| Health Advisory -- December 9, 2006
Imported Measles
This advisory describes a confirmed a case of measles in an adult traveler who acquired the disease abroad and arrived in King County on Dec. 8th. The infected person visited only a small number of public areas in King County while contagious (contagious period Dec. 3-11). The risk to the public from this case is low however it is possible that other persons may have been exposed to the disease.
The ill traveler flew from Milan, Italy (Linate Airport) to Amsterdam, Netherlands (Schiphol Airport) on KLM (Volo) flight 3416 and arrived in San Francisco on KLM (Vovo) flight 605 on DEC 2 and subsequently flew to Las Vegas, NV on December 3rd on U.S Airways Flight 178 and traveled over land to the Grand Canyon and Monument Valley, The ill traveler returned to San Francisco on December 6th on U.S. Airways Flight 574. Public Health authorities in those areas have been alerted, as has the Centers for Disease Control and Prevention Division of Global Migration and Quarantine who assist with tracing of possible exposures during international air travel. The ill traveler flew to Seattle on Alaska Air flight 399 on December 8th and promptly sought medical attention at which time measles was suspected and Public Health was notified. Public Health is working with the healthcare facility where the ill traveler was seen to contact any persons who might have been exposed. Specific locations and times where persons may have been exposed to measles in King County are available on Public Health’s website (www.metrokc.gov/health/measles2006.htm) and our telephone hotline (206-296-4949). The case was confirmed on DEC 9th by serology (positive measles IgM) at the Washington State Public Health Laboratory.
Recognizing measles: Measles is characterized by a prodromal illness with fever, cough, coryza, and conjunctivitis followed in 2-4 days by a maculopapular rash. The red rash usually begins on the face and spreads to the rest of the body. Koplik spots which look like grains of sand appear on the oral and/or buccal mucosa 1-2 days prior to rash onset and last a few days. The absence of Koplik spots does not rule out measles. Measles patients often feel ill enough to seek medical care BEFORE rash onset. Patients with prodromal symptoms compatible with measles who have risk factors for exposure to measles should be evaluated for possible measles. Suspect measles cases should bypass patient waiting areas and airborne isolation precautions used whenever possible. Reception staff should know how to identify and isolate patients who present with these symptoms. Complications of measles can include otitis media, bronchopneumonia, laryngotracheobronchitis, diarrhea, and encephalitis. Measles cases are contagious from 1-2 days before onset of symptoms (typically 4 days before rash onset) through 4 days after rash onset. The incubation period is approximately 10 days (14 days to rash onset; range 7-21days).
If you suspect measles and/or for assistance with diagnosis, please contact Public Health promptly by calling (206) 296-4774. We can assist with the collection of specimens and rapid testing at a Public Health laboratory. To avoid a delay in diagnosis, please do not send specimens to a commercial lab and wait for serologic confirmation in order to report. Control measures are most effective if we are able to contact those exposed within 72 hours of exposure.
For exposed susceptible persons: Measles vaccine can be given within 72 hours of exposure to a person with measles to prevent disease. For high risk persons and those for whom vaccine is contraindicated, immune globulin can be given within 6 days of exposure to prevent measles.
Please see the accompanying press release for complete information that is being provided to the public.
Information on MMR vaccine for adults
The following adults do NOT need the measles, mumps, rubella vaccine (MMR):
- Adults with documentation of immunity to measles, mumps, and rubella.
- Men born before 1957.
- Women born before 1957 who are not having more children, have already had rubella vaccine, or have had a positive rubella test (for rubella prevention.)
- Adults who have had two doses of MMR or one dose of MMR plus a second dose of measles vaccine.
- Adults who already have had one dose of MMR and are not at high risk of measles exposure.
The following adults SHOULD get the MMR vaccine if they are not among the categories listed above:
- College student, trade school students, and other students beyond high school.
- Workers in a hospital or other medical facility.
- Adults who travel internationally, or are a passenger on a cruise ship.
- Women of childbearing age.
For more updates and additional information including management of measles in health care facilities see our web page for healthcare professionals at: www.metrokc.gov/health/providers/epidemiology
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