• Article
  • August 7, 2019

Measles and Back to School: What Providers Should Know

As back-to-school season approaches in the wake of this year’s measles outbreak, the medical community needs to know what to look for.

The state of measles in the U.S.

  • From January 1 to July 25, 2019, there have been 1,164 individual cases of measles confirmed in 30 states, according to the Centers for Disease Control and Prevention (CDC) 
  • This is the greatest number of cases reported in the U.S. since 1992 and since measles was declared eliminated in 2000, nearly 20 years ago.

For Jennifer Lighter, measles has always been something she read about in textbooks.

“We just don’t really see measles anymore, but we’ve seen 54 cases of laboratory-confirmed measles over the past few months—and half of the patients were admitted to the hospital,” says Lighter, M.D., hospital epidemiologist, Hassenfeld Children’s Hospital at NYU Langone in New York City, pediatric stewardship director, assistant professor of pediatric infectious diseases, NYU School of Medicine. "So no we're quite familiar with it." 

Since measles made a resurgence in the U.S. earlier this year, Lighter has been up close and personal with it. “There are some things you don’t really appreciate from reading that you really get by looking at a child with measles,” she says. “For example, how miserable they look. It’s not really described in a textbook.”

With the back-to-school season approaching, families, school officials and the health care community should know what to look for in children. Measles is “the most contagious pathogen around,” Lighter says. If one person in the room has the measles, 13 to 18 other people in that room could have the measles as well.

What to look for

Lighter says children with measles often have red, cracked, dry lips but do not always present with the hallmark sign of measles—the rash. At least at first. Lighter says it takes up to four days for the rash to appear even though these patients have other symptoms of a respiratory infection, such as coughing, runny nose and conjunctivitis.

Lighter’s advice for pediatric health care providers:

  • Know if there is an outbreak in your region. Lighter and her team pay close attention to the zip codes of outbreaks. So, if a patient is symptomatic and comes from a ZIP code experiencing an outbreak—even if he or she doesn’t yet have a rash—this should be a red flag. “If there is an outbreak in the community, it really needs to be on your radar,” she says.
  • Check behind the ears. Even though the expectation is that the rash starts on the face, it actually starts behind the ears and spreads to the face from there, Lighter says. If children present with a red rash behind the ears, coupled with symptoms of a respiratory infection, they may have the measles. Because the rash doesn’t appear for the first four days, the disease “is masked in a way, so it has a head start,” Lighter says.
  • Keep the conversation going. Although some people can bring back measles from other countries where large measles outbreaks occur—such as Israel, Ukraine and the Philippines—Lighter says the spread of measles can be due to a lack of discussion. She recommends pediatricians have conversations with vaccine-hesitant parents and families, who typically do not wish to have their children vaccinated at the recommended times by the Advisory Committee on Immunization Practices (ACIP)

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