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6 fhea.com Fitzgerald Health Education Associates, Inc., March 2015 Clinical Update: Measles at risk for permanent developmental disability as well as vision and hearing loss. Subacute scleros- ing panencephalitis (SSPE) is a degenerative cen- tral nervous system disease that can develop 6 to 12 years after measles infection. It is largely seen in children who contract the illness early in life (<5 years of age), occurring in up to 18 per 100,000 in this group. SSPE is characterized by the gradual onset of altered cognition and per- sonality changes along with my- oclonia and muscle spasms, pro- gressing to coma and death. SSPE occurs only with wild disease and does not occur post MMR vaccine. 11 Treatment Treatment of measles is supportive. However, for children with severe cases, such as those who require hospitalization, treatment with vi- tamin A supplementation is recom- mended. 6 It should be adminis- tered immediately on diagnosis and again the following day. Recommended daily doses are: • 50,000 IU for infants <6 months • 100,000 IU for infants 6-11 months • 200,000 IU for children ≥12 months. 6 Persons exposed to measles who have no reli- able evidence of immunity against the disease should be offered post-exposure prophylaxis (PEP), which can provide some protection or modify the clinical course of disease. 2 If the exposure occurred within the previous 72 hours, the MMR vaccine can be given as PEP. If exposure occurred within 6 days, intramuscular immune globulin (IMIG) can be giv- en; IMIG is especially recommended for persons at risk for severe illness and complications from measles. The CDC recommends giving IMIG to all infants younger than 12 months of age who have been exposed to measles; infants aged 6 through 11 months can be given MMR in place of IMIG if administered within 72 hours of exposure. Persons who receive either form of PEP should be moni- tored for signs and symptoms of measles in com- munity-based isolation for at least one incubation period (7-21 days). 2 Preventing Measles NPs can help prevent measles outbreaks by mak- ing sure all their patients are fully vaccinated ac- cording to the U.S. immunization schedule. The first MMR vaccine dose is recommended for all chil- dren at age 12 through 15 months, and a second dose is recommend- ed at age 4 through 6 years. How- ever, children aged 6 to 11 months who are traveling outside the Unit- ed States should receive 1 dose of MMR. Children aged ≥12 months traveling internationally should re- ceive 2 doses of MMR vaccine, sep- arated by at least 28 days. The sec- ond dose is needed because between 2% and 5% of people do not develop measles immunity after the first MMR dose. 12 Two doses of MMR are approximately 97% effective at preventing measles. For adults without evidence of immunity, one MMR dose should be given, unless the person is in a high-risk group (healthcare personnel, interna- tional travelers, students at post-high school edu- cational institutions, and people exposed to measles in an outbreak setting); these persons should receive 2 doses. And, given the role that unvaccinated travelers play in spreading the dis- ease, it is important to ensure that international travelers have evidence of immunity against measles before they travel (see Table). While healthcare provider diagnosis of the disease was once an acceptable way of verifying measles im- munity, the Advisory Committee on Immunization Practices (ACIP) no longer considers healthcare provider diagnosis as evidence of immunity for measles. 12 NPs can help prevent measles outbreaks by making sure all their patients are fully vaccinated according to the U.S. immunization schedule.