With uptick in U.S. measles cases, CHOP doctor urges physicians to be vigilant

A recent uptick in measles cases across the country has one local doctor concerned that her peers may lack a keen enough awareness to recognize and, in turn, prevent the spread of the disease if it were to present in their offices.

Dr. Julia Sammons, director of Infection Prevention and Control at the Children’s Hospital of Philadelphia, has been practicing since 2006. She admits she has never seen or treated measles.

“Due to the large success of the measles vaccine and having trained in an era where measles has been nearly eliminated, I hope I never have to learn,” she said. “But the next step is to certainly be prepared.”

Contrast her experience with Dr. Paul Offit, 63, and chief of infectious diseases at CHOP.

“Anybody who’s older like me, when they hear the word ‘measles’ gets upset because we know what that disease could do,” he said.

Offit vividly recalls February 1991 in Philadelphia, when an outbreak hit two church communities of unvaccinated kids, resulting in about 1,000 infections and nine deaths.

“The city was in a panic,” he said.

Offit thinks that and previous experience with measles patients have equipped him to identify the symptoms and rashes, which may have some subtle but key differences with other diseases including scarlet fever.

“I can usually tell within two minutes if a patient has measles. They’re sick and uncomfortable. You can see it,” says Offit. “How to convey that, you don’t really appreciate it until you see it.”

Measles was pretty much eliminated in the U.S. by the year 2000, largely thanks to successful vaccination efforts. But the disease is now creeping back. Factors in that revival include increased international travel and drop-offs in vaccinations in some communities, due to philosophical or religious reasons.

A recent federal report identified 129 measles cases and 13 outbreaks in the U.S. so far this year, with the closest one to Philadelphia taking place in New York City. Several dozen cases were linked to travel to places including the Philippines, which is experiencing a more widespread outbreak.

Doctor’s offices may be a source for secondary transmissions, Sammons said.

“I think some of the lessons learned from the recent outbreak is that those cases may not have been recognized in a timely manner in a clinic or doctor’s office where they might have been presenting,” she said.

In a column published in the Annals of Internal Medicine this week, Sammons said doctors, especially of her generation who’ve never experienced measles, should review symptoms and at least consider it as a possibility for kids who come in with typical signs. That can include a high fever, characteristic red, blotchy rash, red eyes, tiny white to bluish raised dots on the interior surfaces of the mouth, a recent international travel history or a recent history of being around travelers.

“If measles is suspected, airborne precautions should be implemented immediately,” she wrote. “Such precautions include appropriate patient isolation and the use of personal protective equipment.”

In 2013, Pennsylvania and Delaware reported zero measles cases. New Jersey had three.