection of measles virus RNA. OCHCA CDCD can arrange pick up of appropriate specimens for rapid test turnaround by contacting us at 714-834-8180. Specimens require OCHCA CDCD approval prior to submission.
• Appropriate PCR specimen collection is performed by swabbing of the throat or nasopharynx using synthetic (not cotton or with wood) placed in a screw capped container with viral transport media (VTM) or universal transport medial (UTM). Specimens should be maintained at 2-8°C and transported within 72 hours.

Post-exposure Prophylaxis

• Measles-Mumps-Rubella (MMR) and immune globulin (IG) is effective as post-exposure prophylaxis (PEP) when administered within the appropriate interval from exposure.
• Susceptible persons >6 months of age with 1 or no documented doses of MMR may receive MMR vaccine to decrease their risk of developing severe disease if not contraindicated.  
• Children 6-11 months of age may receive either MMR vaccine within 72 hours of exposure or IG within 6 days of exposure to decrease their risk of severe disease.
• Individuals with a contraindication to MMR vaccine may receive IG < 6 days after date of last exposure to prevent disease. However, only IG administered < 6 days after first exposure to measles is considered adequate PEP for public health contact management. Persons who receive IG > 6 days after the first exposure to the case while the case is infectious should be placed in isolation & quarantine.

Isolation & Quarantine

• Exposed individuals who do not have documented immunity to measles, had a known exposure to measles, and who have not received PEP (MMR vaccine <72 hours of first exposure) or (IG <6 days of first exposure) should isolate for a period of 21 days from last exposure.

Prevention

• Unexposed but not immune individuals should be vaccinated unless there is a contraindication.

• OCHCA Measles Page
• California Department of Public Health (CDPH) Measles Page
• CDC Measles Page