STATE DEPARTMENT OF HEALTH

Cases of measles confirmed in state

posted 04/08/04
Measles has been confirmed by serologic testing in two children from King and Snohomish Counties who were recently adopted in China. The children were part of a group of adoptees and adoptive parents who returned from China March 26, 2004.

The adoptive families in Washington are residents of King and Snohomish Counties, and thus far, no other affected counties in Washington have been identified. In addition to Washington, adoptive families returned to four other states: Alaska, Florida, Maryland and New York, and at least six other children from two states (Maryland and Washington) have developed a febrile rash illness and are considered probable cases of measles.

Onset of the first rash illness in the group was March 22, and exposure to measles likely occurred in Hunan or Guangdong provinces in China. The families returned via multiple airline flights, including at least two children who were ill with rash and fever at the time of the flight. The Centers for Disease Control and Prevention is investigating possible exposures on internal and domestic flights.

San Juan County Health Officer Frank James said because of relatively low immunization rates, this could represent a significant exposure. An unvaccinated person could get the disease by simply breathing the air for up to two hours after the infected person has left a space.

One dose of vaccine is 95% effective two doses are 99%, disease is considered very effective in producing durable immunity. All of those born before Jan. 1, 1957 are considered immune but the actual percentage is likely about 97%. Given the number of cases there could be wider spread of the disease.

Healthcare providers in Washington should consider measles when evaluating patients with a febrile rash illness, particularly children recently adopted from China and their household and family members and social contacts.

Clinical manifestations of measles: The incubation period for measles is usually 14 days (range 7-18 days), and the communicable period from about five days before until four days after rash onset. Complications are most common among very young children, and include pneumonia and encephalitis. Infection control for suspected or confirmed measles should include standard and airborne precautions.

Symptoms characteristic of measles include:

• A prodrome of fever, cough, coryza, or conjunctivitis that may precede the onset of rash
  
  
• A generalized maculopapular rash that begins on face and neck and lasts at least three days
  
  
• Temperature greater than or equal to 101.0° F (greater than or equal to 38.3°C)

Laboratory diagnosis of measles:

• Measles immunoglobulin M (IgM) antibody detected in a specimen obtained 2-28 days after rash onset
  
  
• Significant rise in measles immunoglobulin G (IgG) antibody in paired acute and convalescent specimens obtained two weeks apart
  
  
• Isolation of measles virus from a nasopharyngeal or urine specimen collected before the fifth day of rash

Specimens should be sent to the Washington State Department of Health Public Health Laboratories for rapid testing by contacting your local health department, NOT to a commercial reference laboratory.

Prevention of measles: Measles may be prevented in susceptible persons by post-exposure prophylaxis with measles-containing vaccine given within 72 hours of exposure, or in those at risk for serious complications with intramuscular immunoglobulin given with six days of exposure.

Measles can be prevented by measles-mumps-rubella (MMR) vaccine. All children 12 months of age or older who have not previously been immunized against measles should get a measles vaccine, with a second dose between the ages of four and six. The Department of Health Immunization Program provides MMR and other childhood vaccines to local health departments and health-care providers. The supply of measles vaccine is strong.

For details on vaccine recommendations, see www.cdc.gov/nip/vaccine/MMR/default.htm.

Please report suspected measles immediately to your local health jurisdiction (see www.doh.wa.gov/LHJMap/LHJMap.htm) or Washington State Department of Health Communicable Disease Epidemiology Section (206.361.2914 or 1.877.539.4344) and for assistance with collection of appropriate laboratory specimens, consultation on infection control and management of potentially exposed contacts.

Information about measles and details on the measles-mumps-rubella vaccine is available on the Department of Health Web site. The Centers for Disease Control and Prevention (CDC) Web page has more on measles and also provides health information and guidelines regarding international adoptions .

The Public Health - Seattle and King County Web site has King County measles information; and local information in Snohomish County is available on the Snohomish Health District Web site.

SAN JUAN ISLANDER © 2009

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