Public Health Alert -- Measles Exposures Related to New Suspect Case;
DOH Urges Residents to Get Up-to-Date on Vaccinations

The New Jersey Department of Health has identified a third person suspected of having measles who may have exposed additional people at Somerset Medical Center and the public at several locations in Somerset County between March 6 and 12. The suspected case announced on Friday of last week has been confirmed as measles. Initial exposure was through a patient with measles.

Measles is a highly contagious viral illness that can cause serious medical complications. As a result, DOH recommends that anyone who visited the following locations during the dates/times listed below, contact a health provider immediately to discuss potential exposure and risk of developing the illness:

Somerset Medical Center, 110 Rehill Ave, Somerville, NJ 08876:

  • March 4, between 8 a.m. and 6 p.m.
  • March 5, between 8 a.m. and 6 p.m.
  • March 6, between 9 a.m. and 4:30 p.m.
  • March 7, between 9 a.m. and 8 p.m.
  • March 8, between 9 a.m. and 2 p.m.
  • March 11, between 8:45 a.m. and 2 p.m.

Steeplechase Cancer Center, 30 Rehill Ave, Somerville, NJ 08876:

  • March 6, between 2:30 p.m. and 5:30 p.m.
  • March 8, between 12 p.m. and 5:30 p.m.
  • March 11, between 2 p.m. and 5 p.m.
Somerset County Human Services Building, 27 Warren St, Somerville, NJ 08876
  • March 6, between 9:15 a.m. and 2 p.m.
  • March 7, between 10:30 a.m. and 7 p.m.
  • March 11, between 10:30 and 4 p.m.

Somerset County Administration Building, 20 Grove St, Somerville, NJ 08876

  • March 7, between 10 a.m. and 12:30 p.m.

Carlo's Pizza & Pasta, 572 Union Ave, Bridgewater, NJ 08807

  • March 8, between 4:00p.m.and 6:45 p.m.

T.G.I.Friday's, 395 U.S. 202, Bridgewater, NJ 08807

  • March 9, between 5:30 p.m. - 10:00 p.m.

Barnes & Noble Booksellers Somerville, 319 Rte 202/206, Bridgewater, NJ 08807

  • March 9, between 8 p.m. and 10:30 p.m.

Bloomingdale's at Bridgewater Mall, 410 Commons Way, Bridgewater, NJ

  • March 10, between 3:00 p.m. and 6:30 p.m.

Adam & Eve Hairstylists, 626 U.S. 206, Hillsborough, NJ 08844

  • March 12, between 6 p.m. and 9 p.m.

We urge everyone to check to make sure they and their family members are up-to-date on measles/mumps/rubella (MMR) vaccine and all other age-appropriate immunizations. Getting vaccinated not only protects you, it protects others around you who are too young to get the vaccine or can't receive it for medical reasons. Two doses of measles vaccine is more than 99 percent effective in preventing measles, said Dr. Christina Tan, state epidemiologist.

Anyone who suspects an exposure is urged to call a health care provider before going to a medical office or emergency room. Special arrangements can be made for you to be evaluated while also protecting other patients and medical staff from possible infection. People who may have developed symptoms as early as March 13. Measles symptoms include rash, high fever, cough, runny nose and red, watery eyes.

If you're planning an international trip, the World Health Organization recommends that adults or adolescents unsure of their immune status get a dose of measles vaccine before traveling, Dr. Tan added.

Measles is easily spread through the air when an infected person talks, coughs or sneezes. People can also get sick when they come in contact with mucus or saliva from an infected person. Anyone who hasn't been vaccinated or has not had measles is at risk if they are exposed to the virus.

Measles can cause serious complications such as pneumonia and encephalitis (swelling of the brain) in 20 percent of patients, especially children under 5 and adults older than 20. Measles infection in a pregnant woman can lead to miscarriage, premature birth or a low-birth weight baby.

DOH is working with local health departments and with the U.S. Centers for Disease Control and Prevention to locate the patient's contacts.

Somerset Medical Center has alerted employees, patients and others who were potentially exposed at the hospital.

