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December 12, 2022

Growing measles outbreak in central Ohio

Actions requested

  • Be aware of a growing measles outbreak in central Ohio. At this time, no cases have been identified in King County.
  • Consider measles infection in patients with compatible symptoms, including:
    • Prodrome of fever, cough, coryza and conjunctivitis lasting 2–4 days
    • Generalized maculopapular rash that usually begins on the face at the hairline and spreads downward to the neck, trunk, and extremities
    • Koplik spots may appear on buccal mucosa 1–2 days prior to rash
  • Assess patients with measles symptoms for recent international travel, domestic travel to Ohio, or other potential exposure to a confirmed measles case.
  • Instruct reception/triage staff to identify patients who present with symptoms of possible measles
    • Patients with symptoms of measles should wear a mask covering the nose and mouth and should be kept away from patient waiting rooms.
    • Room the patient immediately in a negative pressure room, if available, and close the door. If a negative pressure room is not available, room the patient in a private room.
    • Only staff with documented immunity to measles should be allowed to enter the patient’s room.
    • After the patient is discharged, do not use the room for 2 hours.
  • Isolate and immediately report suspected cases of measles to Public Health at (206) 296-4774; Suspected measles case-patients should be discussed with Public Health prior to discharging or transferring these individuals.
  • Collect specimens on patients with suspected measles:
    • Nasopharyngeal swab (preferred respiratory specimen) for PCR and virus isolation
    • Urine (at least 50 ml) for PCR and virus isolation
    • Serum (at least 1 cc) for measles IgM

  • Route laboratory specimens through Public Health at (206) 296-4774 to expedite testing, do not use a commercial laboratory.

  • Continue to recommend MMR vaccine for those who are not up to date or have no evidence of immunity

  • Acceptable presumptive evidence of immunity against measles includes at least one of the following:
    • Written documentation of adequate vaccination:
      • One or more doses of a measles-containing vaccine administered on or after the first birthday for preschool-age children and adults not at high risk
      • Two doses of measles-containing vaccine for school-age children and adults at high risk, including college students, healthcare personnel, and international travelers
    • Laboratory evidence of immunity (equivocal tests are considered negative)
    • Laboratory confirmation of measles
    • Birth before 1957

Background

As of Dec 12, 2022, Columbus Public Health is reporting 73 measles cases within the central Ohio area. All 73 cases are in people under 18 years of age, of which 70% of cases are under 6 years of age. Twenty-six have been hospitalized with no deaths reported. Sixty-seven of the cases are among unvaccinated individuals with four cases partially vaccinated (1 dose of MMR vaccine).

Measles outbreaks continue to occur in many areas of the world. Additional cases of measles can occur in any community when travelers who get measles abroad bring it back to the United States. When further spread in U.S. communities occur, it is primarily in clusters of unvaccinated persons.

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