Cedars-Sinai Medical Center

medical staff pulse newsletter

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A BI-WEEKLY PUBLICATION FROM THE CEDARS-SINAI CHIEF OF STAFF Jan. 30, 2015 | Archived Issues

Recognition for Chugh, Danovitch, McGovern

Physician News

Sumeet S. Chugh, MD, has received a grant to study how to better predict sudden cardiac arrest, a group led by Itai Danovitch, MD, has published a guide to insurance options for coverage of addiction treatment, and Dermot P.B. McGovern, MD, PhD, has been elected a member of the International Organization for the Study of Inflammatory Bowel Disease.

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Meetings and Events


Grand Rounds

Click here to view upcoming grand rounds.


Upcoming CME Conferences

Click below to view a complete list of all scheduled Continuing Medical Education conferences.

CME Newsletter - January 2015


Milestones

Do you know of a significant event in the life of a medical staff member? Please let us know, and we'll post these milestones in Medical Staff Pulse. Also, feel free to submit comments on milestones, and we'll post the comments in the next issue. Click here to email us your milestones and comments.

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Share Your News

Won any awards or had an article accepted for publication? Share your news about professional achievements and other items of interest.

Click here to share your news

The Measles Outbreak: Answering Your Questions

The U.S. is experiencing a large, multistate measles outbreak that originated in Southern California and has spread to six additional states and Mexico, according to the federal Centers for Disease Control and Prevention.

Key messages for healthcare providers:

  • Measles should be considered in any patient with new onset fever and rash.
  • Airborne isolation (negative pressure) should be used for any patient suspected of having measles.
  • Do not wait for confirmatory testing before isolating the patient and notifying Epidemiology/Infection Control at ext. 3-5574.

What are the symptoms of measles, and when are people contagious?

Measles symptoms usually begin 10-12 days (up to 21 days) after exposure with a prodrome of fever (up to 105 degrees F), malaise, cough, coryza and conjunctivitis. Two to four days later, a maculopapular rash develops around the hairline or ears and spreads downward to the face, trunk and extremities. Severe illness can occur, including pneumonia, encephalitis and death.

Measles is highly infectious and is transmitted by airborne spread of respiratory droplets. Typically, measles patients are contagious from four days before to four days after rash onset. Suspect measles cases should not be allowed in patient waiting areas. They should be masked and placed immediately in an examination room, with the door closed. Patients with suspect measles should be seen at the end of the day and use a separate entrance. The examination room should not be used for two hours.

Who should be vaccinated against measles?

With few exceptions, everyone should be vaccinated against measles. Routine vaccination with two doses of measles-containing vaccine is the safest and most effective way to prevent disease. It is routinely recommended for all children and is a requirement for school attendance. Most children receive their first measles vaccine at age 12 months, with a booster prior to kindergarten. Infants as young as 6 months of age may be eligible for vaccination in certain settings (such as international travel), though this may reduce vaccine efficacy.

The measles vaccine is a live virus vaccine and is contraindicated in patients who are pregnant, as well as those with severe immunodeficiency (including receipt of chemotherapy, long-term immunosuppressive therapy such as >=20mg prednisone daily for >=2 weeks, or advanced HIV with CD4+ T-lymphocyte count <=15%).

Do I need to get a measles booster shot?

Booster shots are not currently recommended for those with evidence of immunity to measles. Evidence of immunity includes any of the following:

  • Born in the U.S. before 1957
  • Written documentation of two or more doses of measles-containing vaccine in high-risk individuals, such as healthcare workers, international travelers and school-age children
  • Written documentation of at least one dose of measles-containing vaccine in individuals not at high risk
  • Documented serologic evidence of immunity (elevated measles IgG)

Note: Those who received killed measles vaccine (offered from 1963-67) should receive at least one additional dose of live measles vaccine.

Healthcare workers who do not meet one of the above criteria should receive vaccination.

How effective is the measles vaccine?

MMR vaccine is highly effective in preventing measles, with a one-dose vaccine effectiveness of 95 percent when administered on or after age 12 months and a 2-dose vaccine effectiveness of 99 percent.

What should I do if I suspect someone may have measles?

Patients suspected of having measles should immediately be isolated from others. In outpatient areas, patients should avoid waiting rooms and be placed in a single room. When possible, they should be masked and seen as the last case of the day and use a separate entrance from other patients. In inpatient settings, patients should immediately be placed in airborne isolation. Do not wait for laboratory confirmation before isolating a patient and notifying Epidemiology/Infection Control.

What tests are available for measles?

Serologic testing is available (IgM and IgG). In addition, nasopharyngeal swabs and/or urine samples may be used to test for the virus by PCR. All testing should be performed in consultation with Epidemiology/Infection Control and public health authorities.

What can I do if I have been exposed to measles?

It is rare for people with immunity to measles to contract the disease following exposure, but cases have occurred. Those with measles immunity who have been exposed should self-monitor for symptoms; no specific prophylaxis is indicated.

Nonimmune, immunocompromised persons, infants ≤ 12 months and others at high risk of complications from measles can be protected with immune globulin ≤ 6 days after exposure. Nonimmune, immunocompetent individuals can receive the MMR vaccine ≤72 hours after exposure.

Click on the following links for more information on the measles situation and vaccination:

U.S. Centers for Disease Control and Prevention

California Department of Public Health

Los Angeles County Department of Public Health