What are the symptoms of the measles?
Measles may have an atypical presentation in a transplant patient and may mimic other viral infections. Usual symptoms include:
- Fever 38.3° C or higher
- Irritability, somnolence
- Cough, coryza and conjunctivitis (the three "C"s)
- Photosensitivity
- Small white spots on the inside of the mouth and throat (Koplik's spots)
- Maculopapular rash that starts on the face three to seven days after the start of the symptoms and progresses down the body
Am I at risk for the measles?
According to the Public Health Agency of Canada (PHAC), you are immune to measles if you meet one of the following criteria:
- Documentation of vaccination:
- Children 12 months to 17 years of age: 2 doses of MMR or MMRV
- Adults > 18 years (born after 1970): 1 dose of MMR
- History of laboratory-confirmed infection
- Laboratory evidence of immunity (Measles IgG positive)
- Born before 1970
How do I know if I'm at risk?
If you are unsure if you received the vaccine or had measles, your doctor can do a blood test (serology for measles) to check to see if you are immune. Those born before 1970 are likely to have been exposed to wild-type viruses, although it may be a good idea to confirm serologic status.
How effective is the measles vaccine?
The measles vaccine is very effective. One dose of measles vaccine is about 93% effective at preventing measles if exposed to the virus and two doses are about 97% effective (https://www.cdc.gov/measles/about/questions-about-measles.html).
What do I do if my measles antibody test is negative (pre-transplant)?
If you are waiting for a transplant, your measles antibody is negative, and you are not receiving immune suppressive medication, then you can get the measles vaccine. However, note that you will need to wait for 4 weeks to get a transplant after getting the measles vaccine. Therefore, before getting the measles vaccine, you need to discuss this with your doctor. You may be too sick to be on hold for a transplant.
What do I do if my test is negative (post-transplant)?
You cannot get the vaccine; it can be very risky if you receive it. Please consult your doctor.
Who else should get the vaccine?
If a household member is eligible for the vaccine, they should be vaccinated to prevent disease transmission in the home. Similarly, contacts at work or school ideally should be immunized. As a transplant recipient, you should wash your hands frequently after contact and not share utensils with anyone vaccinated for measles in the last 2 weeks. Also, avoid changing diapers (or wearing gloves) for 2 weeks in a child that has received the measles vaccine.
I have been exposed to measles. What should I do? Do I need to stay home?
Call your coordinator and let them know. You will need to monitor yourself for symptoms. Do not come to the ER/go to the clinic without speaking to someone from your transplant team about it first as you may be putting others at risk.
I had my transplant already and I think I may have been exposed to someone who has measles, how do I know if I'm at risk for infection?
Your doctor can check your serologic status to see whether you may be non-immune and thus potentially need post-exposure prophylaxis.
What can I do if I am exposed and am not immune?
After exposure, intramuscular gammaglobulin may be helpful for seronegative organ transplant recipients if given within 6 days of exposure, per CDC guidelines. Gammaglobulin is not needed if they have had intravenous immunoglobulin (IVIG) treatment recently (depending on dose, likely within the past 1-3 months). Transplant recipients who have positive serum measles IgG levels have evidence of protective antibodies and do not need gammaglobulin if exposed to measles (http://www.cdc.gov/vaccines/pubs/pinkbook/downloads/meas.pdf).
How is measles spread?
The virus is transmitted through the air, it can survive for up to 2 hours after the infected person has left the area.
How long does it take to show signs of measles after being exposed?
The symptoms can take anywhere between 7-21 days from when you were exposed to appear, typically occurring 10 days after exposure. People are infectious from 1 day before the beginning of symptoms to 4 days after rash onset. The usual time from exposure to the appearance of rash is 14 days (http://www.phac-aspc.gc.ca/publicat/cig-gci/p04-meas-roug-eng.php).
Is there a treatment for measles?
No, there is no treatment for measles.
