Measles Update #2: More Potential Public Exposures in San Diego
Date: January 18, 2015
This CAHAN updates the January 15 measles advisory with new locations of possible public exposures to measles in San Diego County and provides updated case counts for the Disneyland measles outbreak.
Background
Three probable cases of measles were recently reported with several locations identified where the public may have been exposed. Like the 10 confirmed measles cases reported in the county this year, these three individuals traveled to Disneyland on Dec. 18, 2014. None had been vaccinated for measles. Two have recovered from their illnesses, and one is currently ill and isolated at home. Laboratory testing to confirm the cases will be completed early next week, but in an abundance of caution, locations are being announced today where the public may have been exposed.
The California Department of Public Health (CDPH) reports that there are 26 cases confirmed in other California counties, five in other states, and one in Mexico related to the Disneyland outbreak. There are also five cases not linked, for a total of 41 confirmed measles cases being reported in California. Because the incubation period is over for those exposed at Disneyland between Dec.15 and Dec. 20, no new cases should present from this exposure. However, other confirmed measles cases were present at the resort from Dec. 30 to Jan. 2, Jan. 6, 7, and 12. As such, additional measles cases are likely to be reported.
Measles symptoms usually begin 10–12 days (up to 21 days) after exposure with a prodrome of fever as high as 105°F (40.5°C), malaise, cough, runny nose, and conjunctivitis. Three to five days following onset of the prodrome, a maculopapular rash develops. The rash usually begins around the ears and hairline and then spreads down to cover the face, trunk, arms, and legs. More information for providers may be found at the Centers for Disease Control and Prevention (CDC) measles website.
San Diego Public Exposure Sites
Locations and times of potential exposure to the probable cases are:
- Albertsons, 7660 El Camino Real, Carlsbad, on Jan. 13 from 6 a.m. to 5 p.m.
- Ice-Plex Escondido, 555 N Tulip Street, Escondido, on Dec. 30 from 8 p.m. to 10:30 p.m.
- Phil’s BBQ, 579 Grand Ave, San Marcos, on Jan. 11 from 2 p.m. to 5 p.m.
- Regal Carlsbad 12, 2501 El Camino Real, Carlsbad, on Jan. 6 from 9:30 p.m. to 1:30 a.m.
- Sprouts Farmers Market, 471 College Blvd, Oceanside, on Jan. 14 from 4 p.m. to 7 p.m.
- Vista Community Clinic, 1000 Vale Terrace Drive, Vista, on Jan. 16 from 11 a.m. to 5:30 p.m.
The previously confirmed 10 cases may have exposed members of the public at these locations on these dates and times:
- Absolute Personal Fitness, 2000 Main Street, Julian, on Jan. 9 from 5:00 p.m. to 7:00 p.m.
- City of San Diego Operations Building, 1222 First Avenue, San Diego, on Jan. 12 from 6:30 a.m. to 4:00 p.m., Jan 13 from 9:00 a.m. to 4:30 p.m., and Jan. 14 from 6:30 a.m. to 5:30 p.m.
- CVS Pharmacy, 2760 Fletcher Parkway, El Cajon, on Jan 14 from 4:00 p.m. to 7:00 p.m.
- Julian Fitness Center, 2216 Main Street, Julian, on Jan. 9 from 5:00 p.m. to 7:00 p.m.
- Parkway Plaza Mall in El Cajon, Dec. 29 from 10 a.m. to 2 p.m., especially in or around GameStop, Sunglasses Hut, and the carousel in the mall.
- Rite Aid Pharmacy, 1665 Alpine Blvd., Alpine, on Jan. 13 from 4:00 p.m. to 7:00 p.m.
- Sharp-Rees-Steely Urgent Care Clinic, 5525 Grossmont Center Drive, La Mesa, on Jan. 3 between 10:30 a.m. and 1:30 p.m. and Jan. 14 from noon until the clinic was closed at 1:00 p.m.
- Trader Joe's, 5495 Grossmont Center Drive, La Mesa, on Jan. 12 from 4:00 p.m. to 7:00 p.m.
- Vons, 2800 Fletcher Parkway, El Cajon on Jan. 14 from 4:00 p.m. to 7:00 p.m.
Healthcare providers should:
- Consider the diagnosis of measles in patients with an appropriate clinical presentation. Any patient suspected of having measles should be masked and immediately moved to a negative pressure room when available. Providers seeing patients in an office or clinic setting should consider options such as having the patients call ahead when measles symptoms are present and arranging to see suspect measles cases after all other patients have left the office, or assessing patients outside of the building to avoid having a potentially infectious patient enter the office. CDPH guidance on healthcare facility infection control recommendations for suspect measles patients may be found here.
- Notify the County Epidemiology and Immunization Services Branch (EISB) immediately about any suspect cases during office hours by calling (866) 358-2966 (press 5 at the prompt) Monday–Friday 8 a.m.–5 p.m. and (858) 565-5255 after hours and on weekends. This will facilitate time-sensitive public health actions and assistance with clinical decision making.
- DO NOT wait for laboratory confirmation before reporting a suspect case. The County EISB staff can assist with facilitating testing, which includes a throat (or nasopharyngeal) swab and a urine specimen for measles PCR and culture and a serum specimen for measles IgM and IgG.
- DO NOT send potentially infectious suspect measles patients to a reference laboratory for specimen collection.
- Ensure staff and patients are up-to-date. Two doses of measles-containing vaccine (MMR vaccine) are more than 99% effective in preventing measles. Measles vaccines have been available in the United States since 1963, and two doses have been recommended since 1989. The first dose is given at 12–15 months of age, with the second dose usually at age 4-6 years. The second dose may be given any time ≥28 days after the first dose. All medical staff should have two documented doses of MMR or serologic evidence of measles immunity.
- Provide post-exposure prophylaxis when indicated. Guidance from CDPH on measles post-exposure prophylaxis may be found here.
Thank you for your continued participation.
CAHAN San Diego
County of San Diego, Health & Human Services Agency
Epidemiology and Immunization Services Branch
Phone: (619) 692-8499 • Fax: (858) 715-6458
Urgent Phone for pm / weekends / holidays: (858) 565-5255
Email: cahan@sdcounty.ca.gov
Secure Website: http://cahan.ca.gov
Public-Access Website: http://www.cahansandiego.com
CAHAN San Diego Alerts are intended for the use of public health, medical and laboratory professionals in San Diego County. This alert has been approved for reproduction and distribution to interested professionals. An online CAHAN San Diego application is available at http://www.cahansandiego.com for appropriate and interested individuals.