| Health Advisory -- January 10, 2007
Imported Measles in King County
This advisory is regarding a confirmed a case of measles in an adult male Snohomish County resident who acquired the disease in Asia and arrived in King County on January 6th, 2007.
The ill traveler flew from Thailand to Korea and arrived in Seattle on Asiana Flight 272 at 10:00 AM. He had developed fever the day before the flight. After he arrived in Seattle, he immediately went home. A maculopapular rash began on January 8th, starting on his head and spreading to the rest of the body. He then sought medical care on January 9th. The diagnosis was confirmed on January 10th by a positive measles IgM titer at the Washington State Public Health Laboratory.
The patient's infectious period is from January 4th through 12th. The risk to the public is low. However, persons who were on Asiana Flight 242 or who were at Seatac International Airport on January 6th between 10:00 AM and 12:00 noon were possibly exposed to 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. Koplik spots are pathognomonic for measles, but their absence does not rule out the diagnosis. Measles patients often feel ill enough to seek medical care before the onset of rash. Possibly exposed persons with symptoms compatible with measles should be evaluated immediately. Suspected measles cases should be instructed to wear a mask covering the nose and mouth, avoid public places, minimize contact with others, and stay out of patient waiting rooms. Reception staff should be instructed 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 7-21 days).
If you suspect measles and/or would like assistance with diagnosis, please contact Public Health promptly by calling (206) 296-4774. We can help facilitate specimen collection and rapid testing at a Public Health laboratory. To avoid a delay in diagnosis, report suspected cases immediately; do not send specimens to a commercial lab and do not wait for serologic confirmation. 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 (infants under 12 months, susceptible pregnant women, immune compromised) and those for whom vaccine is contraindicated, immune globulin can be given within 6 days of exposure to prevent measles.
For updates and information that is being provided to the public, please visit the Public Health website at: www.metrokc.gov/health/measles2007
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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