Measles Action Plan: For Transplant Families

DASHBOARD OF CURRENT CASES: Measles Cases and Outbreaks | Measles (Rubeola) | CDC

**More important resources and videos at the end of this document.

Navigating the Measles Outbreak: Protecting Our Transplant Children

The recent resurgence of measles across the country has understandably raised concerns, especially for families with children who have undergone transplants. Our children's compromised immune systems make them particularly vulnerable to serious complications from this highly contagious virus. It's crucial to stay informed and take proactive steps to protect them.

Close-up of a child's face showing a typical measles rash with red spots and inflamed skin.

Understanding the Risk: Why Measles Matters to Transplant Families

Measles, a viral infection, spreads easily through respiratory droplets when an infected person coughs or sneezes. Measles virus can stay suspended in the air for hours after an infected person leaves a room. For children who have received transplants, their weakened immune systems may struggle to fight off the virus, leading to severe illness, including pneumonia, encephalitis (brain inflammation), and even death.

Some transplant recipients may not have received both doses of measles vaccine prior to transplant.  Occasionally transplant centers will test if a child has antibodies against measles. If they do not have these antibodies and are eligible for live vaccines after transplant, the team may recommend they get an MMR vaccine.  However, if they are not eligible for live vaccines their transplant may recommend they get immunoglobulin therapy if they are exposed. 

Recognizing the Symptoms: What to Watch For

Early symptoms of measles often mimic a common cold, but they progress rapidly. Here's what to look for:

• High Fever: A temperature of 104°F (40°C) or higher is common.

• Cough: A dry, persistent cough.

• Runny Nose: Clear or slightly colored nasal discharge.

• Red, Watery Eyes (Conjunctivitis): Sensitivity to light may also occur.

• Koplik Spots: Tiny white spots with bluish-white centers on a red background, appearing inside the mouth (usually on the inner lining of the cheeks) two to three days after symptoms begin.

• Rash: A red or reddish-brown rash that starts on the face and spreads down the neck and body. The rash typically appears three to five days after the first symptoms.

  
  

If You Suspect Exposure: What to Do

If you suspect your child has been exposed to measles or is exhibiting symptoms, immediate action is vital:

• Contact Your Transplant Team Immediately: Do not hesitate. Your transplant team knows your child's medical history and can provide the most appropriate guidance. They will want to know details about the possible exposure including if it was direct contact, when it happened, and how long the exposure lasted. They will be able to tell you the best course of action, and any preventative measures that can be taken. In some cases, immunoglobulin therapy may be recommended.

• Isolate Your Child: Keep your child away from others, especially those who are immunocompromised, pregnant, or infants.

• Do Not Go to the Emergency Room or Urgent Care Without Calling First: Inform them that you suspect measles so they can take necessary precautions to prevent the spread of the virus. Calling ahead allows the facility to prepare for your arrival and isolate your child appropriately.

• Follow Medical Advice: Adhere strictly to the instructions provided by your transplant team and other healthcare professionals.

• Document Symptoms: Keep a detailed record of your child's symptoms, including when they started and how they've progressed.

  
  

Prevention is Key: Protecting Your Child

• Vaccination (When Appropriate): Some transplant patients, such as liver recipients on lower levels of immunosuppressive medications, may be in a position to receive MMR and Chicken Pox vaccines. Please ask your team to see if your child might be eligible. 

• Ensure all household and close contacts are up to date on their vaccinations including MMR.  The risk of live viral vaccine transmission between household members is low and much less than the benefit of protecting the transplant patient. Remind community members and classmates of the importance of MMR vaccines to protect vulnerable community members.

• Hygiene Practices: Emphasize frequent handwashing, especially after being in public places. Consider wearing a mask in public places.

• Avoid Crowds: Limit your child's exposure to crowded public spaces, particularly during outbreaks.

• Communicate With Your Child's School: Remind them they have an immune suppressed child in their class and that if any of their classmates presents with a rash, to please communicate with you immediately.

• Stay Informed: Keep up-to-date with information from reliable sources, such as the Centers for Disease Control and Prevention (CDC) and your local health department.

  
  

Support and Resources

Navigating a measles outbreak can be stressful. Remember, you're not alone. Your transplant team is your primary resource, and you can also find support from other transplant families and organizations.

By staying informed and taking proactive steps, we can work together to protect our vulnerable children during this challenging time.

Additional Information and cited sources:

Measles, Mumps, Rubella presented by Taylor Heald-Sargent, MD, PhD (Attending Physician, Infectious Disease, Assistant Instructor of Pediatrics, Northwestern University Feinberg School of Medicine) from the 2024 Pediatric Transplant Conference: https://www.youtube.com/watch?v=00ljppIBXiA

Pediatric Pandemic Network FAQs for families and caregivers: https://pedspandemicnetwork.org/families-caregivers/measles-faq-for-parents-and-families/

The Transplantation Society & International Society for Heart and Lung Transplantation (ISHLT): https://tts.org/tid-guidelines/21-tid/1556-tid-measles-aug2024

Pediatric Infectious Diseases Society (PIDS): https://pids.org/

Centers for Disease Control and Prevention (CDC): https://www.cdc.gov/measles/index.html

Measles | National Foundation for Infectious Diseases (NFID): https://www.nfid.org/infectious-disease/measles/

Disclaimer: This blog post is for informational purposes only and does not constitute medical advice. Please consult with your child's transplant team or healthcare provider for personalized guidance.