Health Advisory: King County measles case traveled through SeaTac airport

| January 27, 2023

Actions Requested

  • Be aware of a confirmed measles case in an adult resident of King County who was exposed during recent international travel and was not previously vaccinated. This person with measles spent time at SeaTac airport and Providence Swedish First Hill Emergency Department during their infectious period:
    • Jan. 18, 2023, 12:26- 3 p.m. — Seattle-Tacoma International Airport, South Satellite (Gate B6) to Baggage Claim (Carousel 04)
    • Jan. 20, 2023, 2- 4:55 p.m. — Providence Swedish First Hill, Emergency Department, 700 Minor Ave, Seattle
    • The infectious period for the case is Jan. 16–Jan. 24, 2023
    • Secondary cases resulting from this case would be expected to occur Jan. 25–Feb. 14, 2023
    • See additional details HERE
  • Be vigilant for potential measles infections among patients who spent time in these locations at the dates/times listed, or had recent international travel, or had domestic travel to Ohio where measles outbreaks are occurring.
  • Screen travel history of patients who exhibit symptoms consistent with measles.
  • Be aware, recently published data from the Washington State Department of Health suggest decreased MMR coverage among Washington kindergarten cohorts. See the Background section below for additional information about immunization and outbreaks.
  • Consider measles infection in exposed patients with compatible symptoms, including:
    • Prodrome of fever, cough, coryza and conjunctivitis for 2-4 days
    • Generalized maculopapular rash that usually begins on the face at the hairline and then spreads to the neck, trunk, and extremities
    • Koplik spots may appear on buccal mucosa 1-2 days prior to rash
  • Utilize the Measles Assessment Quicksheet for Providers when evaluating possible measles cases
  • Assess immunization status of patients at every visit and strongly recommend vaccination based on recommended schedule, health conditions, occupation, and other risk factors such as travel. Under-vaccinated individuals may be at risk for measles infection due to outbreaks that occur in the US or internationally.
  • Collect specimens on patients with suspected measles for diagnostic testing:
    • For PCR and virus isolation:
      • Nasopharyngeal swab placed in viral transport media (VTM)
      • Urine, minimum 20mL, in sterile leak proof container
    • For measles IgM serology:
      • Serum, minimum 1mL, in red top or red-grey top tube
  • Route specimens through Public Health to expedite testing (do not use commercial laboratory).
  • Immediately report suspected cases of measles to Kitsap Public Health (24/7) at 360-728-2235.
  • Confirm the vaccination status of your staff, students, and volunteers.
  • Review your plan to manage rash illnesses in your facility with staff members/volunteers to prevent exposures:
    • In urgent/emergency healthcare settings:
      • Suspected patients should wear a mask covering the nose and mouth and be triaged immediately away from waiting rooms.
      • Room patient in airborne isolation if available
    • In outpatient clinic settings:
      • Schedule suspected patients to be seen at end of day, if possible, and keep them out of waiting rooms.
    • Use standard and airborne infection control precautions.
    • Only staff with documented immunity to measles should enter patient’s room.
    • After patient is discharged, do not use or have staff enter the room for 2 hours.

Background

Current situation

Seattle King County Public Health is investigating a local case of measles in an adult who was exposed while overseas. The case was at SeaTac airport and Providence Swedish First Hill Emergency Department during their infectious period before receiving the diagnosis of measles. The case did not wear a face mask at the airport but did wear a face mask in the healthcare facility, which might have reduced the risk to others in the emergency department. The case has been isolating at home since receiving their measles diagnosis.

Kitsap Public Health District has received no reports of measles cases in Kitsap County.  However, healthcare providers should be vigilant for potential measles infections among persons who spent time in these locations at the dates/times listed, or had recent international travel, or had domestic travel to Ohio where measles outbreaks are occurring. The Ohio outbreak that began in November 2022 has primarily affected unvaccinated children and is up to 85 confirmed cases of which 34 were hospitalized. The greatest risk of measles introduction into U.S. communities is through international travel to areas where outbreaks are occurring. According to the WHO and CDC, measles outbreaks can be found in every region of the world (see link below for locations).

People infected with measles are considered infectious from four days prior to rash onset through four days after rash (total of nine days). Healthcare facilities should screen patients for possible symptoms or exposure to measles either at triage or when scheduling appointments to identify potentially infectious cases and promptly implement recommended infection control measures to prevent transmission to other patients and staff.

Immunization and outbreak trends

Recently published data from the Washington State Department of Health (DOH) suggest decreased MMR coverage among Washington kindergarten cohorts. DOH estimates that during the 2021-22 school year, an estimated 4,000 kindergartners had not received two doses of MMR. Additionally, a recent survey published by the Kaiser Family Foundation (KFF) suggested a recent change in risk perception among parents, with 17% of respondents stating that they believed the risk of the MMR vaccine outweighed the benefits.

There have been five measles outbreaks in Washington state in the past ten years, totaling more than 100 cases. In all instances, the index case was an unvaccinated resident with recent international travel or an unvaccinated resident with exposure to a recent international traveler.

The most recent measles death in the United States occurred in 2015 in Clallam County. The decedent was a 28-year-old woman who had been exposed to a measles case in a health facility waiting room. Although the decedent had reportedly received two doses of MMR as a child, she had been on immunosuppressive medications for an underlying health condition, which put her at increased risk of infection.

Additional Resources

Washington State Department of Health:

CDC measles information for healthcare providers: