Health advisory: First measles case of 2025 in Washington state identified in a King County infant

| February 28, 2025

ACTIONS REQUESTED

Actions Requested 

  • Be aware of a confirmed measles case recently identified in a King County infant. The infant with measles spent time at the following public locations during their infectious period:
    • Feb. 20, 2025, 6-9 p.m. — Apple Store at Bellevue Square 213 Bellevue Square, Bellevue, WA 98004
    • Feb. 21-22, 2025, 2- 10:30 p.m.-2:15am — Seattle Children’s Hospital Emergency Department 4800 Sand Point Way NE, Seattle, WA 98105
    • Feb. 24, 2025, 1-4:15 p.m. — Allegro Pediatrics – Bothell 11724 NE 195th St, Ste 100, Bothell, WA 98011
    • Feb. 25, 2025, 1-4 p.m. — Northwest Asthma & Allergy Center 8301 161st Ave NE, Ste 308, Redmond, WA 98052
    • Feb. 25, 2025, 2:30-5:30 p.m. — Seattle Children’s Hospital Emergency Department 4800 Sand Point Way NE, Seattle, WA 98105 
    • Secondary cases resulting from this case would be expected to occur Feb. 27–Mar. 18, 2025
    • 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 Texas 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 
  • 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. CDC estimates that MMR is 93% effective against measles after one dose and 97% effective after two doses.
    • Note that CDC recommends one dose of MMR for infants aged 6-11 months who will be travelling internationally. Infants who get one dose of MMR vaccine before their first birthday should get two more doses (one dose at 12 through 15 months of age and another dose separated by at least 28 days). 
  • Immediately report suspected cases of measles to Kitsap Public Health (24/7) at 360-728-2235. 
  • 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). Testing at the Washington State Public Health Laboratory must be approved in advance by Kitsap Public Health District or local public health jurisdiction. 
  • 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 

On February 27, 2025, Public Health – Seattle & King County (PHSKC) reported that they were investigating a laboratory-confirmed measles case in a King County infant who may have been exposed abroad. PHSKC identified several locations in King County where other people may have been exposed to the case during the case’s infectious period, including the Seattle Children’s Hospital Emergency Department. These locations and times are listed above. No additional cases linked to this case have been identified at this time.  

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 who report (a) recent international travel, (b) recent domestic travel to U.S. locations experiencing active outbreaks (including western Texas and eastern New Mexico), or (c) belonging to a community with high vaccine exemption rates.  

There is currently an active outbreak occurring in Texas and New Mexico around the Gaines County area. As of February 28, there have been 146 cases reported in Texas and nine cases in New Mexico. There have been at least 20 hospitalizations associated with this outbreak, and one death in a previously healthy school-aged child who was unvaccinated. 

The greatest risk of measles introduction into U.S. communities is through international travel to areas where outbreaks are occurring; from 2020 – March 2024, CDC found that 96% of U.S. cases were associated with exposure outside the U.S. or resulted from exposure to imported cases.1 The World Health Organization (WHO) and the CDC are aware of current active measles outbreaks occurring 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 at the beginning of the 2023-24 school year, over 7,000 Washington kindergartners had not received two doses of MMR.2 Additionally, a recent survey published by the Kaiser Family Foundation (KFF) suggested a recent change in risk perception among parents, with 18% of respondents stating that they believed the risk of the MMR vaccine outweighed the benefits. 

There have been six 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. There were seven measles cases reported in Washington State in 2024, and 12 in 2023; additionally, there were a small number of non-Washington cases identified to have spent time in public locations in Washington State while infectious. 

Prior to the recent death reported in Texas, the most recent measles death in the United States occurred in 2015 in a Clallam County resident, likely resulting from a local exposure on the Olympic Peninsula. 

ADDITIONAL RESOURCES

Washington State Department of Health: 

CDC measles information for healthcare providers: 

CONTACTING THE HEALTH DISTRICT 

  • Call: 360-728-2235 and leave a message. Includes reporting notifiable conditions 24 hours a day, 7 days a week. Leave the patient’s name, date of birth and disease. 
  • Fax: 360-813-1168.