Identify-Isolate-Inform: A Tool for Initial Detection and Management of Measles Patients in the Emergency Department

Abstract

Measles (rubeola) is a highly contagious airborne disease that was declared eliminated in the U.S. in the year 2000. Only sporadic U.S. cases and minor outbreaks occurred until the larger outbreak beginning in 2014 that has become a public health emergency. The “Identify-Isolate-Inform” tool will assist emergency physicians to be better prepared to detect and manage measles patients presenting to the emergency department. Measles typically presents with a prodrome of high fever, and cough/coryza/conjunctivitis, sometimes accompanied by the pathognomonic Koplik spots. Two to four days later, an erythematous maculopapular rash begins on the face and spreads down the body. Suspect patients must be immediately isolated with airborne precautions while awaiting laboratory confirmation of disease. Emergency physicians must rapidly inform the local public health department and hospital infection control personnel of suspected measles cases.

2019-nCoV: The Identify-Isolate-Inform (3I) Tool Applied to a Novel Emerging Coronavirus

“…8,9 The 3I Tool outlined in this paper is consistent with current US CDC guidelines and can be applied in a variety of settings such as those in emergency departments, urgent-care clinics, physicians' offices, and prehospital settings. This paper will first briefly review 2019-nCoV and then present the novel 2019-nCoV 3I Tool as modified from its initial conception for Ebola virus disease 10,11 and later adapted for measles, 12 MERS, 13 mumps, 14 Zika virus disease, 15 hepatitis A, 16 pertussis, 17 and scabies. 18…”

“…The Identify-Isolate-Inform (3I) Tool was initially developed for Ebola virus disease 10,11 and later adapted for measles, 12 MERS, 13 mumps, 14 Zika virus disease, 15 hepatitis A, 16 pertussis, 17 and scabies. 18 This novel tool for suspected 2019-nCoV patients (Figure 1) provides frontline clinicians with a simple algorithm to manage an emerging disease.…”

Scabies: Application of the Novel Identify-Isolate-Inform Tool for Detection and Management

“…The 3I Tool was originally developed for Ebola virus disease and subsequently modified for use in measles, Middle East Respiratory Syndrome (MERS), mumps, Zika, hepatitis A, pertussis, and 2019 nCoV (COVID-19). [13][14][15][16][17][18][19][20]…”

“…34,46,37,[41][42][43] For crusted scabies, both an oral and a topical scabicide should be administered concurrently (Table). 15,19,37 Ivermectin use has also been described for scabies control in endemic areas or outbreaks where topical scabicide use may be difficult. 12 A randomized controlled trial examining mass administration of ivermectin for management of scabies concluded a reduction in prevalence from 32.1% to 1.9% in the ivermectin group compared to a reduction from 41.7% to 15.8% in permethrin-treated controls.…”

“…The Identify-Isolate-Inform (3I) Tool was conceived during the 2014 Ebola virus disease outbreak and later modified for application to the ED evaluation and management of patients with other communicable diseases. [14][15][16][17][18][19][20] The novel modification of this tool presented here can be applied for ED evaluation and management of a patient under investigation for scabies. The Scabies 3I Tool is an algorithm that begins with identifying suspected cases based on symptoms, exposure history, and testing as needed.…”