With people venturing abroad over the summer and heading to festivals, there is a particular risk for vulnerable groups or those who may not be fully vaccinated.
Measles is a highly infectious virus which can lead to life-threatening complications but can be prevented by vaccination. Last year the World Health Organisation said that the virus had been eliminated in the UK, however the current increase in cases is thought to be due to the virus being brought back from other parts of the world where there have been recent outbreaks, particularly in Europe.
As a result of this, PHE has declared a national measles incident, with 781 confirmed cases of measles in England between 1 January 2018 and 22 July 2018.
Recognising measles can be difficult and isn't always at the forefront of a GP's mind when seeing a patient with generalised symptoms of malaise. Public Health England is advising GPs to be mindful of the diagnosis when seeing patients with non-specific viral symptoms, such as coryza, coughs, conjunctivitis or sensitivity to light and high temperatures (typically over 39oC).
Those most vulnerable are aged 15 years and over who may not have had the MMR vaccine when they were younger, and particular consideration should be given to those who have travelled abroad recently, particularly to Europe, and those who have been in communities such as festivals, where transmission of airborne droplets of the virus and contact with respiratory secretions may be more likely. Others at risk include pregnant women, children below the age of one year and immunocompromised patients.
While the illness itself is generally self-limiting it can be associated with unpleasant complications, such as otitis media, diarrhoea, viral pneumonitis and, more rarely, life-threatening complications such as encephalitis and sub-acute sclerosing pan-encephalitis.
Missing a diagnosis of measles could lead to complaints or even potential claims, if a patient has suffered harm as a result of a missed or delayed diagnosis.
In view of this, it may be worth considering the following information and risk management advice.
- Where possible, advise patients to make sure they have had the full course of MMR vaccine, especially before travelling to areas where measles is known to be prevalent.
- Check the vaccination status and travel history of patients presenting with generalised viral symptoms and febrile illnesses.
- Information for patients and their carers can be found on the NHS Choices website.
- Make sure you are familiar with the presentation of measles and when to suspect it as a possible diagnosis. Signs and symptoms include a maculopapular rash, which tends to begin on the face and behind the ears and spreads to the trunk and limbs; fever, and cold-like symptoms. Koplik spots are small red spots with blue/white centres which may appear on the buccal mucosa, however, the presence or absence of these cannot be relied upon when making, or excluding, a diagnosis of measles.
- Measles is a notifiable disease. If you suspect a case, notify the local health protection team immediately, who will arrange testing. They will also advise on the care of vulnerable people, such as those aged under one year, pregnant women and the immunocompromised.
- Provide the patient or their carer with infection control advice, to avoid spread of the virus to other vulnerable individuals. The incubation period lasts from seven to 18 days after exposure. A person can infect others from four days before onset of the rash until four days afterwards.
- Advise patients that their symptoms should resolve within around a week to ten days, but you may wish to arrange a follow up to be sure that they are improving. Secondary bacterial infections may need treatment with antibiotics.
- Check local and national guidelines for the management of measles and action that patients and their carers can take to control or reduce the symptoms.
- Advise patients or their carer to seek urgent medical attention if their symptoms deteriorate, for example, if they cannot control a high temperature, they develop convulsions, there is a change in consciousness or if they develop breathing difficulties.
- If your patient requires hospital admission, inform the admitting hospital of their potential diagnosis so that preparations can be made for their arrival and they can be isolated from other patients and barrier nursed.
- Once the patient has recovered, it may be a suitable time to discuss catching up on any missed vaccinations. For example, if the patient had missed out on MMR they could be vulnerable to infection with rubella and mumps.
- As with all aspects of patient care, it's important to keep accurate records, taken at the time of the consultation, and to record both positive and negative findings.
This guidance was correct at publication 06/08/2018. It is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.