For more information about measles, contact your health care provider. Additionally a call center will open tomorrow, Friday, March 15 to answer provider and public questions at 1-866-341 9788.

The call center hours are:

9 a.m. -7 p.m. Friday
9 a.m.-5 p.m. Saturday
9 a.m. -5 p.m. Sunday

The U.S. Centers for Disease Control and Prevention's web site has additional information at www.cdc.gov/measles.

New Jersey Department of Health
Vaccine Preventable Disease Program
Measles Public FAQs
Date: March 14, 2013

MEASLES EXPOSURES IN NJ

Q: Was there a recent measles exposure in NJ?

A: There are two measles exposure situations that NJDOH and Somerset County Health Department are currently investigating.

Situation #1

On March 8th, the local health department was made aware of an employee at Somerset Medical Center who developed fever and a rash. This person had contact with a known laboratory confirmed case of measles in an unvaccinated individual who recently traveled internationally. The person worked while potentially infectious, potentially exposing persons visiting Somerset Medical Center during the following dates and times:

March 4, 8:00 a.m. - 6:00 p.m.
March 5, 8:00 a.m. - 6:00 p.m.
March 6, 8:00 a.m. - 2:00 p.m.

A press release was distributed to urge NJ residents to make sure they are up-to-date on vaccinations and to alert those individuals who may have been exposed.

On March 13th, NJDOH received laboratory confirmation of measles for the employee, making it a confirmed case.

Situation #2

On March 13th, the local health department was made aware of an additional suspect case of measles. This person had suspected contact with a known laboratory confirmed case of measles in an unvaccinated individual who recently traveled internationally. This person potentially exposed persons visiting the following locations at the dates and times specified:

Somerset Medical Center, 110 Rehill Ave., Somerville, NJ 08876

March 6, 9:00 a.m. - 4:30 p.m.
March 7, 9:00 a.m. - 8:00 p.m.
March 8, 9:00 a.m. - 2:00 p.m.
March 11, 8:45 a.m. - 2:00 p.m.

Steeplechase Cancer Center, 30 Rehill Ave., Somerville, NJ 08876

March 6, 2:30 p.m. - 5:30 p.m.
March 8, 12:00 p.m. - 5:30 p.m.
March 11, 2:00 p.m. - 5:00 p.m.

Somerset County Human Services Building, 27 Warren St, Somerville, NJ 08876

March 6, 9:15 a.m. - 2:00 p.m.
March 7, 10:30 a.m. - 7:00 p.m.
March 11, 10:30 - 4:00 p.m.

Somerset County Administration Building, 20 Grove St, Somerville, NJ 08876

March 7, 10:00 a.m. - 12:30 p.m.

Carlo's Pizza & Pasta, 572 Union Ave, Bridgewater, NJ 08807

March 8, 4:00p.m. - 6:45 p.m.

T.G.I.Friday's, 395 U.S. 202, Bridgewater, NJ 08807

March 9, 5:30 p.m. - 10:00 p.m.

Barnes & Noble Booksellers Somerville, 319 Rte 202/206, Bridgewater, NJ 08807

March 9, 8:00 p.m. - 10:30 p.m.

Bloomingdale's at Bridgewater Mall, 410 Commons Way, Bridgewater, NJ

March 10, 3:00 p.m. - 6:30 p.m.

Adam & Eve Hairstylists, 626 U.S. 206, Hillsborough, NJ 08844

March 12, 6:00 p.m. - 9:00 p.m.

Q: Are you sure the person has measles?

A:

Situation #1

Yes. Positive test results have been received for the employee and this person is now considered to be a confirmed case.

Situation #2

No. At this time, this person is suspected to have measles. Test results are pending but we may never know for sure if the person has measles.

Q: Why didn't you wait until you got laboratory confirmation before issuing the press release?

A: If you are unvaccinated and exposed to measles, you may prevent infection by getting vaccinated within 72 hours of exposure. Also, certain people might benefit from immune globulin (a blood product containing antibodies to the measles virus) to lessen the severity of infection. Immune globulin needs to be given within 6 days of exposure. Getting the information to people as soon as possible is critical to protecting individuals and the community.

