Measles

As most of you are aware, there has been a measles outbreak in Quebec since the spring. As the problem is ongoing public health authorities have recently distributed reminders to both physicians and the lay press.

These are the links to the information that was recently sent out to all physicians:

The first link is the information letter sent to physicians:
http://media.ofsys.com/T/OFSYS/H/508274/09nZ11/Lettre-DrPoirier-rougeole.pdf

The second link is measles information from the Quebec government website:
http://www.msss.gouv.qc.ca/sujets/prob_sante/rougeole/rougeole.php

A brief reminder of the symptoms you are looking for:

1. fever
2. rash
3. conjunctivitis/coryza
4. cough

This is a link to some photos, and management information:
http://media.ofsys.com/T/OFSYS/H/508102/M2VAy0/Infolettre-affiche.pdf

Here is some practical information on what to do if you have a suspected case in our ED:

1. Patient should wear a mask, and be isolated ideally in a negative pressure room, and if unavailable, at least in a room with the door closed
2. Obtain a sample to confirm the diagnosis (IgG & IgM in the serum, and if possible an NPA or a urine sample for measles culture - clearly label all specimens as being for measles)
3. Update (Jan 12/2012), as serum IgM is less sensitive if the patient has had rash for < 72 hours, this is where PCR is most useful. Therefore when you send a sample for PCR, clearly mark this or other relevant clinical information on the pink virology form (i.e. also useful if patient is the contact of a known case of measles).
4. Inform the public health authorities (this is not an emergency, so only call public health and ask to speak to the ID MD during regular working hours at 514-528-2400, also call our infection control during regular working hours at 514-934-1934, x 23149, and after hours leave a message at 514-412-4485 with the patient's name and MRN, and whether they were in contact with any patients of concern, ie. under 12 months of age or immunocompromised (where Ig may be indicated). The lab will also report the disease once it is confirmed, but it is important to report it as soon as you suspect it clinically.
5. Inform the patient to stay home for a period of 4 days after the onset of the rash

Thank you to Drs. Caroline Quach & Jesse Papenburg for the added information above.
Our ID physicians remain your resources for additional information.