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Currently there is a cluster of measles in Clark County with 14 confirmed cases 3 suspect cases, and over 1,000 contacts. Locations of exposure are all in Vancouver, WA and Portland, OR. There are no confirmed cases in Snohomish County presently. Providers should suspect measles in any patient with fever and rash, especially if they had recent travel to Clark and Multnomah Counties. Specific exposure locations are listed on the Clark County Public Health webpage: https://www.clark.wa.gov/public-health/public-health-investigating-14-confirmed-3-suspected-measles-cases
Measles Clinical Presentation:
Measles symptoms usually begin 10-12 days (up to 21 days) after exposure with a prodrome of fever (up to 105ºF) for 2-4 days followed by cough, conjunctivitis, or runny nose, and a maculopapular rash typically moving from the hairline down to cover the entire body. The rash lasts 5-6 days or longer. Severe illness can occur including pneumonia, encephalitis, and death.
Transmission and Infection Control:
Virus is spread directly from person to person by inhalation of suspended respiratory droplet nuclei or when infectious nasopharyngeal secretions come into contact with the mucous membranes of a susceptible person. Measles virus is sensitive to strong light and drying, but remains infectious in aerosol form in air for approximately 2 hours. Measles is one of the most contagious of all infectious diseases, with >90% attack rates among susceptible close contacts. Suspect measles cases should not be allowed in patient waiting areas. They should be masked and placed immediately in an examination room, with the door closed. Patients with suspect measles should be seen at the end of the day and use a separate entrance if possible. The examination room should not be used for at least two hours after the patient has left.
Suspected measles patients should not be referred to commercial labs or other departments/facilities for testing or other services. Coordinate specimen collection with the Snohomish Health District if appropriate media is not available or additional guidance is needed.
Routine vaccination with two doses of measles-containing vaccine is the safest and most effective way to prevent disease. MMR vaccine is 90% to 95% effective in preventing measles. The best way to protect patients from measles and to meet school immunization requirements is to ensure that children receive their first dose of MMR routinely at age 12 months and their second dose at age 4 to 6 years. Ask about travel plans. Infants traveling internationally should be protected against measles by receiving a first dose between age 6 to 11 months, but will require two additional doses at 1 year and between 4 to 6 years.
Exposed non-immune immunocompetent individuals should receive the MMR vaccine ≤72 hours after first exposure as an immediate prevention measure (PEP). If MMR vaccine is not administered within 72 hours of exposure it should still be offered to provide protection from future exposures.
Exposed non-immune immunocompromised persons, infants ≤ 12 months, and others at high risk of complications from measles can be protected with immune globulin ≤ 6 days after exposure. Clinicians may consider administering immune globulin to any suspected contact in accordance with Washington State Department of Health Guidelines found at https://www.doh.wa.gov/Portals/1/Documents/5100/420-063-Guideline-Measles.pdf.
Snohomish Health District Communicable Disease Program at (425) 339-5278