Clinician Alert: Measles confirmed in Clackamas County resident | January 16, 2026

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On this page

  1. Requested actions of area clinicians
  2. Background
  3. Clinical signs and symptoms
  4. Resources
  5. Contact Information for Public Health

Measles was confirmed in an unvaccinated Clackamas County resident on January 15, 2026. Oregon Health Authority (OHA) and Clackamas County health officials have not yet determined whether the person has traveled outside of Oregon, or if the case is linked to other known cases. OHA put out a press release to inform the public of the case.

Requested actions of area clinicians

  • Consider measles on the differential diagnosis for any patient with clinically compatible symptoms, especially if they are unvaccinated, report an exposure to measles, or have traveled internationally or to an area in the U.S. with a current measles outbreak.
  • Collect specimens for testing. Nasopharyngeal (NP) or oropharyngeal (OP) swab for measles PCR testing is preferred. Nasal swabs are not recommended.
  • Immediately notify your infection prevention team and the local public health authority (i.e., the health department) where the patient lives if you suspect measles. See 24-hour contact information under the “Resources” section below.
  • Encourage vaccination in individuals 12 months and older who are not up-to-date with measles vaccination. Individuals traveling to places known to have measles should get vaccinated in advance. (Vaccinate infants between the ages of 6–12 months who are planning to travel to places with active measles outbreaks or ongoing transmission. Our region does not yet have community-wide spread, thus this is not yet a recommendation for those not travelling, but can be considered. They will still need 2 doses after 12 months of age.)
  • Distribute this notification to clinicians in your organization and networks.

Background

Measles is a highly contagious respiratory virus that passes from an infected person to another through coughing or sneezing and is considered to have both droplet and airborne transmission. Common complications from measles include otitis media, diarrhea, and pneumonia. Even in previously healthy individuals, measles can cause serious illness requiring hospitalization. Approximately 1-3 of every 1,000 children infected with measles will develop encephalitis. Approximately 1-3 of every 1,000 children infected with measles will die. Measles can also be complicated by subacute sclerosing panencephalitis, a rare and fatal degenerative disease of the nervous system which can develop 7-10 years following illness.

Measles can be prevented with the safe and highly effective MMR (measles, mumps, rubella) vaccine.

Clinical signs and symptoms

Early prodromal symptoms of measles include high fever, cough, runny nose (coryza), and conjunctivitis (eye redness). These non-specific symptoms may be followed 2 – 3 days later by Koplik spots (1-2 mm white spots on the buccal mucosa). Measles rash appears 3 – 5 days after prodromal symptoms and typically appears first on the head or neck, spreading down the body to affect the trunk, arms, legs and feet. The measles rash is maculopapular and may coalesce as it spreads. Fever tends to persist through the rash stage.

Testing

Collect ALL of the following specimens when possible, listed in order of preference:

1. Nasopharyngeal (NP) swab for measles PCR. This is the preferred test for diagnosis given high sensitivity and reliability early in disease:

  • NP swab should be collected within 5 days of rash onset; after 5 days, NP swab should be accompanied by urine.
  • Oropharyngeal (OP) is also acceptable.
  • Nasal swabs are not acceptable.
  • Be sure to use appropriate viral sample collection swabs: a synthetic swab, such as Dacron or rayon on a plastic shaft, and submit in Viral Transport Media (VTM) or Universal Transport Medium (UTM).
  • Call Public Health for approval to send to OSPHL for most timely results (see below).

2. Urine for measles PCR:

  • Urine PCR test is most sensitive 3-10 days after rash onset.
  • Urine should be accompanied by a respiratory swab (NP or OP) if at all possible.

3. Serum for measles IgM and IgG testing:

  • Measles specific IgM antibody may not be present until 3 days after rash onset and may persist for about 30 days after rash onset.
  • A positive IgG early in illness may suggest prior immunity.
  • False-positive IgM can occur due to cross-reactivity with other causes of febrile rashes (e.g., Parvovirus), prior vaccination, and other factors such as presences of rheumatoid factor.

