Measles

About Measles

Measles is a highly contagious viral respiratory illness that is transmitted from person to person by direct contact with respiratory droplets or airborne spread. After exposure, up to 90% of susceptible persons develop measles.1

The average incubation period for measles is 10 to 12 days from exposure to prodrome and 14 days from exposure to rash (range, 7–21 days). It is the most deadly of all childhood rash/fever illnesses.1,2 

From January 1 to October 3, 2019, the greatest numbers of measles cases in the US affecting 31 states were reported since 1992.3

Measles Is a Serious Disease1,4

Even in previously healthy children, measles can cause serious illness requiring hospitalization.

  • 1 out of every 1000 children with measles will develop acute encephalitis, which often results in permanent brain damage
  • 1 to 3 out of every 1000 children who become infected with measles will die from respiratory and neurologic complications
  • Subacute sclerosing panencephalitis is a rare but fatal degenerative disease of the central nervous system characterized by behavioral and intellectual deterioration and seizures that generally develop 7 to 10 years after measles infection

The Centers for Disease Control and Prevention (CDC) recommends that the following patient groups at risk for severe disease and complications from measles receive an immune globulin intramuscular (IGIM) such as GamaSTAN1:

  1. Infants <12 months of age
  2. Pregnant women without evidence of measles immunity
  3. Severely immunocompromised persons

IGIM can be administered to other persons who do not have evidence of measles immunity, but priority should be given to persons exposed in settings with intense, prolonged, close contact (eg, household, daycare, and classroom).

The CDC can provide more information on measles and prevention. 


Postexposure Prophylaxis for Measles1

If administered within 6 days of exposure, an IGIM such as GamaSTAN can prevent or modify measles in persons who are nonimmune. IGIM is not indicated for persons who have received 1 dose of measles-containing vaccine at age ≥12 months, unless they are severely immunocompromised.

Historically, IGIM has been administered for short-term measles prophylaxis and was the product used to demonstrate efficacy for measles postexposure prophylaxis.  

INDICATIONS AND USAGE

GAMASTAN (immune globulin [human]) is indicated for prophylaxis following exposure to hepatitis A infection, prevention or modification of measles in susceptible persons exposed fewer than 6 days previously, modification of varicella, and modification of rubella in exposed women who will not consider a therapeutic abortion.

Limitations of Use

GAMASTAN is not indicated for routine prophylaxis or treatment of viral hepapitis type B, rubella, poliomyelitis, mumps, or varicella.

IMPORTANT SAFETY INFORMATION

Thrombosis may occur with immune globulin products, including GAMASTAN. Risk factors may include: advanced age, prolonged immobilization, hypercoagulable conditions, history of venous or arterial thrombosis, use of estrogens, indwelling central vascular catheters, hyperviscosity, and cardiovascular risk factors. Thrombosis may occur in the absence of known risk factors.

For patients at risk of thrombosis, do not exceed the recommended dose of GAMASTAN. Ensure adequate hydration in patients before administration. Monitor for signs and symptoms of thrombosis and assess blood viscosity in patients at risk for hyperviscosity.

GAMASTAN is contraindicated in patients who have had anaphylactic or severe systemic hypersensitivity reactions to immune globulin (human) and in IgA-deficient patients with antibodies against IgA and a history of hypersensitivity.

Administer GAMASTAN cautiously to patients with a history of prior systemic allergic reactions following the administration of human immunoglobulin preparations. Have epinephrine available for treatment of acute allergic symptoms, should they occur.

Inject intramuscularly only. Do not administer GAMASTAN intravenously because of the potential for serious reactions (eg, renal dysfunction/failure/hemolysis, transfusion-related acute lung injury [TRALI]). Do not inject into a blood vessel.

GAMASTAN is made from human blood; it may carry a risk of transmitting infectious agents, eg, viruses, the variant Creutzfeldt-Jakob disease (vCJD) agent, and, theoretically, the Creutzfeldt-Jakob disease (CJD) agent.

The most common adverse reaction reported for GAMASTAN S/D during post-approval use was fatigue.

Antibodies in GAMASTAN may interfere with the response to live virus vaccines such as measles, mumps, polio, rubella, and varicella. Defer live vaccine administration for up to 6 months after GAMASTAN administration.

Please see full Prescribing Information for GAMASTAN.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.


References:

  1. McLean HQ, Fiebelkorn AP, Temte JL, Wallace GS; Advisory Committee on Immunization Practices (ACIP). Prevention of measles, rubella, congenital rubella syndrome, and mumps, 2013: summary recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2013;62(RR-04):1-34.
  2. World Health Organization. Immunization, vaccines and biologicals. https://www.who.int/immunization/monitoring_surveillance/burden/vpd/surveillance_type/active/measles/en/. Updated October 11, 2019. Accessed October 31, 2019.
  3. Centers for Disease Control and Prevention. Measles cases and outbreaks. https://www.cdc.gov/measles/cases-outbreaks.html. Reviewed October 11, 2019. Accessed October 31, 2019.
  4. Centers for Disease Control and Prevention. Measles (Rubeola). https://www.cdc.gov/measles/hcp/index.html. Reviewed February 5, 2018. Accessed October 30, 2019.