From the Guidelines
The patient should continue her Humira treatment but take precautions to minimize exposure to the measles-exposed children at school, such as practicing good hand hygiene and considering wearing a mask, due to the potential reduced effectiveness of the measles vaccine in immunocompromised individuals. Despite having received two measles vaccinations, patients on Humira (adalimumab) have suppressed immune systems that may reduce vaccine effectiveness 1. The patient should monitor for any symptoms of measles such as fever, rash, cough, or red eyes. If direct exposure occurs or symptoms develop, she should contact her healthcare provider immediately, as post-exposure prophylaxis with immunoglobulin might be needed within 6 days of exposure 1. Key considerations include:
- Avoiding direct contact with the measles-exposed children
- Practicing good hand hygiene
- Considering wearing a mask at school during the outbreak
- Monitoring for symptoms of measles
- Ensuring the school is following proper infection control protocols, such as airborne infection–control precautions and implementing other infection-control measures to control the spread of measles 1. It is also important to note that available data suggest that live virus measles vaccine, if administered within 72 hours of measles exposure, will prevent, or modify disease 1. However, in this case, the patient has already received two measles vaccinations, so the focus should be on minimizing exposure and monitoring for symptoms.
From the Research
Measles Vaccination and Post-Exposure Prophylaxis
- The patient has received two measles vaccinations, which provides a high level of immunity against measles 2.
- However, the patient is on Humira, which may affect the immune system's response to infections.
Risk of Measles Exposure
- There are 3 kids at school with measles, but they are not in the patient's class and there is no direct exposure.
- The risk of exposure is considered low, but not zero.
Post-Exposure Prophylaxis (PEP) Options
- Measles, mumps, and rubella vaccine (MMR) or immune globulin (IG) can be used as PEP against measles 3, 4.
- The effectiveness of MMR PEP is around 83.4% 3, while IG PEP has been shown to be 100% effective in some studies 3, 4.
- The patient's vaccination status and immune system function should be taken into account when deciding on PEP.
Management and Prevention
- The patient should be monitored for symptoms of measles, such as fever, cough, and rash 5.
- If symptoms develop, the patient should be isolated to prevent spread to others, and treatment may include vitamin A, intravenous immunoglobulin, or ribavirin 5.
- Healthcare workers should take precautions to prevent the spread of measles, including wearing N-95 masks and isolating patients in an airborne infection isolation room 5.