Case Closed Friday: Disease from the Day Care

Earlier this week, we gave you a hypothetical patient with the following case:

This week's hypothetical patient is a 7-month-old girl whose mother brings her to a day care at her

high school, where the mother is a senior student planning to graduate in a few months. The baby has been coughing, has a runny nose, red eyes, and is running a fever. Upon examination, the pediatrician finds small, red spots with blue-white centers inside the infant's mouth. The pediatrician orders a blood test for the infant and asks the mother where she takes her child for day care. After the pediatrician's suspicions are confirmed by the results of the blood test, the pediatrician calls the day care to issue a quarantine recommendation. She administers an injection of immune serum globulin to the child and tells the mother to keep the baby on fluids, use acetaminophen and cool compresses to help control the fever, and to keep the baby away from others for a week. She also tells the mother that the baby will likely develop a rash and may take several weeks to get better. They had a lengthy discussion about how to care for the infant over the next few weeks, then scheduled a follow-up appointment.

Today, we reveal that our hypothetical patient was diagnosed as having: 

Measles

In our hypothetical situation, the 7-month-old girl had not had her MMR vaccine either because she was too young (most infants in the U.S. are not vaccinated for MMR until 12 months, but infants may be vaccinated at 6 months if traveling out of the country or in measles-prone regions) or because her mother had chosen not to vaccinate her child. We are not given enough information to know which case is the most correct for the situation. Measles is preventable with vaccination, but those who are unable to get the vaccine (due to age or immune status) rely on heard immunity to protect them. Measles is extremely contagious and there is no known cure. Administration of a post-exposure vaccine can help non-immunized individuals if given within 72 hours of exposure to measles. This may stop the illness from manifesting, or make the symptoms milder and last for a shorter time if the disease does manifest. Infants exposed to the virus can be given immune serum globulin within 6 days of exposure to help prevent full-blown measles or lessen the severity of the symptoms. Patients can take acetaminophen to help control fevers, but should not take aspirin, which is linked to the development of Reye's syndrome. There is no cure for measles, so patients are told to get plenty of fluids and to control their fevers as best they can until the disease passes.

Thanks for joining us for this week's Mystery Case and we hope to see you next week!