Missouri Department of Health & Senior Services Health Alerts 2018

2018·0.12 MB·English

by  Missouri Department of Health and Senior Services

Missouri Department of Health & Senior Services

Health A lert: Health Alert

March 20, 2018

FROM: RANDALL W. WILLIAMS, MD, FACOG

Possible Measles DIRECTOR

Exposures in the
SUBJECT: Possible Measles Exposures in the St. Louis Area
St. Louis Area

On March 18, 2018, the Missouri Department of Health and Senior Services (DHSS)
received a report of a confirmed case of measles who traveled to the St. Louis area
while infectious. The case’s travel itinerary during the infectious period was reported
as follows:
March 20, 2018

This document will be updated as new Date Time Location
information becomes available. The
March 13, 2018 11:00 AM-3:00 PM The Magic House; Kirkwood, MO
current version can always be viewed
March 13, 2018 3:30 PM-4:15 PM Racanelli’s New York Pizzeria; Kirkwood, MO
at http://www.health.mo.gov.
March 13-14, 2018 4:15 PM-11:00 AM Homewood Suites; Chesterfield, MO
The Missouri Department of Health &

Senior Services (DHSS) is now using
On March 19, 2018, a public health investigation was initiated by St. Louis County
4 types of documents to provide
important information to medical and Department of Public Health and DHSS to identify and contact persons known to be
public health professionals, and to potentially exposed to measles. However, potential transmission of the measles virus
other interested persons:
to unknown susceptible persons who had contact with the case may have occurred.

Health Alerts convey information
of the highest level of importance Measles is a highly contagious, acute viral illness that is transmitted by contact with an
which warrants immediate action or infected person through coughing and sneezing. Patients are considered to be
attention from Missouri health
contagious from 4 days before until 4 days after the rash appears. Immune Globulin
providers, emergency responders,
(IG) can be administered to exposed individuals within 6 days of exposure to prevent
public health agencies, and/or the
public. or reduce the symptoms of measles infection for those without evidence of immunity.

Health care providers that may see patients concerned about an exposure should
Health Advisories provide
important information for a specific consider having IG on hand in the event it is needed, both for this contact investigation
incident or situation, including that event and in the future.
impacting neighboring states; may not

require immediate action.
Health care providers should maintain a high index of suspicion for measles among

Health Guidances contain febrile patients with a rash. Patients with clinical signs/symptoms compatible with
comprehensive information pertaining measles (febrile rash plus cough, coryza, and/or conjunctivitis) should be asked about
to a particular disease or condition,
the exposures detailed above, recent travel abroad and contact with returning travelers,
and include recommendations,
guidelines, etc. endorsed by DHSS. or contact with someone with a febrile rash illness. Their vaccination status should also
be verified. Immunocompromised patients may not exhibit a rash, or may exhibit an
Health Updates provide new or
atypical rash. The incubation period for measles from exposure to fever is usually about
updated information on an incident or
situation; can also provide informa- 10-12 days and from exposure to rash onset is usually 14 days (range, 7 to 21 days).
tion to update a previously sent
Health Alert, Health Advisory, or Persons who have been exposed to measles should contact their health care provider if
Health Guidance; unlikely to require
they develop cold-like symptoms with a fever and/or rash. They should NOT go to any
immediate action.
health care facility without calling first. The suspect case should be kept separated
__________________________________
from others to prevent further spread. (Note that measles virus can remain infectious in
the air for up to 2 hours after an infected person leaves an area such as a waiting room.)
Office of the Director
Isolate suspect measles case-patients and immediately report suspected cases to the
912 Wildwood
local public health agency, or to DHSS at 573/751-6113 or 800/392-0272 (24/7). To
P.O. Box 570
Jefferson City, MO 65102 ensure prompt public health response, do not wait for laboratory confirmation.
Telephone: [phone]
Detection of measles-specific IgM antibody and measles RNA by real-time polymerase
Fax: [phone]
Website: http://www.health.mo.gov chain reaction (RT-PCR) are the most common methods for confirming measles
2

infection. Healthcare providers should obtain both a serum sample and a throat swab (or nasopharyngeal
swab) from patients suspected to have measles at first contact with them.

