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.
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.
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.
