Winter 2019 Measles Outbreak: Frequently Asked Questions

About Measles

How common is measles?

Measles is rare in Oregon because almost everyone has been vaccinated. People who get sick are usually unvaccinated or too young (less than 12 months) to receive the shot. Travelers from other countries also sometimes carry measles. Learn more about Outbreaks from the CDC.

What’s the risk?

Measles is very contagious. It is spread through the air after a person with measles coughs or sneezes. People with measles can spread the virus to others when they have a cough, runny nose or conjunctivitis — symptoms often confused for a common cold. You can catch measles just by being in a room where someone with measles coughed or sneezed - even two hours later.

Most people in our area have been vaccinated against measles and so are protected. People who are most likely to catch measles are people who have not been vaccinated, especially pregnant women, infants under 12 months and people with weakened immune systems. People with measles often develop an ear infection, lung infection, or diarrhea. Very serious complications are less common and include brain infection and damage to the cornea that can cause blindness. For every 1,000 children infected with measles, one or two will die.

What are the symptoms of measles, and how soon do they appear?

Measles symptoms typically appear seven to 14 days after a person is infected.

  • 1 to 3 days: Cold-like symptoms including a cough, runny nose, and sore throat develop along with a fever and red, itchy eyes.

  • 2 to 3 days: tiny white spots (Koplik spots) appear inside the mouth

  • 3 to 5 days: A rash breaks out, appearing as flat red spots on the face beginning at the hairline and spreading downward. Fevers may spike to more than 104 degrees Fahrenheit.

How is measles treated?

There is no cure for measles. Over-the-counter medications such as Tylenol can help relieve the fever that accompanies measles, and other symptoms typically disappear within two to three weeks. But in Oregon, about 1-in-3 people with measles have been hospitalized because of complications.

How can I prevent measles?

The best protection against measles is the measles-mumps-rubella vaccine, known as the MMR. About two weeks after the first MMR vaccine close to 95 percent of people have lifelong immunity. About 99 percent of people with two MMR vaccines are protected for life. Almost everyone who has not had an MMR shot will get measles if they are exposed to the measles virus.

Exposure to Measles

Is it safe to go to the locations on the exposure list?

Measles is a virus that can remain in the air for up to two hours after a sick person has left the area. Locations people visited while they were contagious have been listed along with specific windows of time. Only people who visited those locations during those specific times, and who are not vaccinated, should be concerned.

The locations are safe for people who have been vaccinated or who visited outside of the specific dates and times.

Do exposure sites have to do special disinfection?

Measles is spread through the air, when an infected person talks, coughs or sneezes, and another person breathes that in or has contact with the mucus or spit.  The virus can remain in the air for up to two hours after an infected person has left, at which time the risk is gone.

What is the health department’s role when there is a case of measles?

A public health department confirms a suspected case of measles with lab tests. A team of health professionals Spends a lot of time talking to the people who are sick to figure out how they contracted an illness. Sometimes that can be a mystery.

They work really closely with the sick people to contain that illness — in the case of measles, that usually includes isolating people at home and checking in every day — sometimes multiple times a day — to track their health.

They also try to figure out where the sick person spent time during the days they were contagious. They share this information directly with people who were exposed, such as in the families or schools. They also share the information with the public if the sick person visited public places like a shopping center or the airport.

What do I do if I think I was exposed?

Those who should be concerned about measles are anyone who:

  1. Is not vaccinated or has a compromised immune system, AND

  2. Believes they have been exposed to measles, AND

  3. Shows symptoms of measles

If these three things occur, call a healthcare provider, urgent care, or your local health department. Staff can help make sure you’re seen quickly and without exposing anyone else who might be in a waiting room.  

Is this considered an outbreak?

For surveillance purposes, we define an outbreak as 3 or more cases. The Oregon case is part of the Washington outbreak.

Measles Vaccine and Immunity

How do I know if I’m immune?

  • A person is considered immune to measles if any of the following is true:

  • You were born before 1957

  • You have laboratory evidence of immunity

  • You have documentation of vaccination as follows:

    • Pre-school children: 1 dose

    • Children in grades K–12: 2 doses

    • Women of childbearing age: 1 dose

If I think I was exposed to measles and haven't been vaccinated, can I still get the vaccine?

Healthy kids and adults can get the measles vaccine anytime. If it is given quickly — within 3 days after exposure —, it may prevent measles. A treatment called immunoglobulin can be given by injection within six days to someone who is not immune and was definitely exposed to measles. It is generally reserved for infants under age 12 months, non-immune pregnant women, and individuals who are immunosuppressed.

How soon are you immune after getting the shot?

It takes about two weeks after getting the shot to become immune.

