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January 16, 2019

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  • Be aware of 14 confirmed and 3 suspected cases of measles among children in Clark County, WA, since January 15th and linked to an index case visiting from Europe; 13 cases are unimmunized, one case has unverified immunization status.

  • Consider measles infection in patients with compatible symptoms, including:
    • Prodrome of fever, cough, coryza and conjunctivitis lasting 2–4 days
    • Generalized maculopapular rash that usually begins on the face
    • Koplik spots may appear on buccal mucosa 1–2 days prior to rash

  • Assess patients with measles symptoms for recent international travel or travel to Clark County, WA, or to Oregon (see locations at link, below), and/or potential exposure to a confirmed measles case or exposure location.

  • Instruct reception/triage staff to identify patients with symptoms of possible measles at presentation.
    • Patients with symptoms of measles should wear a mask covering the nose and mouth and should be kept away from patient waiting rooms.
    • Room the patient immediately and close the door.
    • Only staff with documented measles immunity should be allowed to enter the patient’s room.
    • After the patient is discharged, do not use the room for 2 hours.

  • Report suspected cases of measles to Public Health at (206) 296-4774 immediately, before discharging or transferring patients.

  • Collect specimens on patients with suspected measles:
    • Nasopharyngeal swab (preferred respiratory specimen) for PCR and virus isolation
    • Urine (at least 50 ml) for PCR and virus isolation
    • Serum (at least 1 cc) for measles IgM

  • Route laboratory specimens through Public Health to expedite testing, do not use a commercial laboratory.
Measles outbreaks continue to occur in multiple European countries with over 40,000 cases reported in the first half of 2018 alone. Approximately half of the cases in the WHO European Region have been in Ukraine. There are currently no King County exposure locations.