Health Advisory: Growing Measles Outbreak in Ohio – Measles Reminders and Readiness

December 20, 2022

Action Requested 

• Be aware of a growing measles outbreak in central Ohio. At this time, no cases have been identified in Snohomish County.
• Consider measles infection in patients with compatible symptoms, including:
  1. Prodrome of fever, cough, coryza and conjunctivitis lasting 2–4 days
  2. Generalized maculopapular rash that usually begins on the face at the hairline and spreads downward to the neck, trunk, and extremities
  3. 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
  1. Patients with symptoms of measles should wear a mask covering the nose and mouth and should be kept away from patient waiting rooms.
  2. 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.
  3. Only staff with documented immunity to measles should be allowed to enter the patient’s room.
  4. After the patient is discharged, do not use the room for 2 hours.
• Isolate and immediately report suspected cases of measles to Public Health. In Snohomish County, contact the Snohomish Health District at 425-339-3503. Other counties: Find your local health jurisdiction here. 
  1. Suspected measles case-patients should be discussed with Public Health prior to discharging or transferring these individuals.
• Collect specimens on patients with suspected measles:
  1. Nasopharyngeal swab (preferred respiratory specimen) for PCR and virus isolation
  2. Urine (at least 50 ml) for PCR and virus isolation
  3. Serum (at least 1 cc) for measles IgM
• Route laboratory specimens through Public Health 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 previous measles infection
  • Birth before 1957

Background 

Recently, Columbus Public Health declared a measles outbreak centralized in Columbus, Ohio. As of December 14, 2022, all confirmed cases are reported to be unvaccinated, partially vaccinated, or have an unknown vaccination history. All cases have been school-aged children.

Washington (WA) state has not been impacted by this outbreak; however, WA Department of Health (DOH) maintains vigilance for measles. The last two measles outbreaks in Washington State occurred in 2019. There were a total of 87 cases from the two outbreaks – which remains to be the most cases the state has seen since 1990. The last confirmed measles case in WA state occurred in early 2022. This case had international travel and there were no reports of any domestic spread from this case. Since then, there have been no other confirmed measles cases in the state.

The MMR (measles, mumps, and rubella) vaccine continues to be the most effective tool against measles infection. However, recent analyses published by the CDC and by WA DOH indicate a substantial decrease in administered pediatric vaccines, including the MMR vaccine, during the COVID-19 pandemic. Due to this decrease in MMR vaccinations, there may be a larger population susceptible to measles in our communities. With this in mind, we encourage our partners to continue to be on alert for potential measles.

Additional Resources 

• Measles Specimen Collection and Handling Guidance 
  • Measles RT-PCR 
  • Measles IgG 
  • Measles IgM 

• The CDC Epidemiology and Prevention of Vaccine-Preventable Diseases (The Pink Book) - Measles 
• The CDC Pink Book Webinar Series – Measles, Mumps, and Rubella 
• CDC Measles Cases and Outbreaks (U.S.) 
• Global Measles Outbreaks (CDC) 
• MMR ACIP Vaccine Recommendations
• www.snohd.org/measles
•  www.doh.wa.gov/measles