An unvaccinated Multnomah County resident returning from international travel was recently diagnosed with measles. Public exposures occurred during travel and prior to diagnosis.
See Oregon Health Authority’s press release on June 24, 2025
Requested actions
We request that area clinicians:
- Consider measles on the differential diagnosis for patients who present with compatible symptoms, especially if they report an exposure, had recent travel or are unvaccinated for measles.
- Collect specimens for testing. Nasopharyngeal (NP) or oropharyngeal (OP) swab for measles PCR testing is preferred.
- Immediately notify your infection prevention team and the local public health authority (i.e., health department) where the patient lives if you suspect measles. See 24-hour contact information below.
- Encourage vaccination in those 12 months and older who are not up-to-date with measles vaccination. People traveling to places known to have 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. See CDC Measles Vaccination Recommendations.
- Distribute this notification to clinicians in your organization and networks.
Public health is working with the case to identify and monitor close contacts.
Who may have been exposed
People might have been exposed if they were in any of these areas during these times:
- Flight UA1832/SN8869 (Brussels Air Operated by United Airlines) on Tuesday, June 17 (economy cabin); departed Chicago O’Hare International Airport at 4:01 p.m. CDT, arrived at Portland International Airport at 6:29 p.m. PDT.
- Portland International Airport arrivals and baggage claim between 6:30 p.m. and 8:30 p.m. on Tuesday, June 17.
- Lake Oswego Safeway, located at 401 A Ave., Lake Oswego, in Clackamas County, between 11:30 a.m. and 3:00 p.m., on Sunday, June 22.
Because most people in the Portland Metro region have been vaccinated against measles, the risk to the general public is low. However, those who were in the same locations as the contagious traveler should be aware of their measles vaccination history and watch for any symptoms.
If symptoms appear
Including an unexplained maculopapular rash, fever, cough, runny nose or red eyes – the person should call their doctor’s office or urgent care clinic to schedule a visit. Call first to talk about getting care without spreading measles to others.
About measles
Measles is a highly contagious respiratory virus that passes from an infected person to another through coughing or sneezing. It’s 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.
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.
- Throat swab is also acceptable.
- 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 before submitting a specimen.
(Note: counties in Washington state do not require approval before sending to the Washington state lab).
Call the appropriate local public health authority immediately if you suspect measles. These tests should be ordered for patients who may have been exposed if their evaluation shows:
- A compatible illness; AND
- Likely susceptibility to measles
Testing Resources
- Lab testing for measles at Oregon State Public Health Laboratory
- OSPHL test request forms and collection kits
Healthcare infection control
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 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 an 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 (the time depends on the air change rate), and doors should be kept closed during this time.
- Patients who are under evaluation for measles should isolate at home to protect others from infection.
- 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 age 12–15 months 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 2 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.
People traveling to places known to have measles should get vaccinated in advance. This includes infants between the ages of 6–12 months. See CDC Measles Vaccination Recommendations.
Post-exposure prophylaxis with IV immunoglobulin within 6 days after exposure is recommended for certain susceptible individuals who have been exposed to measles. Consult Oregon recommendations for post-exposure prophylaxis (PDF).
In general, 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)
The MMR vaccine, if administered to non-immune persons within 72 hours of initial measles exposure, or immunoglobulin (IG), if administered within 6 days of exposure, 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.
Note: There is a 5% chance of a vaccine rash after immunization. This 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.
Contacts
State and local public health departments may be reached 24 hours a day to report suspect cases, discuss testing and for consultation:
- Clackamas County Health Department:503-655-8411
- Multnomah County Health Department: 503-988-3406
- Washington County Public Health: 503-846-3594
- Oregon Health Authority epidemiologist on-call: 971-673-1111
Resources
Manual for the Surveillance of Vaccine-Preventable Diseases: Measles (CDC)
Thank you for your partnership,
Richard Bruno, MD, MPH | Multnomah County Health Officer
Sarah Present, MD, MPH | Clackamas County Health Officer
Christina Baumann, MD, MPH | Washington County Health Officer