2025 – PAGE 316 – INFECTIOUS DISEASES
(DOUBLE TAKE) MEASLES POST-EXPOSURE PROPHYLAXIS: The table below describes prophylaxis for people who are exposed to measles and who are not pregnant or immunocompromised.
| Age | Exposed <3 days ago | Exposed 4-6 days | Exposed >6 days |
| < 6 months old | IGIM | IGIM | No PEP indicated because it’s too late to prevent the onset of the disease |
| 6-11 months old | MMR | IGIM | |
| > 12 months old | MMR #1 if never received.
MMR #2 if it’s been at least 28 days since MMR #1. No PEP needed if already received 2 MMR doses. |
Too late for PEP.
MMR #1 after home quarantine for 21 days if never received. MMR #2 may be given to >4 years old if it’s been at least 28 days since MMR #1. |
- PEARLS: DO NOT GIVE MMR for at least 6 months after giving IGIM, DO NOT GIVE MMR and IGIM at the same time.
- PEARL: For severely immunocompromised patients, give IVIG (or IGIM if <12 months old) if it’s been <6 days since exposure, regardless of immunity to measles.
- PEARL: For pregnant patients with unknown immunity or only 1 MMR vaccine, draw stat measles titers to determine immunity. If immune, PEP is not indicated. If non-immune (IgG negative or 0 doses MMR), give IVIG if it’s within 6 days of exposure.
- PEARL: If a child gets the MMR vaccine within 72 hours of exposure, let them go back to daycare or school.
- MNEMONIC: Mom’s antibodies can linger and “fight” the MMR vaccine until about 6 months, which is why we give IGIM as post-exposure prophylaxis to those under 6 months of age.
- TREATMENT: The treatment for measles is supportive.
- NAME ALERT: Note that this is not the GERMAN MEASLES caused by the RUBELLA VIRUS.
- (DOUBLE TAKE) MNEMONIC: Imagine a patient who is bored because he’s stuck in a NEGATIVE PRESSURE ISOLATION room, and the only channel he gets to watch is MTV. Negative pressure isolation is required for Measles, Mycobacterium Tuberculosis and Varicella. As mentioned in the Aspergillus section, that, too, requires negative pressure isolation.
(DOUBLE TAKE) RUBELLA VIRUS (AKA GERMAN MEASLES)
In children, the Rubella virus causes “German measles” and presents with a mild fever and a maculopapular rash. The rash starts on the face and then spreads to the trunk and extremities within 24 hours. The facial rash disappears as the body rash starts. The rash resolves within 3 days. In unimmunized children who get this infection, it’s generally a benign, self-limited viral illness. Diagnose with an IgM for acute cases.
- CONGENITAL RUBELLA: Most affected children were exposed during the first trimester. Eye issues are the most common finding. Exposure can result in cataracts, microphthalmia, deafness, a patent ductus arteriosus (PDA), and blueberry muffin rash.
IMAGE: www.pbrlinks.com/BLUEBERRY1
IMAGE: www.pbrlinks.com/BLUEBERRY2
PEARL: Pregnant women should NOT get the MMR vaccine (it’s live).
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- MNEMONIC: Imagine looking at a PDA (personal data assistant) with an image of a BLUE BELL. The opening of the BELL looks like an EYE, and the hammer of the bell looks like a WHITE BALL. At the top of the bell, there is a tag hanging off of it that says “LIMITED.”
- KEY: PDA = patent ductus arteriosus, BLUE = blueberry muffin rash, BELL = ru-BELL-a, EYE SHAPED OPENING = microphthalmia and the WHITE BALL = a cataract.
- MNEMONIC: Imagine looking at a PDA (personal data assistant) with an image of a BLUE BELL. The opening of the BELL looks like an EYE, and the hammer of the bell looks like a WHITE BALL. At the top of the bell, there is a tag hanging off of it that says “LIMITED.”
- NAME ALERT/MNEMONIC: Measles, German measles, rubella, roseola, and rubeola can cause confusion. You will not be given the terms rubeola or German measles on the pediatric boards. You will be given the names as they appear in the MMR vaccine (MEASLES, mumps, and RUBELLA).