Does an infant carry his mother’s immunity up until a certain point?

Most newborns are born immune to measles because of maternal antibodies, but antibodies quickly go away. The rate of decline varies, but it might lead to no protection as early as 3-7 months.

I was vaccinated decades ago, am I still protected?

Healthy adults with one documented MMR vaccine are considered protected for life. If you are unsure of your vaccine history or just want peace of mind, it is safe to get another MMR vaccine. Health care workers are generally held to a higher standard of two documented vaccines as proof of immunity.

I think I had measles as a child, can I get it again?

If you are certain you have had measles, you are immune for life.

I’m not sure I was vaccinated. What should I do?

You can get the MMR vaccine at any time; there is no harm in getting one even if you may have had one or more in the past.

There is a blood test that measures measles antibody and can be used as proof of immunity.  The test can be unreliable, so anyone with two documented MMR vaccines is still considered immune even if test for an antibody is “negative.”

What if I don't have health insurance and I need to get vaccinated?

If you do not have insurance for your child or if your insurance does not cover immunizations for your child, Multnomah County will immunize your child for $21.96 per shot. No child is denied immunizations because of inability to pay. Call 503-988-3406 or visit https://multco.us/health/immunizations to learn more.

For adults and fully insured children, there is an administration fee of $54 per shot, plus $70.85 for the cost of the vaccine. Adults with certain health conditions may qualify for a vaccine at lower or no cost. Read more at https://multco.us/health/immunizations

Measles Vaccine Supply

Oregon has an adequate supply of the Measles, Mumps, Rubella, and Varicella vaccine. The vaccine is available through primary care doctors and at many local pharmacies.

Intentional exposure

Some people might have been exposed to chickenpox on purpose when they were children, at a so-called “chicken pox party.” Parents should NOT intentionally expose children to measles.

Measles can be dangerous, especially for babies and young children. It can also cause ear infections, dehydration, pneumonia and brain inflammation. The best way to avoid the virus and complications is to be up to date on the measles vaccine.

Measles Vaccine Safety

All major medical and public health professional groups consider the measles vaccine safe and effective. Since the MMR vaccine was introduced nearly 40 years ago, about 575 million doses have been administered worldwide.

The most common side effects include a sore arm from the shot, a fever, mild rash or temporary pain and stiffness in the joints. Parents should always speak to a trusted health care provider about vaccine questions.

Measles and children

I’m planning a trip to Portland. Should I get my infant vaccinated before we come? Should I cancel my plans?

Measles is not considered widespread in Portland at this time. There is no current public health recommendation for early immunization of infants. The risk of disease in any setting where people mix is never zero, so families need to decide what they are most comfortable doing.

Should I still go to my WIC appointment? Are my kids safe in the health clinics?

There have been no known measles exposures at any Multnomah County Health Department clinic, including the office for the Women, Infants, and Children (WIC) program. Find a complete list of exposures in Oregon, visit the Multnomah County Oregon Exposure page.

Should I get my 6-month-old vaccinated?

There is no current public health recommendation for early immunization of infants. The first dose of MMR is recommended at 12 months.

My child received one MMR vaccine but isn't due for her second shot until she’s 4. Is she at risk?

There is no current public health recommendation to speed up the MMR vaccine schedule. Anyone over age 1 can get the second MMR anytime as long as it is 4 weeks after the first MMR.  

Within two weeks of the first MMR vaccines, about 95 percent of people have lifelong immunity. Among those with two doses, about 99 percent of people have lifelong immunity.

Measles and schools

Where can I find the vaccination rate at my child’s school?

To view the vaccination rates of schools in Oregon, view the interactive Oregon Vaccination Map.

I’m a teacher. If there is a case at my school, what documentation do I need to provide to show I am immune to measles?

Proof of immunity for healthy adults, including teachers, is any one of these:

  • One documented measles vaccine

  • Birth before 1957

  • Lab test proving immunity from prior measles disease or vaccination

How can administrators prepare, in case someone with measles spends time at our school or daycare?

Health Officers recommend that each facility designate a point person who can communicate with public health officials if a measles case is identified at their facility. A single case of measles would always prompt health officials to immediately review staff and student vaccination records to determine the risk of further spread. Local health officials would work with school administrators to keep unvaccinated kids out of school for a 21-day symptom watch.

If there is an exposure at my school, who will be excluded and for how long?

One confirmed case of measles in a school or childcare center is enough for local public health officials to request students’ vaccine records and keep unvaccinated kids out of school for a 21-day symptom watch.

Measles and Health Care Providers

What is the current vaccine schedule for measles?

