Paediatric Acute care Guidelines PMH Emergency Department

Background

Transmission and Epidemiology:

  • Highly infectious
  • Droplet spread or direct contact with secretions (the child is usually coughing)
  • The virus may be suspended in the air for up to an hour after an infected person leaves the room or waiting area
  • Patients are infectious for 3-4 days prior to the rash developing and a further 4-6 days from onset of rash
  • After exposure to measles, it is usually about 10 days (range 7-18 days) to the onset of fever and about 14 days until the onset of rash

Assessment

Examination

  • The child appears miserable, febrile and unwell
  • The 3 C’s
    • Cough
    • Coryza
    • Conjunctivitis
  • Coarse blotchy maculopapular rash (Morbilliform)
  • Koplik spots appear 1-4 days before the rash appears – white spots on the bright red buccal mucosa of the cheek opposite the premolar

Investigations

At PMH: Contact on call Microbiology to ensure rapid processing 

  • Measles antibodies (IgM and IgG)
  • Measles IgM appears 1-2 days after the appearance of the rash and persists for 1 month
  • NPA – for viruses and urgent PCR
  • Urine for measles PCR

Management

Public Health Management

  • Upon suspicion of measles, isolate immediately within the department. See ED Guideline: Rash Management 
  • Suspected measles cases should always be discussed with the PMH Clinical Microbiologist (to coordinate local response)
  • Laboratory confirmation is always required
  • Take a contact history
  • Susceptible contacts may be advised to be immunised by their GP (for up to 72 hours after the first exposure). Alternatively they may have Normal Immunoglobulin from 72 hours to 7 days after the first exposure.
  • Advise isolation at home until results become available. If positive, the exclusion time is 6 days from the onset of the rash
  • If possible, avoid hospitalisation, because of the infectivity. Admit for clinical condition warranting interventions only. 

Complications

  • Pneumonia – is the most common cause of death in measles and may progress onto bronchiolitis obliterans
  • Acute otitis media
  • Diarrhoea and vomiting
  • SSPE (Sub Acute Scelerosing Pan Encephalitis) – a rare late complication

Nursing

References

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