Action Special Issue: July 18, 2014

Texas Investigating Potential Measles Exposures

A health alert issued by the Texas Department of State Health Services (DSHS) advises physicians to consider measles in their diagnoses. The department published the alert following notification by the Kansas Department of Health and Environment that more than 30 Texans may have been exposed to the highly contagious disease at a Wichita, Kan., softball event during the Fourth of July weekend.                           

At least three Texas recreational softball teams traveled to Wichita to participate in a tournament, held at the South Lakes Sports Complex. DSHS is investigating to determine who may have been exposed. 

The department has not yet identified any Texas measles cases associated with the event. Last year, there were 27 reported measles cases in Texas and none in 2012.

The alert urges health care professionals, hospitals, laboratories, schools, childcare facilities, and others to report to local health departments patients suspected of having measles, as required by Texas law. Lab confirmation isn't required to report measles suspects, and reports can be made by calling (800) 705-8868. 

According to the alert, the measles incubation period is about two weeks from exposure to onset of rash but may be as short as one week or as long as three weeks. People are contagious from four days before onset of rash to four days after the appearance of rash. The rash usually begins on the face and spreads to the trunk. Other symptoms include fever (higher than 101 degrees), cough, runny nose, and sore eyes. 

The alert includes information on measles testing, prophylaxis, and exclusion criteria. Postexposure prophylaxis recommends measles, mumps, rubella (MMR) vaccine for those exposed (6 months and older) without evidence of immunity to measles. MMR vaccine should be administered within three days of exposure. 

Physicians should check all patients' vaccination history and offer vaccine to anyone who is not up to date with the vaccine schedule, the alert states. 

The alert's guidance on health care worker immunity advises all health facilities to ensure they have current documentation of measles immunity status for all staff members — not just health care professionals. Documentation of immunity includes:  

  • Birth prior to 1957,
  • Written record of receipt of two doses of MMR vaccine, or
  • Positive serological titers.  

Exposed health care workers without documented immunity should be excluded from work from days five to 21 after exposure.

DSHS urges anyone in Texas who attended the Wichita softball event to call the department at (512) 776-7676 to report the potential exposure.  


Tips for Caring for Central American Immigrant Families

So it’s a typical day at your office. You walk into the exam room to find a Honduran mother and her two young children, brand new to this country and fresh off a bus ride from the Border Patrol processing station in McAllen. 

What do you have to do to make sure they’re healthy and to protect your community from disease? 

Adults crossing the border with children constitute a unique population in the current immigration crisis. They make up about 20 percent of the tens of thousands of Central Americans coming into the country through the Rio Grande Valley now, according to Texas Department of State Health Services Executive Commissioner David Lakey, MD. 

Unaccompanied minor immigrants are processed through the Office of Refugee Resettlement and receive health screens and immunizations. But adults with children are processed differently and are being released directly by the Border Patrol. They typically end up at the bus station and are sent to destinations across the country where they have other family members. Dr. Lakey has asked federal officials to conduct full health screenings for this population, but that is not happening yet. 

The Border Patrol is not tracking where these families are going, so TMA can’t alert you ahead of time if they may show up at your practice. As a service to physicians who see these adults and children, we are sharing a link to the Advisory Committee on Immunization Practices recommended immunization schedules for persons age birth through 18 years. The link includes catch-up schedules and minimum intervals between doses for children whose vaccinations have been delayed. 

In addition, while some families will have their immunization records with them, children entering childcare or school may need assistance with the required vaccinations. 

If you are interested in volunteering your services at the border, DSHS is keeping a list of physicians and sharing that information with local health officials. Please contact DSHSborderissues@dshs.state.tx.us.

 




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