Growing measles outbreak in central Ohio

Actions requested

• Be aware of a growing measles outbreak in central Ohio. At this time, no cases have been identified in King County.
• 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 at the hairline and spreads downward to the neck, trunk, and extremities
    
  • Koplik spots may appear on buccal mucosa 1–2 days prior to rash
• Assess patients with measles symptoms for recent international travel, domestic travel to Ohio, or other potential exposure to a confirmed measles case.
• Instruct reception/triage staff to identify patients who present with symptoms of possible measles
  
  • 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 in a negative pressure room, if available, and close the door. If a negative pressure room is not available, room the patient in a private room.
    
  • Only staff with documented immunity to measles should be allowed to enter the patient’s room.
    
  • After the patient is discharged, do not use the room for 2 hours.
• Isolate and immediately report suspected cases of measles to Public Health at (206) 296-4774; Suspected measles case-patients should be discussed with Public Health prior to discharging or transferring these individuals.
• 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 at (206) 296-4774 to expedite testing, do not use a commercial laboratory.
  
  
• Continue to recommend MMR vaccine for those who are not up to date or have no evidence of immunity
  
  
• Acceptable presumptive evidence of immunity against measles includes at least one of the following:
  
  • Written documentation of adequate vaccination:
    
    • One or more doses of a measles-containing vaccine administered on or after the first birthday for preschool-age children and adults not at high risk
      
    • Two doses of measles-containing vaccine for school-age children and adults at high risk, including college students, healthcare personnel, and international travelers
      
  • Laboratory evidence of immunity (equivocal tests are considered negative)
    
  • Laboratory confirmation of measles
    
  • Birth before 1957