The recommended schedule has not changed as a result of this outbreak. The first dose is recommended between 12-15 months of age to avoid interference from maternal antibody. The definitive resource on the timing of the second dose is the CDC Pink Book, which states:

  • The second dose of MMR may be administered as soon as 28 days after the first dose.

  • Children who have received two doses of MMR vaccine at least 4 weeks apart, with the first dose administered no earlier than the first birthday, do not need an additional dose when they enter school.

  • Infants 6-12 months and other healthy unvaccinated contacts to measles cases are recommended to receive MMR vaccine as post-exposure prophylaxis if given within 72 hours of exposure. MMR provides permanent protection and may prevent disease if given within 72 hours of exposure.

  • Post-exposure prophylaxis with immunoglobulin within 6 days after exposure is recommended for certain susceptible individuals who have been exposed to measles. Immunoglobulin is prioritized for susceptible individuals at risk for severe disease including:

    • Infants under age 12 months (intramuscular IG 0.5 mL/kg, max 15 mL)

    • Pregnant women without evidence of immunity (400 mg/kg IVIG)

    • Severely immunocompromised persons regardless of vaccination history (400 mg/kg IVIG)

Read more from the Oregon Health Authority on Measles Prevention, Prophylaxis, and MMR Recommendations

How do I protect other patients and staff if someone is sick with measles?

Preventing healthcare exposures is critical to keep high-risk groups safe. Measles can spread through the air even after the patient is no longer present. CDC notes that the virus can live up to 2 hours in airspace where the infected person coughed or sneezed.

When possible, use phone triage and assessment to determine if patients who might have measles need to be seen in-person.

  • Did they visit a known exposure location?

  • Are they up-to-date on their vaccinations?  

If a patient needs to be evaluated in-person, or arrives unexpectedly with symptoms compatible with measles, consult with your health system’s infection control program. Consider the following options to minimize exposure to others:

  • If possible patient may be scheduled as the last patient of the day.

  • If patient privacy can be protected, patient can be briefly evaluated outside, at least 30 feet away from others. Once mask is placed and a clear path to exam room prepared, patient can be escorted into the building.

  • Whenever possible, patient should be escorted from a separate clinic entrance that allows direct access to an exam room without exposing others.  

  • The number of health care workers interacting with the patient should be kept to a minimum.

  • If the patient is already in the clinic, patient should be roomed immediately rather than allowed to wait in the lobby.

  • The exam room door should remain closed at all times, and the patient should remain masked during the entire visit.

  • All labs and clinical interventions should be done in the exam room.

  • The exam room should not be used for 2 hours until after the patient has left.

  • Any patient referred to an Emergency Department for evaluation should be placed immediately in a negative pressure room and seen by staff who are fully immunized against measles and wearing a fit-tested N-95 mask or powered air purifying respirator (PAPR).

Consider all relevant potential diagnoses; if measles is considered likely then specific testing can be facilitated by contacting the local health department.  Patients who are likely to have measles but do not need inpatient admission should be instructed to isolate at home until measles is ruled out clinically or via testing.

How do I report measles?

All cases and outbreaks are reportable to local public health authorities by individuals, health care providers, and clinical laboratories. To report a case of measles, contact your county’s Public Health Department:

  • Multnomah County: 503-988-3406

  • Washington County: 503-846-3594

  • Clackamas County: 503-655-8411

  • Deschutes County: 541-322-7418

  • Marion County: 503-588-5621

  • Clark County: 564-397-8182

  • King County: 206-296-4774

How do I order a measles test?

Traditional measles IgM has poor sensitivity early in illness and is only considered reliable if obtained 72 or more hours after rash onset. The Oregon State Public Health Laboratory uses a highly sensitive RT-PCR test that is more reliable upon health department approval. This test can be requested by contacting the local health department of the patient if evaluation shows:

  1. A compatible illness; AND

  2. Susceptibility to measles; AND

  3. Exposure to a known case or public exposure location; recent foreign travel

Read more on measles testing in this fact sheet from the Oregon Health Authority.

Learn More

Anyone with questions about measles infection or the measles vaccine should call their primary care provider or their local county health department:

  • Multnomah County: 503-988-3406

  • Washington County: 503-846-3594

  • Clackamas County: 503-655-8411

  • Deschutes County: 541-322-7418

  • Marion County: 503-588-5621

  • Clark County: 564-397-8182

  • King County: 206-296-4774

Multnomah County has pamphlets in English, Spanish, Chinese, Russian, Vietnamese or Somali.

Tacoma-Pierce County publishes posters on measles transmission and protection in English, Spanish, Russian, Ukrainian and more.

The Oregon Health Authority has toolkits on airborne diseases, including measles.

The Washington State Department of Health has measles tool kits and fact sheets in Spanish, Russian and more.