Q: Why is everyone who was at the locations listed at risk?

A: Measles is highly contagious and is spread easily through the air. Therefore, we are asking everyone who was at the locations listed during the times stated to review their immunization history.

Q: If I think I been exposed to measles, what should I do?

A: You should contact your doctor immediately if you believe you or your child has been exposed to measles. If your child has not been vaccinated, measles vaccine may prevent disease if given within 72 hours of exposure. Immune globulin (a blood product containing antibodies to the measles virus) may prevent or lessen the severity of measles if given within 6 days of exposure.

Q: When would people who might have been exposed to measles develop symptoms?

A: People might develop symptoms 7 - 18 days after exposure. People exposed on the dates, times, and locations listed may become ill as early as March 11 and as late as March 30.

Q.: How do I know if I am immune to measles?

A: Your healthcare provider is the best person to determine if you are immune to measles (i.e., protected from getting measles) based on your vaccination record and any medical conditions you might have. In general, if you received two doses of measles- containing vaccine (MMR or MMRV) separated by at least 28 days on or after 12 months of age, you are considered immune. In addition, you can see if you are immune by checking a blood test called serology. These tests can be ordered by your healthcare provider. People born before 1957 are also considered immune since the disease was common then but there is no guarantee that you are immune unless you were vaccinated or have a blood test.

RECENT MEASLES CASES IN NJ

Q: Are there reports of measles infection in NJ?

A: Since January, NJDOH has two confirmed cases and one case currently under investigation.

Q: Is there currently a measles outbreak in the U.S. or in other countries?

A: Normally, the U.S. sees about 60 cases of measles per year. But in 2011, the number of reported cases was higher than usual � 222 people had measles. Nearly 40% of these people got measles in other countries, including Europe and Asia. They brought it to the U.S. and spread it to others, causing 17 measles outbreaks across the U.S.

In 2011, NJ also experienced an increase in measles cases. NJ experienced 4 confirmed and 3 probable cases (confirmed cases only are reported to CDC). In addition to the cases, NJDOH was notified by other health authorities of numerous laboratory-confirmed measles occurring in other jurisdictions with numerous NJ contacts. NJDOH worked closely with local health authorities to notify those contacts, assess immunization status, and quarantine susceptible individuals as appropriate to prevent further spread of the disease. In 2012, the number of NJ cases decreased, only 2 confirmed cases were reported.

The increased number of measles importations into the United States in 2011 underscores the importance of vaccination to prevent measles and its complications.

DESCRIPTION OF MEASLES

Q: What is measles?

A: Measles is a very contagious respiratory disease caused by a virus. Before vaccine was available, it was a common childhood disease in the United States and is considered the most deadly of all childhood rash/fever illnesses. It is still common in areas of the world where there are unvaccinated populations.

Q: What are the symptoms of measles?

A: Symptoms can include fever, rash, runny nose, cough, loss of appetite, and �pink eye.� The rash usually begins at the hairline, moves to the face and upper neck, and proceeds down the body as the disease progresses. However, people may be infectious before they begin to show symptoms.

Q: What is the incubation period?

A: The incubation period is the time between being exposed to the measles virus and the appearance of the first symptoms. The incubation period for measles ranges from 7 to 18 days.

Q: How serious is the disease?

A: Measles itself is unpleasant, but the complications are dangerous. Six to 20 percent of the people who get the disease will get an ear infection, diarrhea, or even pneumonia. One out of 1000 people with measles will develop inflammation of the brain, and about one out of 1000 will die.

Q: How can I catch measles?

A: Measles is highly contagious. Infected people are usually contagious from about 4 days before their rash starts to 4 days afterwards. When an infected person talks, coughs, or sneezes, the virus is released into the air and enters another person�s body through the nose, mouth or throat. People can also become sick if they come in contact with the mucus or saliva (spit) from an infected person. The measles virus can live on infected surfaces or hang in the air for up to two hours.

Q: How contagious is measles?

A: Measles is one of the most contagious diseases. Ninety (90%) of susceptible people will be infected after coming in contact with someone with measles.