The Missouri State Public Health Laboratory (MSPHL) provides laboratory support for the diagnosis of
measles infections occurring in Missouri. MSPHL will only test specimens that are approved by state
public health officials. A specimen for molecular detection by RT-PCR should be collected and
submitted to MSPHL along with the initial serum specimen, and include NP swab, throat swab, or urine
(see the CDC instructions below). Please note that a RT-PCR specimen should NOT be substituted for a
serum specimen. Serum specimens submitted to MSPHL will be tested for measles IgM and rubella IgM
as requested by the investigating epidemiologist. The RT-PCR specimen will be referred to a Vaccine
Preventable Disease (VPD) Reference Laboratory. VPD laboratories are established in cooperation with
public health laboratories and the Centers for Disease Control and Prevention [CDC] to provide reference
testing and surge capacity.

The sensitivity of measles IgM assays varies, and may be diminished during the first 72 hours after rash
onset. If the result is negative for measles IgM and the patient has a generalized rash lasting more than 72
hours, a second serum specimen should be obtained and the measles IgM test should be repeated (AAP.
Red Book, 2015; p. 537).

For questions regarding storage and shipping of all samples, please contact the MSPHL Virology Unit at
573-751-3334.

Measles serology instructions:
http://health.mo.gov/lab/measlesrubella.php

CDC measles RT-PCR instructions (do NOT ship specimens directly to CDC):
https://www.cdc.gov/measles/lab-tools/rt-pcr.html

For further guidance, please refer to:
https://www.cdc.gov/measles/hcp/index.html

https://www.cdc.gov/mmwr/preview/mmwrhtml/rr6204a1.htm?s_cid=rr6204a1_w

Questions should be directed to DHSS’ Bureau of Communicable Disease Control and Prevention at
573/751-6113 or 800/392-0272 (24/7).
Missouri Department of Health & Senior Services

Health A lert: Health Alert

April 12, 2018

FROM: RANDALL W. WILLIAMS, MD, FACOG

Possible Measles DIRECTOR

Exposures in the
SUBJECT: Possible Measles Exposures in the Kansas City Area
Kansas City Area

On April 6, 2018, the Missouri Department of Health and Senior Services (DHSS)
received a report of a possible case of measles in Kansas City, Missouri.
Confirmatory testing was completed and reported as positive on April 11, 2018.
April 12, 2018 The case’s travel itinerary during the infectious period was reported as follows:

This document will be updated as new
Date Location Name Exposure Location
information becomes available. The
current version can always be viewed Timeframe Address
at http://www.health.mo.gov. March 30, 2018 Barnes & Noble 8:00 AM-10:30 AM Oak Park Mall

The Missouri Department of Health & 11323 W 95th St
Senior Services (DHSS) is now using Overland Park,
4 types of documents to provide
KS
important information to medical and
public health professionals, and to March 30, 2018 Subway 11:30 AM-2:30 PM 312 E 51st St
other interested persons: Kansas City, MO

Health Alerts convey information March 30, 2018 Cosentino’s Price 12:30 PM-5:00 PM 6327 Brookside
of the highest level of importance Chopper Plaza
which warrants immediate action or
Kansas City, MO
attention from Missouri health
March 31, 2018 Laundroplex 5:00 PM-10:00 PM 575 NW 68th St
providers, emergency responders,
public health agencies, and/or the Kansas City, MO
public. March 31, 2018 Quick Trip 7:00 PM-9:30 PM 601 NW 68th St

Health Advisories provide Kansas City, MO
important information for a specific April 1, 2018 Pleasant Valley 10:30 PM-2:30 PM 1600 MO-291
incident or situation, including that
Baptist Church Liberty, MO
impacting neighboring states; may not
require immediate action. (church and lobby)

Note: Locations where individuals may have been exposed to measles, but can be
Health Guidances contain
comprehensive information pertaining identified, are not listed. Those individuals will be notified separately.
to a particular disease or condition,
and include recommendations,
On April 6, 2018, a public health investigation was initiated by Kansas City,
guidelines, etc. endorsed by DHSS.
Missouri Health Department and DHSS to identify and contact persons known to be
Health Updates provide new or
potentially exposed to measles. However, potential transmission of the measles virus
updated information on an incident or
to unknown susceptible persons who had contact with the case may have occurred.
situation; can also provide informa-
tion to update a previously sent
Health Alert, Health Advisory, or Measles is a highly contagious, acute viral illness that is transmitted by contact with an
Health Guidance; unlikely to require infected person through coughing and sneezing. Patients are considered to be
immediate action.
contagious from 4 days before until 4 days after the rash appears. Immune Globulin
__________________________________
(IG) can be administered to exposed individuals within 6 days of exposure to prevent
or reduce the symptoms of measles infection for those without evidence of immunity.
Office of the Director
Health care providers that may see patients concerned about an exposure should
912 Wildwood
consider having IG on hand in the event it is needed, both for this contact investigation
P.O. Box 570
event and in the future.
Jefferson City, MO 65102

