August 13, 2018

The Oregon Health Authority has identified a laboratory confirmed case of measles in a traveler who may have exposed many individuals in the Portland Metro area, Yamhill County, and Vancouver, Wash. The current case is not related to the three cases identified in July by Multnomah County. The full OHA Provider Alert follows this summary. Please share widely with your colleagues, facility managers, medical directors, and infection control practitioners.

Be Aware: Susceptible individuals exposed to this traveler could develop symptoms of fever and respiratory symptoms anytime from August 9th until August 26th; the rash that is so well known with measles usually develops several days after onset of fever and respiratory symptoms.

What to do

If you see or hear from one of your patients with possible measles symptoms, take the following steps:

1. Determine if your patient could have been exposed at the locations identified by OHA (see below)

2. If your patient is potentially exposed and ill with fever, cough, coryza (runny nose) and conjunctivitis (pink eye) then contact the local health department of the patient’s residence AND determine if the patient needs medical attention

3. If the patient needs medical attention then arrange for an evaluation that minimizes any exposure to others by:

a. Contacting the facility where the patient will be evaluated so preparations can be made

b. Have the patient wear a mask and be immediately placed in a room with door closed

c. Evaluate, including lab testing, in a negative pressure room if possible

d. Evaluate the patient for all relevant diagnoses; if measles is still suspected then specific testing can be facilitated by contacting the local health department

e. If the patient does not need immediate medical evaluation, then contact the local health department to obtain advice on specific testing.

Local Health Department 24/7 contact numbers:

  • Clackamas County Public Health 503-655-8411

  • Clark County Public Health 360-397-8182

  • Multnomah County Public Health 503-988-3406

  • Washington County Public Health 503-846-3594

  • Yamhill County Public Health 503-434-7525

Below is OHA’s Provider Alert

Dear Colleagues, Please share the following message with your health care providers.

Date: August 11, 2018

Oregon Public Health is investigating a confirmed case of measles whose symptom onset was July 30th. Individuals who were at the following locations may have been exposed:

July 30, PDX Airport, Terminal E, 2:15—3:45 p.m.

July 31, Leno Medoyeff Bridal, 710 NW 23rd Ave., Portland, 3:30—5:30 p.m.

Aug. 1, Tom’s Pancake House, 12925 SW Canyon Rd., Beaverton, 7—9:30 a.m.

Aug. 2, Max Red Line, Beaverton Transit Center to Pioneer Square, 12:30—1 p.m.

Aug. 2, Max Red Line, Pioneer Place to Beaverton Transit Center, 5:30—6 p.m.

Aug. 5, Verde Cocina, 5515 SW Canyon Ct., Portland, 2—4:30 p.m.

Public health officials are also contacting individuals known to have been exposed at several private locations. Contacts are being advised to watch for signs and symptoms of measles and to seek health care for diagnosis by calling ahead so as to avoid exposing others in waiting rooms and lobbies.

Clinical Presentation:

  • Please consider measles in patients who:
  • Present with febrile rash illness and the “3 Cs”: cough, coryza (runny nose) or conjunctivitis (pink eye)
  • Recently traveled internationally or were exposed to someone who recently traveled
  • Have not been vaccinated against measles

Health care providers should also consider measles when evaluating patients for other febrile rash illnesses, including dengue (www.cdc.gov/dengue/) and Kawasaki disease (www.cdc.gov/kawasaki/).

If you suspect measles, do the following immediately:

  1. Mask and isolate patients (in a negative-pressure room, if possible) to avoid disease transmission.

  2. Report the suspect measles case to their health department. The directory of communicable disease programs, including after-hours phone numbers, is here: www.oregon.gov/oha/PH/DiseasesConditions/CommunicableDisease/ReportingCommunicableDisease/Documents/reportdisease.pdf.

  3. Obtain specimens for testing from patients with suspected measles, including viral specimens. Detailed information can be found in the Oregon Investigative Guidelines (www.oregon.gov/oha/ph/DiseasesConditions/CommunicableDisease/ReportingCommunicableDisease/ReportingGuidelines/Documents/measles.pdf).  

Ways to minimize exposure to others include:

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

  • If feasible, appropriate, and 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 them to access an exam room directly 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 immune to measles and wearing a fit-tested N-95 mask or powered air purifying respirator (PAPR).

For persons who plan to travel internationally, health care providers should encourage timely vaccination of all persons aged ≥6 months who lack evidence of measles immunity.* One dose of MMR vaccine is recommended for infants aged 6–11 months traveling internationally, and 2 doses for persons aged ≥12 months, with a minimum interval of 28 days between doses.

Routine MMR vaccination is recommended for all children, with the first dose given at age 12–15 months, and a second dose at age 4–6 years. Unless they have other evidence of immunity,[*] adults born after 1956 should get at least 1 dose of MMR vaccine, and 2 appropriately spaced doses of MMR vaccine are recommended for health care personnel, college students and international travelers.

Measles was documented as “eliminated” in the United States in 2000. However, importation of measles cases and subsequent limited local transmission still occur. Additional guidance for health care providers can be found at:

CDC measles

CDC Provider Resources for Vaccine Conversations with Patients

Oregon Health Authority Measles webpage                                                                      

Oregon Measles Investigative Guideline

 

Presumptive evidence of measles immunity is defined as:

1.    Birth before 1957 (but see §6.2 of the Oregon Investigative Guidelines)

2.    Laboratory-confirmed disease

3.    Laboratory evidence of immunity (protective antibody titers) or

4.    Documentation of age-appropriate vaccination with a live measles virus-containing vaccine:

  • Pre-school children: 1 dose

  • Children in grades K–12: 2 doses

  • Women of childbearing age: 1 dose

  • Health care personnel born during or after 1957: 2 doses

  • Students at post-high-school educational institutions: 2 doses

  • International travelers ≥12 months of age: 2 doses

  • Children 6–11 months of age who plan to travel internationally: 1 dose

  • All other adults: 1 dose.