An 11-month-old girl is brought to the emergency department by her parents due to a rash. Yesterday, the patient developed a rash on her face that has now spread over her entire body. The parents say that she has been ill for the past 3 days with fever, cough, rhinorrhea, and "pink eye." The patient has no other medical problems and has received all age-appropriate vaccinations as of age 6 months. She takes no medications and has no allergies. Approximately 3 weeks ago, the family returned from a trip to the Philippines for her grandfather's funeral. The patient lives with her parents and several pets, including a dog, turtle, and new kitten. Temperature is 39.6 C (103.3 F), blood pressure is 80/50 mm Hg, pulse is 120/min, and respirations are 30/min. The patient appears tired and irritable with dry mucous membranes. The conjunctivae are injected without discharge. The lungs are clear to auscultation. Examination shows a blanching, erythematous maculopapular rash covering the face and entire body except for the palms and soles. Which of the following infection-control measures is most effective in preventing the spread of this patient's infection to others in the emergency department?

Question

An 11-month-old girl is brought to the emergency department by her parents due to a rash.  Yesterday, the patient developed a rash on her face that has now spread over her entire body.  The parents say that she has been ill for the past 3 days with fever, cough, rhinorrhea, and "pink eye."  The patient has no other medical problems and has received all age-appropriate vaccinations as of age 6 months.  She takes no medications and has no allergies.  Approximately 3 weeks ago, the family returned from a trip to the Philippines for her grandfather's funeral.  The patient lives with her parents and several pets, including a dog, turtle, and new kitten.  Temperature is 39.6 C (103.3 F), blood pressure is 80/50 mm Hg, pulse is 120/min, and respirations are 30/min.  The patient appears tired and irritable with dry mucous membranes.  The conjunctivae are injected without discharge.  The lungs are clear to auscultation.  Examination shows a blanching, erythematous maculopapular rash covering the face and entire body except for the palms and soles.  Which of the following infection-control measures is most effective in preventing the spread of this patient's infection to others in the emergency department?

Quizplus · Accepted Answer

11ec25c8_d1b4_8c38_bc81_51eed469b5ab_MD0003_00 This ill-appearing patient who has a maculopapular rash with cephalocaudal spread after a prodrome of cough, coryza, and conjunctivitis likely has measles. Measles is a highly contagious virus that can cause outbreaks in unvaccinated persons. Symptoms manifest 1-3 weeks after inhalation of infectious respiratory particles, which can remain airborne for hours in a closed space (eg, airplane, clinic waiting room). Measles can also spread via direct contact of respiratory particles with a mucosal surface (eg, mouth, eyes). Patients are most contagious during the prodrome but can spread disease for several days after resolution of the rash. Patients with known or suspected measles should be isolated and placed on airborne precautions (negative pressure room, N95 face mask for health care personnel). N95 face mask The best way to prevent measles infection is by 2 doses (at age 1 and 4) of the live attenuated measles vaccine, which generates immunity in >95% of vaccinated persons. For planned international travel, an additional dose between age 6 and 11 months is also recommended. This patient has not yet received the measles-mumps-rubella vaccine and likely acquired the disease during international travel. (Choice B) Antibiotic prophylaxis can decrease transmission of Neisseria meningitidis or Bordetella pertussis but has no role in viral disease. (Choice C) Postexposure prophylaxis can be considered for patients exposed to viruses such as influenza, varicella, and HIV. There is no antiviral prophylaxis for measles. (Choice D) Passive immunization is achieved by administering high concentrations of specific antibody against a pathogen. It is an effective postexposure prophylaxis for varicella and rabies but is not available for measles. (Choice E) Vitamin A deficiency is associated with increased morbidity with measles infection. Vitamin A supplementation is therefore recommended for hospitalized patients with measles but plays no role in the prevention of measles transmission. Educational objective: Measles is characterized by a prodrome of cough, coryza, and conjunctivitis followed by a maculopapular rash that spreads in a cephalocaudal pattern. This highly contagious infection is transmitted by the airborne route. References: Patterns of measles transmission among airplane travelers. (http://www.ncbi.nlm.nih.gov/pubmed/23127863) Measles. (http://www.ncbi.nlm.nih.gov/pubmed/21855993)

An 11-Month-Old Girl Is Brought to the Emergency Department by Her