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Posted on: January 28, 2019

Health Advisory: Measles Outbreak in Clark County, Washington — Jan. 28, 2019

Key Messages:

According to Washington Department of Health, 34 people in Clark County and 1 adult in King County, and 1 person in Multnomah County, Oregon have been confirmed as measles.
Report all patients with suspected measles immediately to the Snohomish Health District. Gain approval from the Health District prior to submittal of labs for testing. See “Actions Requested” below.

Action requested:

Screen for acute rash illness with fever at entry to any clinic or healthcare facility.
If you suspect measles:
- IMMEDIATELY institute respiratory and airborne precautions for all persons with a measles like rash and fever.
- IMMEDIATELY report to Snohomish Health District at (425) 339-5278 and request approval for laboratory testing BEFORE submitting to the Public Health Laboratory.
Obtain specimens for confirmation of diagnosis: blood for serology, nasopharyngeal/throat swabs for Viral Culture (NP swab preferred) and Urine for PCR.
Do not send suspect measles cases to a commercial laboratory for specimen collection. All specimens should be sent to the Public Health Laboratory AFTER consultation with the Snohomish Health District.
Susceptible contacts with respiratory symptoms or fever should stay home and call the Snohomish Health District.
Reduce exposures: schedule patients for end of the day and have them enter via a separate entrance if possible. Ensure that facility personnel are aware of the specific reason for referral so that special arrangements can be made to keep them out of areas used by other patients.
Do not send suspect measles cases to the Emergency Department (ED) unless they require hospitalization. Be sure to notify the ED first.
Persons with possible measles should avoid contact with others until the diagnosis is known.

Specimen Collection:

Contact the Snohomish Health District for approvals and instructions prior to collecting specimens.
Collect serum for both measles IgM and IgG antibodies. Provide at least 1 cc of serum.
NOTE - measles serology results collected earlier than 72 hours after rash onset may result in a false negative result so may need to be repeated.
In addition, if within 14 days of rash onset:
- Nasopharyngeal or throat swab: To collect the nasopharyngeal swab (preferred respiratory specimen), swab the posterior nasal passage with a Dacron™ or rayon swab with a non-wooden shaft and place the swab in 2–3 ml of viral transport medium. Store specimen in refrigerator and transport on ice to arrive at PHL within 72 hours of collection, and
- Collect a urine specimen. Collect at least 50 ml of clean voided urine in a sterile urine cup for PCR (urine specimens do not have not be processed by the submitting lab).
Store all specimens in the refrigerator at 4-8ºC and transport on cold pack(s) to PHL
For additional information regarding collection, storage and shipping of specimens for viral isolation, see: https://www.cdc.gov/vaccines/pubs/surv-manual/chpt22-lab-support.pdf.
All specimens sent to PHL must be accompanied by a completed PHL virology form: https://www.doh.wa.gov/Portals/1/Documents/5230/302-017-SerVirHIV.pdf. Along with the patient and submitter names, be sure to include the date of collection, date of rash onset, and immunization history (if known) on the form.

Prevention:

Exposed non-immune immunocompetent individuals should receive the MMR vaccine ≤72 hours after first exposure as an immediate prevention measure (PEP). If MMR vaccine is not administered within 72 hours of exposure it should still be offered to provide protection from future exposures.

Exposed non-immune immunocompromised persons, infants ≤ 12 months, and others at high risk of complications from measles can be protected with immune globulin ≤ 6 days after exposure. Clinicians may consider administering immune globulin to any suspected contact in accordance with Washington State Department of Health Guidelines found at https://www.doh.wa.gov/Portals/1/Documents/5100/420-063-Guideline-Measles.pdf.

Additional Resources