Q: How is measles diagnosed?

A: A health care provider will observe symptoms and take a blood sample to find out if a person is infected with measles. Healthcare providers may also send urine or throat swabs to try to isolate the virus.

Q: What should I do if I think I was exposed?

A: Call your health care provider first to discuss your exposure so special arrangements can be made for you to be evaluated without putting other patients and medical office staff at risk. A person infected with measles can be infectious before they have any symptoms of the disease.

Q: What should I do if I get sick?

A: If you become ill with measles-like symptoms, including fever, rash, runny nose, cough, loss of appetite, and pink eye seek medical attention but remember to call your health care provider before going to the medical office and inform them that you were exposed to someone with measles or that you have symptoms of measles so that special arrangements can be made to prevent exposure to other patients and medical office staff.

Q: What is the treatment for measles?

A: There is no medicine for measles, only supportive treatment (bed rest, fluids and fever reduction). Most patients will recover on their own. Patients who develop complications from measles may need treatment specific to these complications.

MEASLES VACCINATION

Q: How can measles be prevented?

A: Measles is a vaccine-preventable disease. Getting vaccinated against measles will protect people from getting the disease. The measles vaccine is given in combination with the vaccines for mumps and rubella. This vaccine (MMR) follows a two-dose schedule (one shot at 12 months and a second shot at four to six years of age). However, the second dose of MMR can be given anytime as long as it is at least four weeks after the first dose.

Another option is the MMRV vaccine (MMR plus varicella [chickenpox] vaccine). MMRV is only licensed for use in children between the ages of 12 months through 12 years. MMRV can only be given through age 12 years and should be separated from a previous dose of varicella-containing vaccine by 12 weeks.

If you are traveling outside the US, ask your healthcare provider if you or your child should receive an MMR vaccine. Because there is ongoing measles transmission in other countries, the Centers for Disease Control and Prevention is recommending that children age 6 - 12 months of age receive the MMR before traveling. If your child was exposed to measles and is 6 months of age or older, your healthcare provider might recommend vaccination.

Q: How is this vaccine given?

A: This vaccine is given by subcutaneous injection, meaning that the vaccine is deposited just under the skin and not deep into the muscle. 

Q: If I had measles vaccines as a child, am I still protected?

A: Yes. The measles vaccine usually provides life-long immunity. However, a small number of people do not develop immunity after receiving the vaccine.

Q: If I have been sick with measles in the past, am I immune?

A: Yes, if you had measles in the past, you would be protected. People do not get measles more than once. However, you should still receive the MMR or MMRV vaccine to be protected against mumps, rubella, and varicella (chickenpox). Also, some people may think they had the measles but actually had another illness with a rash. If you are unsure, you should get vaccinated or have a blood test to make sure you are immune especially if you are traveling outside the United States. If you are exposed to someone with measles, public health authorities will not accept physician or family diagnosed measles as proof of immunity.

Q: How can I locate my immunization records?

A: Contact your health care provider regarding your past immunization history. Schools and colleges may also have records of your immunization history.

Q: What if I cannot locate my immunization records?

A: If you cannot locate your immunization records, you can ask your doctor for a measles titer (blood test) which will let you know if you have immunity to measles.

Q: What if I cannot obtain proof of immunity?

A: People without proof of immunity who have been exposed to measles will need to stay at home (quarantine) from day 7 through day 18 following exposure to prevent spread to other people. Exact dates depend on your date(s) of exposure. For example, if you were exposed on 3/4/13, you will need to stay at home from 3/11 through 3/22/13. You can check with your local health department or health care provider to assist you with determining correct dates to remain at home.

Q: Will getting an extra dose of measles vaccine be harmful?

A: No. Although, CDC does not routinely recommend more than 2 doses of MMR vaccine, there is no harm in receiving an additional dose of vaccine if you are not sure of your vaccine history.

Q: What are the side effects from the MMR and MMRV vaccines?

A: Mild side effects are soreness at the site of the injection, fever, mild rash, and, rarely, swelling of the glands. Moderate and severe side effects are rare.