Telephone: [phone]
Health care providers should maintain a high index of suspicion for measles among
Fax: [phone]
febrile patients with a rash. Patients with clinical signs/symptoms compatible with
Website: http://www.health.mo.gov
measles (febrile rash plus cough, coryza, and/or conjunctivitis) should be asked about
2

infection. Healthcare providers should obtain both a serum sample and a throat swab (or nasopharyngeal
swab) from patients suspected to have measles at first contact with them.

The Missouri State Public Health Laboratory (MSPHL) provides laboratory support for the diagnosis of
measles infections occurring in Missouri. MSPHL will only test specimens that are approved by state
public health officials. A specimen for molecular detection by RT-PCR should be collected and
submitted to MSPHL along with the initial serum specimen, and include NP swab, throat swab, or urine
(see the CDC instructions below). Please note that a RT-PCR specimen should NOT be substituted for a
serum specimen. Serum specimens submitted to MSPHL will be tested for measles IgM and rubella IgM
as requested by the investigating epidemiologist. The RT-PCR specimen will be referred to a Vaccine
Preventable Disease (VPD) Reference Laboratory. VPD laboratories are established in cooperation with
public health laboratories and the Centers for Disease Control and Prevention [CDC] to provide reference
testing and surge capacity.

The sensitivity of measles IgM assays varies, and may be diminished during the first 72 hours after rash
onset. If the result is negative for measles IgM and the patient has a generalized rash lasting more than 72
hours, a second serum specimen should be obtained and the measles IgM test should be repeated (AAP.
Red Book, 2015; p. 537).

For questions regarding storage and shipping of all samples, please contact the MSPHL Virology Unit at
573-751-3334.

Measles serology instructions:
http://health.mo.gov/lab/measlesrubella.php

CDC measles RT-PCR instructions (do NOT ship specimens directly to CDC):
https://www.cdc.gov/measles/lab-tools/rt-pcr.html

For further guidance, please refer to:
https://www.cdc.gov/measles/hcp/index.html

https://www.cdc.gov/mmwr/preview/mmwrhtml/rr6204a1.htm?s_cid=rr6204a1_w

Questions should be directed to DHSS’ Bureau of Communicable Disease Control and Prevention at
573/751-6113 or 800/392-0272 (24/7).
Missouri Department of Health & Senior Services

Health A lert: Health Alert

April 20, 2018

FROM: RANDALL W. WILLIAMS, MD, FACOG
Possible Measles DIRECTOR
Exposures in the
Kansas City Area SUBJECT: Possible Measles Exposures in the Kansas City Area

The Missouri Department of Health and Senior Services (DHSS) continues to
April 20, 2018 receive reports of measles cases in Kansas City, Missouri. Newly identified

exposures of concern include:
This document will be updated as new
information becomes available. The
current version can always be viewed
Date Location Name Exposure Location Address
at http://www.health.mo.gov.
Timeframe

The Missouri Department of Health & April 6, 2018 KCI Expo Center- 8:30 AM–1:00 PM 11730 NW Ambassador Dr.
Senior Services (DHSS) is now using
Midwest Parent Kansas City, MO
4 types of documents to provide
Educators Vendor
important information to medical and
public health professionals, and to Hall
other interested persons: April 10, 2018 Nebraska 9:30 AM–2:00 PM 1601 Village West Pkwy

Health Alerts convey information Furniture Mart Kansas City, KS
of the highest level of importance Note: Locations where individuals may have been exposed to measles, but can be
which warrants immediate action or identified, are not listed. Those individuals will be notified separately.
attention from Missouri health

providers, emergency responders,
public health agencies, and/or the The Kansas City, Missouri Health Department and DHSS continue to work to
public. identify and contact persons known to be potentially exposed to measles. However,

