www.elitecme.com | 2019 | INFECTIOUS DISEASE, DISASTER PLANNING & WOUND CARE 23 and preventing or addressing complications. While there are no antivirals approved by the U.S. Food and Drug Administration (FDA) for the treatment of measles, the measles virus has shown susceptibility to ribavirin. Subsequently, ribavirin has been used for cases of measles in severely immu- nocompromised individuals, or in those with SSPE. No controlled studies have evaluated this; additionally, its use is considered to be experimental (McLean, 2013). Maintaining adequate hydration to replace fluids lost through diarrhea or emesis is essen- tial. Intravenous rehydration may be neces- sary in severely dehydrated patients. Fever management is also extremely important, and treatment with antipyretics (such as acetamin- ophen) may be necessary. Since vitamin A deficiency is associ- ated with severe measles, the World Health Organization (WHO) recommends that all children with measles should be treated with vitamin A, regardless of the country in which they live. One dose of vitamin A should be given immediately upon diagnosis and a second dose should be given 24 hours later. Children under six months of age should receive 50,000 IU per dose; those between six and 11 months of age should receive 100,000 IU per dose. Children older than 12 months should receive 200,000 IUs per dose. Children that exhibit clinical signs of vitamin A defi- ciency should receive a third, age-specific dose two to four weeks later. The use of vitamin A supplementation in measles patients is associ- ated with a decrease of approximately 50% in morbidity and mortality (Chen, 2017). Patients with measles should be isolated from other people for four days after rash development. In the health care setting, HCP should follow airborne precautions during the period of communicability to minimize dis- ease transmission, regardless of the immuni- zation status of the HCP. Airborne precautions should be followed starting three to five days before the appearance of rash until four days after rash development; these precautions may need to be followed longer in immunocompro- mised patients. All staff entering the patient’s room should wear a respirator. Additionally, patients with measles should be placed in sin- gle-patient, airborne-infection isolation rooms (CDC, 2017-2). POST-EXPOSURE PROPHYLAXIS People who have been exposed to measles who do not have evidence of immunity should be offered post-exposure prophylaxis in an attempt to prevent, or modify, the course of the measles. The primary treatment for post-exposure prophylaxis is the measles, mumps, and rubella (MMR) vaccine. The MMR vaccine is best administered within 72 hours of exposure to the virus. If the MMR vaccine is not given within 72 hours of measles exposure, it should still be offered at any time after exposure to protect against further exposures (CDC, 2017-2). If administered after the third day, but prior to the sixth day after exposure to the virus, human immunoglobulin (Ig) may be given to prevent or modify the disease process. However, human Ig is typically reserved for use in immunocompromised patients, infants, and pregnant women without evidence of immunity to measles. Human Ig should be given intramuscularly (IM) or intravenously (IV) immediately after exposure and followed in six months with the measles vaccine (Chen, 2017). The recommended dose of IgIM is 0.5 mL/kg, with a maximum dose of 15 mL/kg. The recommended dose of IgIV is 400 mg/kg (CDC, 2017-2). Ig should be used to decrease the risk of infection and complications in high-risk patients who have been exposed to measles. It should not be used as an outbreak control measure. It should be given with priority to patients exposed to measles in close contact for prolonged periods of times, such as a care- giver of a measles patient (CDC, 2017-2). Health care workers without evidence of immunity who are exposed to measles should receive the MMR vaccine within 72 hours of exposure, or Ig within six days of exposure. After receiving Ig, health care workers should not return to the health care setting right away in order to minimize the potential for the spread of disease and to maintain the effec- tiveness of the Ig. Exposed health care workers without mea- sles immunity should be excluded from work— from day five after initial exposure until day 21 after last exposure—regardless of post-expo- sure prophylaxis. People who return to work in other settings should be evaluated on a case- by-case basis; return to work should depend on the intensity of the close contact with the disease, the population worked with, and their immune status. Other patients who receive post-exposure prophylaxis should be monitored for signs of measles for at least one incubation period. Patients who refuse post-exposure prophylaxis should be excluded from settings where mea- sles is present; for example, children should be kept from school unless they receive post-ex- posure prophylaxis (CDC, 2017-2). SELF-ASSESSMENT QUESTION Answers are listed on the last page of the course. 4. The recommended dose of IgIM for post-exposure prophylaxis of measles is _____ mL/kg, with a maximum dose of ____ mL/kg. a) 0.5; 15. b) 1; 15. c) 0.5; 30. d) 3; 30. MEASLES VACCINATION The measles virus was first isolated in 1954. This virus isolation led to the licensure of two vaccinations in 1963: an inactivated vaccine and a live attenuated vaccine. The inactivated vaccine, known as the killed-mea- sles vaccine (KMV), was removed from the market in 1967 as it did not provide adequate protection against. Patients who received this vaccine developed atypical measles when exposed to the virus. Several iterations of the live attenuated vaccine were licensed in the 1960s as developers attempted to decrease the incidence of adverse effects in vaccine recipients. The measles vaccine was com- bined with the mumps and rubella vaccines in 1971 to produce the MMR vaccination; single-antigen measles vaccinations are no longer available in the U.S. (CDC, 2016). EFFICACY OF MEASLES VACCINATION After MMR vaccination, approximately 95% of children vaccinated at 12 months of age develop measles antibodies; 98% of children vaccinated at 15 months of age develop measles antibodies. Between two percent and five percent of children who receive only a single dose fail to develop immunity to measles, which can be related to passive immunity present in the child, |  CONTINUING EDUCATION