The first dose of MMRV vaccine has been associated with rash and higher rates of fever than MMR and varicella vaccines given separately. Rash has been reported in about 1 person in 20 and fever in about 1 person in 5. Seizures caused by a fever are also reported more often after MMRV. These usually occur 5-12 days after the first dose. Getting vaccinated is much safer than getting measles.

Q: Who should NOT receive measles vaccine?

A: Anyone who experiences a severe allergic reaction (e.g., hives, swelling of the mouth or throat, difficulty breathing) following the first dose of MMR should not receive a second dose.

Pregnant women should not receive the MMR vaccine, and women should try not to become pregnant for four weeks following vaccination with MMR. While there is no evidence that the measles vaccine causes fetal damage, women are advised not to receive the MMR vaccine during pregnancy as a safety precaution based on the theoretical possibility of a live vaccine causing disease.

Severely immunocompromised persons should not be given MMR vaccine. This includes persons with a variety of conditions, including congenital immuno-deficiency, AIDS, leukemia, lymphoma, generalized malignancy, or those undergoing immunosuppressive therapy. 

Q: Can I get the MMR or MMRV if I have a family member who is immunocompromised or is pregnant?

A: Yes. It is safe to receive the vaccine if you live with someone who is pregnant or immunocompromised.

Q: Can individuals with an egg allergy receive MMR vaccine?

A: Yes. In the past it was believed that persons who were allergic to eggs would be at risk of an allergic reaction from the vaccine because the vaccine is grown in tissue from chick embryos. However, recent studies have shown that this is not the case. Therefore, MMR may be given to egg-allergic individuals without prior testing or use of special precautions.

Q: How effective is the measles vaccine?

A: Measles vaccine (MMR vaccine or MMRV vaccine) is very effective and is the best way to prevent measles. Measles vaccine effectiveness has been estimated at ~95% for one dose and ~99% for two doses.

Q: Why do I need two doses of measles vaccine?

A: About 5%of people do not develop immunity after getting the first shot. Therefore, it is recommended that everyone get a second shot. After two doses, more than 99% of people will be protected.

Q: Does the MMR vaccine cause autism?

A: No. Studies have shown that MMR vaccine does not cause autism. The question about a possible link between MMR vaccine and autism has been extensively reviewed by independent groups of experts in the U.S. including the National Academy of Sciences Institute of Medicine. These reviews have concluded that the available epidemiologic evidence does not support a causal link between MMR vaccine and autism.

 The MMR-autism theory had its origins in research by Andrew Wakefield and colleagues in England. They suggested that inflammatory bowel disease (IBD) is linked to persistent viral infection. In 1993, Wakefield and colleagues reported isolating measles virus in the intestinal tissue of persons with IBD. The validity of this finding was later called into question when it could not be reproduced by other researchers. In addition, the findings were further discredited when an investigation found that Wakefield did not disclose he was being funded for his research by lawyers seeking evidence to use against vaccine manufacturers. In February 2010, the British medical journal, The Lancet, retracted Dr. Wakefield's 1998 research paper and his work is considered fraudulent. Dr. Wakefield has lost his license to practice medicine.

The retracted article by Wakefield and interviews with celebrities citing anecdotal reports of autism following vaccination have received a lot of attention by the media. However, many well-designed scientific studies appearing in peer-reviewed journals have consistently failed to show a causal relationship between MMR vaccine, or any vaccine, and autism.

Q: What if I received two doses of measles vaccine but develop symptoms of measles?

A: No vaccine is 100% effective. If you are sick, you should contact your healthcare provider to discuss your symptoms. You should never attend work or school if you are ill to prevent spread of disease to others.

Q: Where can I get more information on measles?

A: For more information, contact:

  • Your health care provider
  • Your local health department
  • NJ Department of Health

Vaccine Preventable Disease Program 609-826-4860

http://www.nj.gov/health/cd/measles/index.shtml

Centers for Disease Control & Prevention:

http://www.cdc.gov/vaccines/

http://www.cdc.gov/measles/index.html

This information is intended for educational purposes only and is not intended to replace consultation with a health care professional.