The Shopper Thursday, September 5, 2013 Measles Advisory that contact be made while the patient is present in the clinical setting in order to facilitate testing and initiation of the public health investigation, including follow-up of potential exposures. Infection Control Precautions: Measles is highly contagious and is transmitted primarily from person to person by respiratory droplets and airborne spread. The incubation period is about 2 weeks (range of 7-18 days) from exposure to onset of fever. Persons are contagious from 4 days before onset of rash to 4 days after appearance of rash. In the urgent/emergency healthcare settings, suspected cases should be triaged quickly from waiting areas, with airborne isolation precautions recommended. In other outpatient settings, suspected cases should be scheduled at the end of the day, if feasible. Healthcare workers caring for patients suspected of having measles should use airborne infection control precautions. (www.cdc.gov/hicpac/2007IP/2 007isolationPrecautions.html ) Persons with measles commonly present in physician’s offices or emergency rooms and pose a risk of transmission in these settings. All healthcare personnel should have documented evidence of measles immunity on file at their work location (www. immunize.org/catg.d/p2017. pdf ). Healthcare facilities are reminded to review the immune status of all employees. Diagnostic Testing: Testing for measles should be done for all suspected cases of measles. The following specimens should be collected for all patients suspected to have measles at the time of the initial medical visit: *Blood drawn and submitted for serological testing to detect IgM antibody *Pharyngeal swab (preferred) or nasal aspirates for viral isolation and PCR testing. Control Measures: Outbreak control measures are more effective when applied as early as possible. Measles vaccination may prevent disease if given early (within 72 hours of exposure) to susceptible persons, who are those who have potentially been exposed and are not fully vaccinated (i.e. those not having received 2 measles vaccines.) Measles vaccination following exposure may also provide some long-term protection, but generally should be followed with a second vaccination in at least 1 month for the best protection. Immune globulin may be indicated for some persons, but should not be used to control an outbreak. Contraindications to measles vaccination include previous anaphylactic reaction to a vaccine component and severe immunosuppression. Measles vaccination is also contraindicated during pregnancy and pregnancy should be avoided for at least a month following vaccination. Close contact with a pregnant woman is NOT a contraindication. Breastfeeding is NOT a contraindication to either the woman or the breastfeeding child. Find printable versions in various formats and recommendations for all ages at http://www.cdc.gov/vaccines/ schedules/ . EXCLUSIONARY CRITERIA: In those with measles, rash onset typically appears between the 3rd and 7th day of illness. Children should be excluded from school and other related group settings until after the fourth day of rash onset. During an outbreak, susceptible persons (i.e., those without documented immunization or previous measles infection) should be isolated from those who have measles to prevent further propagation of the disease. In schools or other group settings, children who have not been immunized should be excluded from the setting for at least two (2) weeks after the last day of rash onset of a measles case and observed for signs and symptoms. Additional information on exclusion and readmission can be found at http://www.dshs. state.tx.us/idcu/health/schools_ childcare/ . 7 Surprisingly Dangerous Animals Beavers are widely recognized for their nearly human skill at felling trees and manipulating waterways. These giant rodents possess sharp, always-growing front teeth. Their massive incisors act like living saws on trees, but we seldom imagine beavers as a threat to humans. However, beavers are territorial and defensive, and they will not hesitate to use their teeth. We usually reserve a level of respect for marine mammals due to their awesome power and size, but we don’t consider them mean-spirited. The short-finned pilot whale, actually a large dolphin, stands out as a fearsome exception to the rule. Resembling a small sperm whale, it has a personality worthy of the Herman Melville novel. This sea animal is notorious among marine biologists as a dolphin that has a problem with us. We tend to think of deer as harmless herbivores; however, diet has absolutely nothing to do with personality. Planteating ungulates possess powerful hooves and massive antlers that can inflict grievous wounds on those who cross a territorial deer. Encounters with wild deer have resulted in humans being charged in the most random and unexpected circumstances. Wolves get all the blame and trigger unparalleled levels of fear, but a smaller canine may actually pose more of a threat to humans. The red fox is wide- 21 The Texas Department of State Health Services has been notified of a laboratoryconfirmed case of measles in a Tarrant County resident. It is believed this case is associated with travel to a country where measles is endemic but ten additional, associated suspect cases are currently being investigated and laboratory results are pending. There have now been 7 confirmed cases of measles in the Texas, 4 from the North Texas region since April 2013. GUIDANCE FOR HEALTH CARE PROFESSIONAL Identification of Suspect Cases: Physicians and other healthcare providers are requested to consider measles in the initial differential diagnosis of patients presenting with the following symptoms particularly those who have traveled abroad or come into contact with known measles cases: *Fever (typically ≥101°F (38.3°C) AND *Generalized macropapular rash lasting ≥3 days AND *Cough, runny nose, conjuctivitis OR Koplick spots (bluish-white specks or a redrose background appearing on the buccal and labial mucosa usually opposite the molars) Immediately report any suspect cases of measles to The Texas Department of State Health Services, HSR 2/3 at 817-822-6786. It is preferred ly considered cunning, but disturbingly, young humans may be treated as potential prey. Foxes may even invade human dwellings to stalk their victims. We may be inclined to view raccoons as adorable troublemakers, but these small carnivores launch attacks more like a miniature bear. Raccoons are somewhat doglike animals native to the Americas and have adapted with exceptional success to urban environments. With powerful teeth and razorsharp claws, habituated raccoons can inflict terrible injuries on both humans and pets. Parrots are extraordinarily intelligent tropical birds that are also stereotyped as companions of eyepatch-wearing pirates, but in reality, parrot ownership might place you in the market for an eyepatch. Large parrots - such as Amazons, African grays, or macaws - possess extremely powerful bills, capable of removing digits. They are sometimes prone to hostile behavior, which can be directed to the owner. Parrot owners have reported injuries including lost eyes and even amputated fingers. Being attacked by a hyena might be the worst way to have your day (or life) ruined. 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