Ensure individuals are up to date on MMR vaccination especially for children and those traveling internationally

Actions requested

• Be aware of increases in measles cases and outbreaks occurring in every region of the world. Total US measles cases in 2024 already exceed the total for all of 2023.
• Ensure all patients without evidence of measles immunity are current on MMR vaccine, especially children aged >12 months and those travelling internationally.
  • Assess immunization status during healthcare visits and recommend vaccination based on recommended schedule, health condition, occupation, and other risk factors. 
  • Schools, early childhood education providers, and healthcare providers should work to ensure students are current with MMR vaccine
  • CDC recommends that all U.S. residents age 6 months and older without evidence of immunity who plan to travel internationally, receive MMR vaccine at least 2 weeks prior to departure.
• Be prepared for the possibility of patients with measles at your facility and review protocols for rapidly identifying and isolating suspect cases.
• Consider measles infection in patients with history of travel or suspected measles exposure with compatible symptoms.
• Immediately report suspected measles cases to Public Health at (206) 296-4774 to coordinate testing and before discharging or transferring patients.

Background

Measles is a highly contagious viral illness that typically begins with a prodrome of fever, cough, coryza (runny nose), and conjunctivitis (pink eye), prior to rash onset. Measles can cause severe health complications, including pneumonia, encephalitis and death, especially in unvaccinated persons. Mealses virus is transmitted by direct contact with infectious droplets or by airborne spread when an infected person breathes, coughs, or sneezes, and can remain infectious in the air and on surfaces for up to 2 hours after an infected person leaves an area. Infected people are contagious from 4 days before the rash starts through 4 days afterward.

Declines in measles vaccination rates both locally and globally have increased risk of measles outbreaks worldwide. In the U.S., measles is commonly associated with unvaccinated U.S. travelers returning from other countries where measles is actively circulating. International visitors and returning U.S. travelers can expose residents in transit and after arrival, leading to additional cases and possibility for larger outbreaks.  Measles is preventable through vaccination. MMR vaccines are safe and highly effective, with two doses being 97% effective against measles (one dose is 93% effective). When more than 95% of people in a community are vaccinated (coverage >95%) most people are protected through community immunity. However, vaccination coverage among King County kindergarteners has decreased from 94% during the 2021-2022 school year to 92% in the 2022-2023 school year. This decrease in MMR coverage highlights the importance of targeted efforts at increasing vaccine confidence and access.