Volume 28 Number 1
By Frank Hubbell, DO
The reason for this article is simple: there is currently an outbreak of a highly contagious viral illness – measles. This epidemic has been going on for the past several months, with over 80 cases being reported in more than 14 states.
Measles Case Study:
You are with a local ambulance squad and are asked to transport a 4yo child to the local emergency department who reportedly has a fever, chills, cough, and lethargy.
Upon arrival at the home, you are presented with a child who appears sick. She has a rash on her face and neck, conjunctivitis, and a runny nose, is feverish, and has a cough. Mom states that her daughter has been sick for the past several days, but seems to be getting worse. She developed the rash overnight.
4yo female, whose mom states has been sick for 4 days and is getting worse. She is c/o a sore throat, cough, runny nose, fever, and conjunctivitis.
LOC: A & O x 3
RR & Effort: 20 and not labored
HR: 96 and regular
SCTM: + for a rash on her face and neck, feverish, and moist
Skin is + for erythematous macules on her face and neck
Eyes + for erythematous conjunctiva with mucopurulent material on the lashes
Throat is + for erythema with whitish spots on the buccal mucosa next to the back molars
Lungs + for crackles; she has a wet cough with deep breathing
Heart – RRR without murmur
Abdomen is + for bowel sounds, soft, and non-tender
M: ibuprofen and Tylenol for the fever
P: none; mom denies any childhood immunizations
L: light dinner last night
E: home from school sick
Viral exanthem – measles
Rest, liquids, supportive care
Quarantine to minimize spread
Receive recommended childhood immunizations
Measles is one of the leading causes of death in children worldwide.
Worldwide: 2013 – 145,700 deaths (down from millions prior to vaccinations)
USA: 2014 – 644 cases reported in 27 states
2015 – so far, >80 cases in 14 states
It is caused by a virus: Paramyxovirus, Morbillivirus.
Transmission is via airborne/droplet-spread.
Incubation: 10 – 12 days
Signs and Symptoms of Measles:
Fever – lasts 4 – 7 days
Coryza (runny nose)
Conjunctivitis (red, goopy eyes)
Koplik’s spots – white spots on the buccal mucosa (short-lived) next to the back molars
Rash – starts on the face and neck, then speads to the trunk and extremities
4 D’s and 3 C’s ⇒ 4 Days with the 3 C’s – Cough, Coryza, and Conjunctivitis before the rash occurs.