A 34-year-old man comes to the clinic for an urgent visit after being notified that his nephew, whom he babysat for several hours 2 days ago, has just been diagnosed with laboratory-confirmed measles. The patient feels well and reports no fever, coryza, cough, or rash. His medical history is significant for severe, fistulizing Crohn disease, for which he is currently treated with infliximab and prednisone ( mg daily). He recalls receiving all of his childhood vaccines but does not have his immunization records available. His vital signs are within normal limits, and physical examination is unremarkable. Which of the following is the most appropriate next step in management?
- Administer intravenous immune globulinAnswer
- BAdminister the live-attenuated measles-mumps-rubella vaccine
- CMeasure serum measles IgG titer and administer the vaccine if negative
- DPrescribe prophylactic oral azithromycin
- EReassure the patient and advise him to return if a rash develops
Answer
Administer intravenous immune globulin
The correct next step is to administer intravenous immune globulin. This patient is severely immunocompromised due to his active treatment with a tumor necrosis factor (TNF)-alpha inhibitor (infliximab) and high-dose corticosteroids ( mg/day of prednisone). According to CDC guidelines, severely immunocompromised individuals who are exposed to measles should receive intravenous immune globulin (IVIG) within days of exposure. This is required regardless of previous vaccination history or documentation, as severe immunosuppressive therapy can attenuate existing immunologic memory, leaving them highly susceptible to complications such as giant cell pneumonia and acute encephalitis.
Step-by-Step Solution
Key Concept
Severely immunocompromised patients exposed to measles must receive intravenous immune globulin (IVIG) within days of exposure, regardless of their prior vaccination status, because live-attenuated vaccines are contraindicated and existing immunologic memory may be severely impaired.