Timely laboratory confirmation of measles is critical to tracking the spread and prioritizing prevention efforts. Tests for measles can be ordered from most commercial labs or through the Oregon State Public Health Laboratory (OSPHL). PCR testing through OSPHL is preferred, because it offers a much faster turnaround time (usually within 3 days of specimen receipt). Approval for testing is required from Public Health prior to specimen submission.

Call the appropriate local public health authority immediately if you suspect measles. These tests should be ordered for patients with:

  1. A compatible illness; AND
  2. Likely susceptibility to measles

Oregon Health Authority and State Public Health Laboratory resources for testing:

Healthcare Infection Control

Please implement these interventions in your clinical settings to minimize exposure to others:

  • Mask and room a patient with possible measles promptly. Use a negative pressure room if available or keep the clinic room door closed.
  • Report any suspected measles cases immediately to the local public health authority of the county where the patient resides (see phone numbers under Resources below).
  • If feasible and appropriate, schedule possible measles patients as the last patient of the day.
  • If feasible and appropriate, consider patient evaluation outdoors at least 30 feet away from others.
  • If possible, escort suspected measles patients into the building via an entrance
    that allows them to access an exam room without exposing others.
  • Minimize the number of health care workers interacting with the patient. Caregivers should have documented immunity to measles and wear a fit tested N-95 mask or PAPR.
  • Perform all labs and clinical interventions in the exam room if possible.
  • The exam room should not be used for 2 hours after the patient has left (time dependent on air change rate), and door should be kept closed during this time.
  • Patients who are under evaluation for measles should isolate at home to protect others from infection.
  • Please let your patients know that Public Health will follow-up with any confirmed cases. Be aware that unvaccinated or under-vaccinated children and staff can be excluded from school during their incubation period.
  • Advise the patient to isolate at home until 4 days after rash onset. Measles can be transmitted from 4 days before until 4 days after rash onset.
  • Alert your infection prevention team as soon as you suspect measles.

Prevention and Post-Exposure Prophylaxis

Measles is best prevented by 2 doses of MMR or MMRV. In normal circumstances, the first dose is recommended at 12–15 months of age to maximize immune response. 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 4 weeks (28 days) after the first dose. Children who have already 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.

Individuals traveling to places known to have known community spread of measles should get vaccinated in advance. It is also important to vaccinate infants between the ages of 6–12 months who are planning to travel to places where measles is common. The CDC provides vaccine recommendations to help people plan for travel.

Providers should consider post-exposure prophylaxis for patients who were exposed to measles and are either susceptible to measles or at risk for severe disease. There are two types of post-exposure prophylaxis for measles:

  • MMR vaccine: must be administered within 72 hours of initial measles exposure.
  • Immunoglobulin (IG): must be administered within six days of exposure.

For vaccine eligible people aged ≥6 months exposed to measles, administration of MMR vaccine is preferable to using IG, if administered within 72 hours of initial exposure. For infants 6–12 months of age, either MMR vaccine or IG may be provided. Do not administer MMR vaccine and IG simultaneously.

The following patient groups are at risk for severe disease and complications from measles and should be prioritized to receive IG:

  • 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)

Postexposure prophylaxis may provide some protection or modify the clinical course of disease among susceptible persons. However, vaccination should be offered at any interval following exposure in order to offer protection from future exposures.

Please note, there is a 5% chance of a vaccine rash after immunization—which could be confused with measles, especially if given during the incubation period after exposure. However, this should not deter you from vaccinating. The MMR vaccine should not be used in pregnant or severely immunocompromised patients.

Resources

Manual for the Surveillance of Vaccine-Preventable Diseases: Measles (CDC)
Oregon Health Authority website on Measles/Rubeola
American Academy of Pediatrics Measles Vaccine Information
American Academy of Family Physicians Measles Vaccine Information

More information about wastewater surveillance:

Contact Information for Public Health

State and local public health departments may be reached 24 hours a day to report suspect cases, discuss testing and for consultation:

Thank you for your partnership,

Richard Bruno, MD, MPH, Health Officer | Multnomah County Health Department
Teresa Everson, MD, MPH, Deputy Health Officer | Multnomah County Health Department
Sarah Present, MD, MPH, Health Officer | Clackamas County Public Health Division
Christina Baumann, MD, MPH, Health Officer | Washington County Public Health Division