Measles case in King County resident exposed during international travel

Actions requested

• Be aware of a confirmed measles case in an adult resident of King County who was exposed during recent international travel and was not previously vaccinated. This person with measles spent time at SeaTac airport and Providence Swedish First Hill Emergency Department during their infectious period.
  
  • The infectious period for this case is January 16–January 24, 2023
    
  • Secondary cases resulting from this case would be expected to occur during January 25–February 14, 2023.
• Assess immunization status of patients at every visit and strongly recommend vaccination based on recommended schedule, health condition, occupation, and other risk factors such as travel; Under-vaccinated individuals may be at risk for measles infection due to outbreaks that occur in the US or anywhere else in the world.
• Consider measles infection in exposed patients with compatible symptoms, including:
  
  • Prodrome of fever, cough, coryza and conjunctivitis for 2-4 days
    
  • Generalized maculopapular rash that usually begins on the face at the hairline and then spreads to the neck, trunk, and extremities
    
  • Koplik spots may appear on buccal mucosa 1-2 days prior to rash
• Be prepared for the possibility of patients with measles at your facility:
  • In urgent/emergency healthcare settings:
    
    • Suspected patients should wear a mask covering the nose and mouth and be triaged immediately away from waiting rooms
      
    • Room patient in airborne isolation if available
      
  • In outpatient clinic settings:
    
  • Schedule suspected patients to be seen at end of day, if possible, and keep them out of waiting rooms
    
  • Use standard and airborne infection control precautions
    
  • Only staff with documented immunity to measles should enter patient’s room.
    
  • After patient is discharged, do not use or have staff enter the room for 2 hours.
• Collect specimens on patients with suspected measles for diagnostic testing:
  
  • For PCR and virus isolation:
    
    • Nasopharyngeal swab placed in viral transport media (VTM)
      
    • Urine, minimum 20mL, in sterile leak proof container
      
  • For measles IgM serology:
    
    • Serum, minimum 1mL, in red top or red-grey top tube
• Route specimens through Public Health to expedite testing (do not use commercial laboratory).
  
• Report suspected cases of measles to Public Health at (206) 296-4774 immediately before discharging or transferring patients.