Health Advisory: Prepare for measles as cases increase across Washington

Summary

• The risk of measles is increasing across Washington. Both travel-related cases and local transmission are up.
• Immediately notify us of suspected cases at (253) 649-1412. You can call 24 hours a day, 7 days a week.
• Make sure your staff knows how to test for measles and manage cases.
• Ensure your patients without evidence of immunity are up to date on measles vaccination.

Current situation

As of April 15, 37 cases of measles had been identified in Washington in 2026. Washington State Department of Health (DOH) reports at least 9 separate introductions of measles into the state, all associated with domestic or international travel. Many of these patients spread measles to others in Washington.

DOH has identified more than 50 public exposure locations since January. At least 3 cases do not appear linked to other cases or outbreaks and report no out-of-state travel, which means we may have undetected community spread.

You can find the latest information on measles outbreaks and cases on DOH’s website, as well as a map of public exposure locations from the past 21 days.

Actions requested

Identify

• Be familiar with the 3 classic signs and symptoms of measles:
  • Rash (maculopapular, confluent, starts on face and spreads down), and
  • Fever (101.0 Fahrenheit or higher, overlapping the rash onset), and
  • At  least one of the “3 Cs” before the rash:
    • Cough.
    • Coryza (runny nose).
    • Conjunctivitis (red eyes).
• When you evaluate a patient with febrile illness and rash, look for measles risk factors:
  • Unvaccinated (zero doses of a measles-containing vaccine) or unknown vaccination status.
  • Exposure to a case of measles in the last 21 days.
  • Travel in the past 21 days (international or domestic).
  • Exposure to a known measles public exposure location in Washington in the last 21 days.
• Use the Suspect Measles Provider Evaluation Worksheet to gather patient information and guide decision-making for measles testing.

Isolate

• Ensure your facility has protocols to rapidly identify and isolate suspected cases.
  • Patients with suspected measles should be masked at all times.
  • Patients with suspected measles should not wait in common areas, like waiting rooms.
  • Consider posting signs or instructions outside your facility directing patients with rash and fever to call ahead.
• As soon as you suspect measles, immediately:
  • Isolate the patient in an airborne infection isolation room (AIIR).
  • If AIIR is not available, use a private room with a closed door.
• Follow standard and airborne precautions when you evaluate patients with suspected measles.
  • Healthcare providers should wear fit-tested respirators (N95 or better) when in the patient’s airspace.
  • Healthcare providers should wear a gown, gloves, and eye protection for any aerosolizing procedures.
  • Confirm all healthcare workers who assess or care for patients with suspected or confirmed measles have documented measles immunity. Even with appropriate personal protective equipment, healthcare workers without documented measles immunity should not care for patients with suspected or confirmed measles.
• After you discharge a patient with suspected or confirmed measles, the room or area where the patient was assessed should remain vacant for at least 2 hours.
• Follow DOH guidance for preventing measles (rubeola) in healthcare settings.

Notify

• Measles is an immediately notifiable condition in Washington. Call Tacoma-Pierce County Health Department at (253) 649-1412 24 hours a day, 7 days a week.

Test

• We will coordinate measles testing at the Washinton State Public Health Laboratories (PHL).
  • Refer to the Measles Specimen Testing Protocol to learn about testing at PHL.
• PCR (polymerase-chain reaction) testing is the preferred method to diagnose acute measles.
  • Collect PCR specimens as close as possible after onset of the rash, ideally within 10 days.
• Follow PHL guidance for Measles RT-PCR Specimen Collection and Submission:
  • Collect nasopharyngeal (NP) or oropharyngeal (OP) swabs:
    • Place swabs in Viral Transport Media (VTM) or Universal Transport Media (UTM).
    • If you use any other transport media, the test will be rejected.
  • If possible, collect a urine specimen as well as an NP or OP swab.
• Measles testing performed before a patient develops a rash does not rule out measles; if negative, repeat testing would be required.
  • Call us at (253) 649-1412 to discuss whether to pursue early testing for symptomatic patients without a rash who have a known measles exposure (versus isolation and symptom monitoring, with measles testing performed if rash develops).
  • If you have concerns for an unusual measles presentation such as modified measles or if the patient is severely immunocompromised, call us at (253) 649-1412 to discuss.

Manage

• Patients with measles are contagious from approximately 4 days before through 4 days after rash onset.
  • Instruct patients with suspected measles to isolate at home, even while test results are pending.
• If a suspected case of measles is confirmed in your facility:
  • We will coordinate with your facility infection prevention program to identify any patients, staff, visitors, or others who shared airspace with the confirmed case.
  • Follow DOH guidance for Preventing Measles (Rubeola) in Healthcare Settings.
• Post-exposure prophylaxis (PEP) for measles can prevent disease if close contacts are identified rapidly.
  • Follow DOH guidelines for Measles Post-Exposure Prophylaxis.

Vaccinate

• MMR and MMRV are the best tools for preventing infections.
  • Check Washington State Immunization Information System (WAIIS) and medical records for measles vaccination or immunity status.
  • Ensure patients without evidence of immunity are up to date on measles vaccination.
  • Refer to the DOH’s Interim Pediatric Measles Outbreak Vaccination Recommendations to guide decision-making for children who live in or travel to locations with outbreaks.
• Ask patients about upcoming travel plans.
  • If needed, offer measles vaccination at least 2 weeks before travel to patients with upcoming international or domestic travel.

Background

Measles is a highly contagious disease caused by the measles virus. The virus is transmitted by direct contact with infectious droplets or by airborne spread when an infected person breathes, coughs, or sneezes. Measles virus can remain infectious in the air and on surfaces for up to 2 hours. Measles can cause severe outcomes, including pneumonia, immune system dysregulation, encephalitis, and death.

Vaccination remains the most effective way to protect against measles and its complications. Two doses of MMR vaccine are about 97% effective in preventing infections.

The United States is experiencing a rapid increase in cases of measles. As of April 10, 2026, Centers for Disease Control and Prevention (CDC) has reported more than 1,700 cases of measles, with 9% resulting in hospitalization. In 2026, 33 states have reported cases of measles, including Washington. For the latest information about cases of measles and outbreaks across the U.S., visit the CDC Measles Cases and Outbreaks webpage.

Resources

For more info about measles:

• Measles Information for Providers, TPCHD.
• General information about measles, TPCHD.
• Suspected measles evaluation worksheet, TPCHD.
• Measles webpage, for general info about measles, DOH.
• Measles Cases in Washington State, DOH.
• Measles Public Exposure Locations in WA State, for a map of recent public exposures, DOH.
• Measles PEP for Non-Symptomatic Susceptible Contacts, DOH.
• Interim Pediatric Measles Outbreak Vaccination Recommendations, DOH.
• MMR Vaccine FAQ, measles vaccine info to share with patients, DOH.
• MMR Vaccine FAQ for Healthcare Providers and LHJs, DOH.

Contact

Immediately report suspected or confirmed cases of measles.

You can reach us 24 hours a day, 7 days a week at (253) 649-1412.