Julia Shaklee Sammons, MD, MSCE
Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M14-0892.
Sammons JS. Responding to Measles in the Postelimination Era. Ann Intern Med. 2014;161:842. doi: 10.7326/L14-5030-2
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Published: Ann Intern Med. 2014;161(11):842.
I appreciate Dr. Duchin's expansion on some of the nuances in measles recognition. It is true that clinical presentations may vary in those who have been previously vaccinated. Immunocompromised patients may also present with a modified clinical picture. In addition, I agree that the absence of Koplik spots should not exclude measles from the differential diagnosis of a patient who has other relevant clinical features and an appropriate exposure history, particularly because these spots are transient, lasting between 2 and 3 days. Still, for providers who have never seen measles, the critical first step is awareness and the consideration of measles in returned travelers with febrile rash illness.
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