Health Advisories provide potential transmission of the measles virus to unknown susceptible persons who had
important information for a specific contact with the case may have occurred.
incident or situation, including that
impacting neighboring states; may not Measles is a highly contagious, acute viral illness that is transmitted by contact with an
require immediate action.
infected person through coughing and sneezing. Patients are considered to be

Health Guidances contain contagious from 4 days before until 4 days after the rash appears. Immune Globulin
comprehensive information pertaining
(IG) can be administered to exposed individuals within 6 days of exposure to prevent
to a particular disease or condition,
or reduce the symptoms of measles infection for those without evidence of immunity.
and include recommendations,
guidelines, etc. endorsed by DHSS. Health care providers that may see patients concerned about an exposure should
consider having IG on hand in the event it is needed, both for this contact investigation
Health Updates provide new or
updated information on an incident or event and in the future.
situation; can also provide informa-
tion to update a previously sent Health care providers should maintain a high index of suspicion for measles among
Health Alert, Health Advisory, or febrile patients with a rash. Patients with clinical signs/symptoms compatible with
Health Guidance; unlikely to require
measles (febrile rash plus cough, coryza, and/or conjunctivitis) should be asked about
immediate action.
__________________________________ the exposures detailed above, recent travel abroad and contact with returning travelers,
or contact with someone with a febrile rash illness. Their vaccination status should also

be verified. Immunocompromised patients may not exhibit a rash, or may exhibit an
Office of the Director
atypical rash. The incubation period for measles from exposure to fever is usually about
912 Wildwood
P.O. Box 570 10-12 days and from exposure to rash onset is usually 14 days (range, 7 to 21 days).
Jefferson City, MO 65102

Telephone: [phone]
Fax: [phone]
Website: http://www.health.mo.gov
2

Persons who have been exposed to measles should contact their health care provider if they develop cold-
like symptoms with a fever and/or rash. They should NOT go to any health care facility without calling
first. The suspect case should be kept separated from others to prevent further spread. (Note that measles
virus can remain infectious in the air for up to 2 hours after an infected person leaves an area such as a
waiting room.) Isolate suspect measles case-patients and immediately report suspected cases to the local
public health agency, or to DHSS at 573/751-6113 or 800/392-0272 (24/7). To ensure prompt public
health response, do not wait for laboratory confirmation.

Detection of measles-specific IgM antibody and measles RNA by real-time polymerase chain reaction
(RT-PCR) are the most common methods for confirming measles infection. Healthcare providers should
obtain both a serum sample and a throat swab (or nasopharyngeal swab) from patients suspected to have
measles at first contact with them.

The Missouri State Public Health Laboratory (MSPHL) provides laboratory support for the diagnosis of
measles infections occurring in Missouri. MSPHL will only test specimens that are approved by state
public health officials. A specimen for molecular detection by RT-PCR should be collected and
submitted to MSPHL along with the initial serum specimen, and include NP swab, throat swab, or urine
(see the CDC instructions below). Please note that a RT-PCR specimen should NOT be substituted for a
serum specimen. Serum specimens submitted to MSPHL will be tested for measles IgM and rubella IgM
as requested by the investigating epidemiologist. The RT-PCR specimen will be referred to a Vaccine
Preventable Disease (VPD) Reference Laboratory. VPD laboratories are established in cooperation with
public health laboratories and the Centers for Disease Control and Prevention [CDC] to provide reference
testing and surge capacity.

The sensitivity of measles IgM assays varies, and may be diminished during the first 72 hours after rash
onset. If the result is negative for measles IgM and the patient has a generalized rash lasting more than 72
hours, a second serum specimen should be obtained and the measles IgM test should be repeated (AAP.
Red Book, 2015; p. 537).

For questions regarding storage and shipping of all samples, please contact the MSPHL Virology Unit at
573-751-3334.

Measles serology instructions:
http://health.mo.gov/lab/measlesrubella.php

CDC measles RT-PCR instructions (do NOT ship specimens directly to CDC):
https://www.cdc.gov/measles/lab-tools/rt-pcr.html

For further guidance, please refer to:
https://www.cdc.gov/measles/hcp/index.html

https://www.cdc.gov/mmwr/preview/mmwrhtml/rr6204a1.htm?s_cid=rr6204a1_w

Questions should be directed to DHSS’ Bureau of Communicable Disease Control and Prevention at
573/751-6113 or 800/392-0272 (24/7).