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Health Advisory: Measles Outbreak in Southwest Washington

An active measles outbreak investigation is underway in Clark and Wahkiakum Counties.

As of Jan. 10, 2024, investigators have identified 3 lab-confirmed and 3 epidemiologically linked measles cases in unvaccinated adults. Symptoms began in mid-to-late December. All report isolating at home during their contagious period. Investigators have not identified any public exposure locations. Healthcare providers should be aware of the presence of measles in Southwest Washington and consider measles in patients with compatible symptoms.

At every visit, assess patients’ immunization status and strongly advise vaccination based on the recommended schedule. Under-vaccinated people may be at risk for measles from outbreaks that occur in the United States or other parts of the world.

Requested actions

Immediately report suspected measles cases. Call Tacoma-Pierce County Health Department 24/7 at (253) 649-1412.

Consider measles in patients with these symptoms:

  • Prodrome of fever, cough, coryza, and conjunctivitis for 2–4 days.
  • Generalized maculopapular rash. Typically begins on the face at the hairline and spreads downward to the neck, trunk, and extremities.
  • Koplik spots may appear on the buccal mucosa 1–2 days before the rash.
  • Patient typically appears very ill.
  • Suspected Measles Case Checklist may help with clinical evaluation.

Immediately isolate patients with suspected measles:

  • Instruct reception and triage staff to identify patients with measles symptoms.
  • Patients with suspected measles should wear a mask covering their nose and mouth.
    • Patient should remain masked during the entire visit.
  • Immediately triage the patient away from the waiting area.
  • Immediately room the patient and close the door.
    • Place the patient in negative pressure isolation, if available.
    • The exam room door should remain closed.
  • Only staff with documented immunity to measles should enter the patient’s room.
    • All staff—even those with immunity—should wear PPE (personal protective equipment).
    • Modified measles cases have occurred in vaccinated healthcare workers with documented immunity.
  • After the patient is discharged, do not enter the room for 2 hours.

Collect specimens from patients with suspected measles for diagnostic testing:

  • For PCR (polymerase chain reaction) and virus isolation:
    • Nasopharyngeal swab placed in VTM (viral transport media).
    • Urine (minimum 20 mL) in a sterile, leak-proof container.
  • For measles IgM (immunoglobulin M) serology:
    • Serum (minimum 1 mL) in a red top or red-grey top tube.

While the patient is still in the office, call Tacoma-Pierce County Health Department at (253) 649-1412. We will coordinate transporting the specimen to Washington State Public Health Lab.