Local Measles Case - Meningococcus - Epiglottitis

From the office of the Medical Health Officer

Measles Alert: Fraser Health Resident has Measles Acquired Overseas 

A Fraser Health resident has come down with measles. Exposure occurred outside of Canada in an area with measles activity. Symptoms described as ‘cold-like’ began on April 18th with rash onset on the 21st, thus the period of communicability dates from approximately April 16th. While infectious, there was movement in the community, including visits to Eagle Ridge Hospital on April 23rd, a physician’s office and admission to Vancouver Hospital on April 24th. Public Health is following up identified contacts; however, because measles can spread through the air, non-immunized or otherwise susceptible individuals may have been exposed unknowingly in the hospital settings or elsewhere. Consider measles, isolate the patient, and call your Health Unit if you see a classic very red maculopapular rash starting behind the ears and back of the neck and spreading from there; with fever, cough, conjunctivitis, Koplik spots on the buccal mucosa, etc., especially in someone with possible exposure and/or born after 1970 who hasn’t had two doses of measles-containing vaccine.

Travelers should ensure they are immune to measles, as measles is active world wide, with a large outbreak in Japan. ProMED (http://www.promedmail.org ; search archives for “measles”) lists measles activity in Italy, Spain, North Korea, Serbia, China, Russia, Kuwait, Brazil, Tanzania, and Scotland.

Measles is infectious from 1 to 2 days before onset of the prodrome (usually about 4 days before rash onset) to 4 days after rash appearance. Incubation period is 7-18 (usually 10) days from exposure to onset of fever and usually about 14 days from exposure to onset of rash. Take IgG and IgM no sooner than 4 days after onset of rash, and repeat 10-20 days later. For cases highly likely to be measles, please also take a nasopharyngeal or throat swab up to 4 days after rash onset and a urine sample up to 7 days after rash onset for viral testing; refrigerate and ship to lab within 24 hours.

Death from Menningococcal Serogroup Y Disease

The sudden death of the grade 10 student at Dr. Charles Best Secondary School in Coquitlam has been confirmed as due to Nesseria meningitidis serogroup Y. This is considered an isolated case, with no secondary spread identified.

We are providing the new quadrivalent conjugate meningococcal vaccine (MenactraTM) to the contacts for whom chemoprophylaxis was indicated. An immunization clinic at Dr. Charles Best Secondary School is scheduled today, Friday April 27th. As stated in a previous memo to physicians in the Tri-Cities area, close contacts for whom preventive antibiotics and now vaccine are indicated are those who are in the same household, have shared sleeping quarters, or have shared things with saliva on them, including drinking containers, straws, water bottles, musical instrument mouthpieces, cigarettes, etc. Casual school contact is not a reason to need preventive antibiotics. At this time, there is nothing to suggest increased risk for staff and students in the school who have not had contact as described above.

Physicians may also be consulted directly by patients requesting antibiotics. Please direct these individuals to the local Public Health Unit for further assessment. Public Health provides preventive antibiotics at no cost to close contacts of persons with invasive meningococcal disease.

Suspect meningococcal or other invasive bacterial disease when patients are generally unwell, especially with fever, vomiting, joint pain, and getting worse fast, with or without meningismus. The non-blanching petechial rash is a late and ominous sign. Emergency antibiotic treatment is critical. Please also continue to report clinically suspect cases of meningococcal disease to your local Public Health Unit.

Death from Epiglottitis Possible Related to E-B Virus and/or H. Influenzae

You may hear of another tragic death this week, that of a Port Coquitlam student. We have been assured that invasive meningococcal disease is NOT suspected. We continue to follow as additional laboratory results become available, but are confident that this is not related to the death of the student from Dr. Charles Best Secondary School.

Suspect epiglottitis when sore throat, with or without fever, is accompanied by muffled or otherwise changed voice, difficulty speaking and swallowing, tachycardia, and difficulty breathing, especially when lying down. Signs include drooling, leaning forward to breathe, taking rapid shallow breaths, supraclavicular or intercostal retraction with inspiration, and/or inspiratory stridor. Children may sit leaning forward with head and nose in the “sniffing” position. Rapid progression of illness is ominous and indicates increased risk for respiratory arrest. Avoid trying to visualize the inflamed epiglottis as this can precipitate airway closure. Acute epiglottitis is a medical emergency because of the potential rapid deterioration to airway obstruction, and should be managed in a hospital setting.