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617-358-7647

Agent

Measles virus is a negative-sense, single stranded RNA virus, which belongs to morbillivirus genus in the Paramyxoviridae family. It consists of a helical nucleocapsid, 100-300 nm in diameter, surrounded by an envelope. The envelope is lined by matrix proteins and carries transmembrane hemaglutinin and fusion glycoproteins which are the virulence factors.

Disease/Infection

The Measles virus may cause measles, a systemic infection starting in the respiratory epithelium of the nasopharynx.

Pathogenicity

Measles can be spread by respiratory droplets and by direct contact with secretions from nose and throat of an infected person. Direct contact is the primary mode of transmission, and airborne droplet and indirect contact are less common modes of transmission. Measles is a highly communicable disease. Patients are infectious from the onset of prodomal symptoms until 2-4 days after rash development, but communicability is higher before rash appearance. Infection may lead to severe complication and can cause death.

  • Special Populations at Risk
    Pregnant women, immunocompromised and malnourished workers are at a greater risk of developing complications, and experience more severe illness. During pregnancy, measles results in increased risk of spontaneous abortion and preterm birth.

Biosafety Information

Risk Group/BSL
Risk Group 2
Biosafety level 2 (may be enhanced – subject to appropriate risk assessment)

Modes of Transmission

Transmission
Skin Exposure (Needlestick, bite, or scratch):Yes
Mucous Membrane Splash to Eye(s), Nose or Mouth:Yes
Inhalation:Yes
Ingestion:No

Host Range/Reservoir
Humans are the primary host, but non-human primates can also be a host, and measles is a threat to their conservation.

Symptoms
Fever (approximately 38.3°C) and malaise develop over 24 hours. These symptoms are followed by cough, coryza (inflammation of the nasal mucous membranes) and conjunctivitis. After 2-3 days of cough, coryza and conjunctivitis, Koplik spots (white and granular lesions in the lateral buccal mucosa) appear. On the fourth day, a macropapular rash appears on the head and neck, behind the ears. The rash then spreads to the rest of the body and persists for 3-5 days before fading. Other symptoms include anorexia and dyspnea. Subjective improvement can begin 2-4 days after the rash first appears.

Common complications include bacterial superinfection, which results in otitis media (middle ear infection), bronchitis, croup and pneumonia (3.5-50% cases), lymphadenopathy, diarrhea and encephalitis (1 in 1,000 cases). Pneumonia is the main cause of mortality. Encephalitis may result in coma and brain damage (25%) or death (15%). Rarer complication includes thrombocytopenic purpura, myocarditis, subacute sclerosing panencephalitis, abdominal pain and acute appendicitis.

Incubation Period
The incubation period is 7-18 days

Viability
MV is susceptible to povidone iodine, formaldehyde, 1% sodium hypochlorite, 70% ethanol, glutaraldehyde, phenolic disinfectants, peracetic acid, hydrogen peroxide.

Survival Outside Host
Agent may survive less than 2 hours on surfaces or objects. Respiratory droplets can remain infective for at least 1 hour in a close space.

Information for Lab Workers

Laboratory PPE

Lab coat, gloves and eye protection when direct skin contact with infected materials or animals is unavoidable. Eye protection must be used where there is a known or potential risk of exposure to splashes.

Containment

BSL-2 facilities, equipment, and operational practices for work involving infectious or potentially infectious materials, animals, or cultures. Procedures that are likely to generate aerosols should be conducted in a biosafety cabinet. Practices may be enhanced based on risk assessment.

In Case of Exposure/Disease

  • For injuries in the lab which are major medical emergencies (heart attacks, seizures, etc…):
    • Medical Campus: call or have a coworker call the Control Center at 617-414–4144.
    • Charles River Campus: call or have a coworker call campus security at 617-353-2121.
      You will be referred to or transported to the appropriate health care location by the emergency response team.
  • For lab exposures (needle sticks, bite, cut, scratch, splash, etc…) involving animals or infectious agents, or for unexplained symptoms or illness call the ROHP 24/7 hour number (1-617-358-ROHP (7647); or, 8-ROHP (7647) if calling from an on-campus location) to be connected with the BU Research Occupational Health Program (ROHP) medical officer. ROHP will refer you to the appropriate health care location.
  • Under any of these scenarios, always inform the physician of your work in the laboratory and the agent(s) that you work with.
  • Provide the wallet-size agent ID card to the physician.

Vaccination

There is a trivalent vaccine using live-attenuated virus of measles, mumps and rubella (MMR), but this vaccine requires constant cold for storage and transport. Vaccination is 2 doses that are 28 days apart, no documentation of titer required if proof of vaccination is provided. Pregnant women should not receive the MMR vaccine.

Information for First Responders/Medical Personnel

Public Health Issues

Measles can spread person to person through direct contact with droplets from respiratory secretions of infected persons. Infected patients are probably contagious from several days before until several days after the onset of rash. Patients with suspected clinical measles should be placed in respiratory isolation. Susceptibility of those workers exposed to measles is determined by assessment of vaccination history or evidence of serologic immunity. Health care providers should immediately report to local board of health (BPHC) where the diagnosis was made.

Diagnosis/Surveillance

Monitor for symptoms, microbiological and serological testing for measles virus or anti-measles antibodies. Throat or nasopharyngeal swabs are generally the preferred sample for virus isolation or RT-PCR detection.

First Aid/Post Exposure Prophylaxis

Perform one of the following actions:

Skin Exposure (Needlestick or scratch):Immediately go to the sink and thoroughly wash the wound with soap and water for 15 minutes. Decontaminate any exposed skin surfaces with an antiseptic scrub solution.
Mucous Membrane Splash to Eye(s), Nose or Mouth:Exposure should be irrigated vigorously.
Splash Affecting Garments:Remove garments that may have become soiled or contaminated and place them in a double red plastic bag.

Treatment

References

Canada Material Safety Data Sheets: Measles Virus. http://www.phac-aspc.gc.ca/msds-ftss/msds99e-eng.php

Mayo Clinic: http://www.mayoclinic.com/health/measles/DS00331/METHOD=print

Manual for the Laboratory Diagnosis of Measles Virus Infection; December 1999, WHO; http://www.who.int/ihr/elibrary/manual_diagn_lab_mea_rub_en.pdf?ua=1

Control of Communicable Diseases Manual. David L. Heymann. Washington DC, USA: American Public Health Association Press, 19th edition 2008; pages 402-408

105 CMR: Department of Public Health, 105 CMR 300.000: Reportable Diseases, Surveillance, and Isolation and Quarantine Requirements: http://www.mass.gov/eohhs/docs/dph/regs/105cmr300.pdf

Centers for Disease Control and Prevention, Specimens for Measles Virus Isolation or RT-PCR Detection: http://www.cdc.gov/measles/lab-tools/rt-pcr.html

Revised: 10/30/2013