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Health Advisory: Large Measles Outbreak in Clark County

Feb. 8, 2019 Update

Clark County Public Health has confirmed 51 cases of measles to date. Several public exposures occurred in the Vancouver/Portland area, including hospitals, clinics, retail, churches and the Portland International Airport. For a full list of exposure sites, see the Clark County Public Health website.

Healthcare providers should be alert for symptoms of measles, especially in unvaccinated people who recently traveled to the Vancouver/Portland area or outside the United States where measles outbreaks are occurring. Countries in Europe and Eastern Europe are currently experiencing large outbreaks.

Actions Requested

Report immediately.

If measles is suspected, immediately call Tacoma-Pierce County Health Department at (253) 798‑6410—24 hours a day, 7 days a week.

Consider measles in patients with the following symptoms:

  • Prodrome of fever, cough, coryza and conjunctivitis for 2 to 4 days.
  • Generalized maculopapular rash that usually begins on the face.
  • Koplik spots may appear on buccal mucosa 1 to 2 days prior to rash.
  • Patient usually appears very ill.
  • The worksheet below can help with clinical evaluation.

Immediately isolate patient with suspected measles.

  • Instruct reception/triage staff to identify patients who present with symptoms of possible measles.
  • If feasible, appropriate and respects patient privacy, briefly evaluate patient outside, at least 30 feet from others. Once a mask is placed over the patient’s mouth and nose and a clear path to the exam room is prepared, escort patient into the building. If there is another entry that will minimize contact with others, use it.
  • Keep patients with suspected measles away from waiting rooms. Immediately put the patient in an exam room and close the door.
  • If possible, put the patient in negative pressure isolation.
  • The exam room door should stay closed at all times. The patient should remain masked during their entire visit.
  • Only staff with documented immunity to measles should be allowed to enter the patient’s room. Even staff with immunity should wear PPE; modified measles cases have occurred in vaccinated healthcare workers with evidence of immunity.
  • After patient is discharged, do not use their exam room for 2 hours.

Collect specimens.

  • Nasopharyngeal swab and urine for PCR and virus isolation.
  • Serum for measles IgM.
  • While the patient is still present, immediately call Tacoma-Pierce County Health Department at (253) 798‑6410—24 hours a day, 7 days a week. We will coordinate specimen transport to Washington State Public Health Laboratory.

Measles fact sheets for patients:

Use this Measles Assessment Matrix to evaluate for measles in patients with rash illness.  


For more information, call Tacoma-Pierce County Health Department at (253) 798-6410.

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