5/25/23 Health Advisory: Measles Activity in Washington State

| May 25, 2023

Background

Seattle & King County and the Washington State Department of Health have identified a confirmed case of measles in a King County resident with unknown vaccine history. There was no specifically identified exposure, and the infection appears to be U.S. acquired (no international travel).

The individual with measles visited the following public locations in Seattle, WA during their infectious period before receiving the diagnosis of measles. Public health professionals should be aware that members of the public may have been exposed to measles at:

5/11/23 12:00 p.m. – 5:45 p.m.
Aki Kurose Middle School
3928 S Graham Street, Seattle, WA 98118

5/1/23 8:45 a.m. – 5:45 p.m.
Aki Kurose Middle School
3928 S Graham Street, Seattle, WA 98118

5/13/23 3:45 p.m. – 6:45 p.m.
Pike Place Market
85 Pike Street, Seattle, WA 98101

5/13/23 4:15 p.m. – 6:45 p.m.
World Market
2103 Western Ave, Seattle, WA 98121

5/15/23 2:00 p.m. – 5:45 p.m.
HopeCentral Pediatrics & Behavioral Health
3826 S Othello Street, Seattle, WA 98118

Up to date information on public exposure locations can be found at https://kingcounty.gov/depts/health/news/2023/May/20-measles.aspx .

Requested Actions

  • Review the following clinical syndrome and be alert to the potential for measles.
    • A generalized rash lasting 3 or more days. (Usually begins on the face and spreads to chest and extremities
      • Immunocompromised patients may not exhibit rash or may exhibit an atypical rash
    • A temperature ≥ 101.0°F (≥ 38.3°C)
    • Cough, coryza, or conjunctivitis
    • Koplik spots may appear on buccal mucosa 1–2 days prior to rash. They usually last about 12-72 hours and resolve with the onset of rash. Koplik spots are usually not present on exam.
  • Check your patient’s immunization records.  Following the first dose of measles vaccine, 93% of individuals respond with adequate immunity; after the second dose of MMR, 97% will respond. Early vaccination (6-12 mo) is not recommended at this time.
  • Assess the Exposure.  90% of susceptible individuals will become ill within 7-21 days (28 days if IG is administered) if they have had close contact with a measles case. 
  • Immediately call the Whatcom County Health to report suspected measles cases. Call 360- 778-6100 and ask to speak to a communicable disease nurse during normal business hours, after hours follow the prompts to the answering service.
  • Collect the appropriate lab specimens. See links for collection instructions from State Lab below.
    • 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 IgG and IgM
  • Clinic instructions for staff to identify patients with symptoms of possible measles at presentation.
    • Patients with symptoms of measles should wear a mask or other cover for 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.
  • Isolate from others until 4 days after rash onset. If prodromal symptoms are present and there is a known exposure or you suspect measles, isolate NOW. People are infectious up to 4 days before onset of rash.

Contacting Whatcom County Health

360-778-6100 Main Call Line – available M-F 8:30am to 4:30pm
360-778-6100 Follow prompts to Afterhours Answering Service – available after 4:30pm and weekends
360-778-6150 Communicable Disease Report Line – 24 hours a day 7 days a week
360-778-6103 Confidential Communicable Disease Fax – 24 hours a day 7 days a week