Public Health

New York State Department of Health: Health Advisory

DATE: February 15, 2024

TO: Hospitals, Local Health Departments, Laboratories, Emergency Rooms, Family Medicine, Pediatrics, Adolescent Medicine, Internal Medicine, Infectious Disease, Infection Control Practitioners, and Primary Care Providers

FROM: New York State Department of Health Division of Vaccine Excellence

UPDATED HEALTH ADVISORY: BE VIGILANT FOR MEASLES CASES

The New York State Department of Health is forwarding a communication issued by the Centers for Disease Control and Prevention to share information about the following:

• Outbreaks have occurred globally, and there have been recently reported cases in New York City and neighboring states (Pennsylvania and New Jersey).
• Despite the United States having declared measles “eliminated” in 2000, outbreaks have continued to occur, including one involving hundreds of cases in New York State as recently as 2019.
• Providers should be on alert for patients who have:
  • febrile rash illness and symptoms consistent with measles (e.g., cough, coryza, or conjunctivitis)
  • have recently traveled abroad, especially to countries with ongoing measles outbreaks.
• Measles is one of the most contagious infections and individuals are contagious from four days before to four days after rash onset.
• Report patients with suspected measles immediately to the local health department of the patient’s residence.
  • If in New York City, report persons with suspected measles immediately to the New York City Department of Health and Mental Hygiene at 866-692- 3641.
  • Do not wait for laboratory confirmation to report.
  • If you have urgent questions regarding measles during evenings, weekends, or holidays, call 866-881-2809.
• Educate patients about measles-containing vaccines. This is especially important before international travel.

Clinical Signs and Symptoms

Measles typically presents in adults and children as an acute viral illness characterized by fever and generalized maculopapular rash. Signs and symptoms appear 7 to 21 days after initial exposure.

The prodrome may include cough, coryza, and conjunctivitis. The rash usually starts on the face, proceeds down the body, and may include the palms and soles. The rash initially appears discrete but may become confluent and lasts several days. 

Symptoms may be mild, absent, or atypical in persons who have some degree of immunity to measles virus before infection (e.g., in previously vaccinated persons).

Serious side effects of measles can include pneumonia, encephalitis, hospitalization, and death.

Transmission and Infection Control

• To promptly identify suspected cases of measles and prevent exposures, consider screening patients for rash with fever at the point of entry of a healthcare facility and inquire about recent international or domestic travel and possible exposure to measles.
• Immediately institute standard and airborne precautions for patients with known or suspected measles and call ahead for patients being referred to other healthcare facilities to prevent healthcare-associated exposures.
• Place the patient in a single-patient airborne infection isolation room.
  • If a single-patient airborne infection isolation room is unavailable, place the patient in a private exam room with the door closed and have them wear a mask. After the patient leaves, it should remain vacant for at least two hours.

Reporting

Suspected measles cases must be reported immediately to the local health department of the patient’s residence. The local health department in New York State (outside of New York City) can assist in arranging testing at the Wadsworth Center Laboratory, and for specimens to arrive at the lab within 24-hours of collection, when feasible.

Specimen Collection (Updated)

Follow Wadsworth Center Laboratory’s tip sheet and collect either a nasopharyngeal swab or throat swab for reverse transcription polymerase chain reaction (RT-PCR), as well as a blood specimen for serology, from patients with suspected measles for testing at the lab. Urine may also contain virus so collect a urine sample in addition when feasible. Follow the packaging and shipping instructions on the tip sheet. However, if sending serology only, address to: Diagnostic Immunology Laboratory at David Axelrod Institute Wadsworth, 120 New Scotland Ave, Albany, NY 12208.

Public Health Action

Those who are infected should be isolated for four days after they develop a rash; standard and airborne precautions should be followed in healthcare settings. People who are suspected to be exposed to measles who cannot readily show that they have evidence of immunity against measles should be offered post-exposure prophylaxis (PEP).

To potentially provide protection or modify the clinical course of disease among susceptible persons, either administer MMR vaccine within 72 hours of initial measles exposure, or immunoglobulin (IG) within six days of exposure. Do not administer MMR vaccine and IG simultaneously, as this practice invalidates the vaccine.

New York State MMR Vaccination Rates (by county)

This report is based on data as of January 1, 2024 from the New York State Immunization Information System (NYSIIS). The rates below are calculated based on data of children who have received 1 MMR (Measles, Mumps, Rubella) immunization by 2 years of age, reported their residency as the State of New York, provided their New York State county of residence, and have at least one immunization or have a New York State birth record outside of New York City. According to CDC, children should receive the first dose of MMR vaccine routinely at age 12 through 15 months of age.

MMR Vaccination Statistics for NYS

• Statewide vaccination rate by 2 years of age is 79.4%.
• Rockland County has the lowest vaccination rate in the state at 54.4% vaccinated by 2 years of age.
• Yates County (56.4%) and Orange County (58.3%) are also at the lowest levels.
• Cayuga County (90.0%) and Clinton County (90.2%) have the highest vaccination rates in the state.

Receipt of 1 MMR dose by 2 years of age

Data Notes

• As of January 8, 2008, all health care providers in New York State, outside of New York City, are required to report all immunizations administered to people less than 19 years of age, along with the person's immunization histories, to NYSDOH using NYSIIS.
• Calculated rates are based on where the individual resides, based on the most recent resident information reported through NYSIIS.
• The New York City Department of Health and Mental Hygiene (NYCDOHMH) maintains non-COVID-19 immunization records for New York City residents through the Citywide Immunization Registry (CIR).
• Some entities that are not under the regulatory authority of the State of New York (e.g., federal entities such as federal military facilities, first nations, and jurisdictions outside of New York State), may not report this data to New York State, and would therefore not have their data included in NYSDOH rates.