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Home My WebLink About20140418_Measles Provider Advisory (PDF)JEFFERSON COUNTY PUBLIC HEALTH 615 Sheridan Street  Port Townsend  Washington  98368 www.jeffersoncountypublichealth.org _____________________________________________________________________________________________ COMMUNITY HEALTH DEVELOPMENTAL DISABILITIES MAIN: (360) 385-9400 FAX: (360) 385-9401 ENVIRONMENTAL HEALTH WATER QUALITY MAIN: (360) 385-9444 FAX: (360) 379-4487 385 - - - 447 379 - - 940 385 - 9401 385 - - - April 18, 2014 To: Jefferson County Health Care Providers From: Thomas Locke, MD, MPH, Jefferson County Health Officer Re: Measles in Washington State – Provider Alert #2 Situation Update: There are currently 13 diagnosed cases of measles in Washington State – 6 in San Juan County, 6 in Whatcom County, and 1 in Kitsap County. The San Juan outbreak was triggered by a young, unvaccinated male returning from Asia. The Whatcom County cases are linked to a large outbreak (>375 cases) occurring in Southern British Columbia. The newly diagnosed Kitsap County case was exposed while in San Juan County and travelled on the Washington State ferry during his contagious period. Whatcom County cases have visited several public venues in the Seattle area. Secondary cases linked to these exposures would be expected to start becoming symptomatic in the next two weeks. A current list of measles exposure sites is attached. The following guidelines are provided to summarize the evaluation of measles exposed individuals, determine measles immunity, and outline infection control practices (including isolation and quarantine) of measles cases or exposed contacts. Consider measles in patients who may have been exposed and with compatible symptoms, including:  Prodrome of fever, cough, coryza and conjunctivitis for 2-4 days.  Generalized maculopapular rash that usually begins on the face.  Koplik spots may appear on buccal mucosa 1-2 days prior to rash (for a picture of Koplik spots see: http://phil.cdc.gov/phil/details.asp?pid=6111 ) .  The time from exposure to onset of fever ranges from 7–18 days (average 10 days), with the rash onset usually occurring within 2–4 days after the first symptoms appear and up to 21 days after the exposure. Report suspected cases of measles to Jefferson County Public Health, 360-385-9400, upon suspicion and before discharging or transferring patient. After hours page the Regional Duty Officer at 360-415-2005. 3. Collect ALL specimens on ALL patients with suspected measles and notify Jefferson County Public Health to expedite testing.  Serum: Collect at least 1 cc of serum (red serum separator tube), AND  Nasopharyngeal swab: Swab the posterior nasal passage with a Dacron™ or rayon swab and place the swab in 2–3 ml of viral transport medium, AND  Urine: Collect at least 50 ml of clean voided urine in a sterile container. 4. Instruct reception staff to promptly identify patients who present with symptoms of possible measles.  Such patients should wear a mask covering the nose and mouth and should be kept away from patient waiting rooms.  Room the patient immediately and close the door.  Only staff with documented immunity to measles should be allowed to enter patient’s room. This is a good time to review the immunization status of your staff and yourself.  After patient is discharged, do not use room for 2 hours. COMMUNITY HEALTH DEVELOPMENTAL DISABILITIES MAIN: (360) 385-9400 FAX: (360) 385-9401 ENVIRONMENTAL HEALTH WATER QUALITY MAIN: (360) 385-9444 FAX: (360) 379-4487 385 - - - 447 379 - - 940 385 - 9401 385 - - 385 - - - 447 379 - - 940 385 - 9401 385 - - MAIN: (360) 385-9400 E FAX: (360) 385-9401 - ENVIRONMENTAL HEALTH WATER QUALITY MAIN: (360) 385-9444 FAX: (360) 379-4487 - Vaccination Recommendations:  Persons born before January 1, 1957 are considered immune to measles because of likely exposure to natural disease prior to widespread vaccination programs.  Persons older than 12 months of age AND who have not received a prior dose of MMR vaccine, should be vaccinated now.  Evaluate all healthcare workers. Healthcare workers should receive two doses of MMR vaccine without regard to date of birth (if they do not have a titer to prove immunity). Exclusions from Work/School: Persons considered exposed to measles include:  Anyone having direct contact with the measles case;  Anyone who shared indoor air space, even for a few minutes;  Anyone who entered a room within two hours after the measles case left. Persons identified as exposed above will be excluded from work or school for 21 days UNLESS they can provide evidence of immunity. Evidence of Immunity 1. Born before January 1st, 1957, OR 2. Record of a positive IgG titer indicating immunity to measles, OR 3. Provide written documentation of adequate vaccination to measles that includes the date of administration (self- reported doses or parental history of vaccination alone are not acceptable).  Preschool children: one MMR given after 12 months of age.  K–12 and adults at high risk (i.e., post-high school educational and college students, healthcare personnel, and international travelers): 2 doses of MMR, with the first dose given on or after the first birthday and with a minimum of 28 days between the first and the second dose.  All other adults born during or after 1957: history of having received at least one dose of live measles virus vaccine on or after the first birthday. NOTE: Persons who were vaccinated with an inactivated vaccine that was available from 1963-1967, and have not been re-vaccinated, may however be at risk for measles. Persons meeting any of the criteria for evidence of immunity can remain at school or work. COMMUNITY HEALTH DEVELOPMENTAL DISABILITIES MAIN: (360) 385-9400 FAX: (360) 385-9401 ENVIRONMENTAL HEALTH WATER QUALITY MAIN: (360) 385-9444 FAX: (360) 379-4487 385 - - - 447 379 - - 940 385 - 9401 385 - - 385 - - - 447 379 - - 940 385 - 9401 385 - - MAIN: (360) 385-9400 E FAX: (360) 385-9401 - ENVIRONMENTAL HEALTH WATER QUALITY MAIN: (360) 385-9444 FAX: (360) 379-4487 - Measles exposure in WA, March and April 2014: Times and locations of possible public measles exposures March 26th to the present; note, the time frames include the two hours of potential exposure after the person with measles left each location: King County: 03/28/2014: 7:15pm–10:00pm Best Western Loyal Inn, 2301 8th Avenue 8:00pm–12am Key Arena, Kings of Leon Concert 11-pm–3amWasabi Bistro, 2311 2nd Avenue 03/29/2014: 1:00am-3:00am Best Western Loyal Inn, 2301 8th Avenue 7:00am-12:00pm Best Western Loyal Inn, 2301 8th Avenue 10am–1:30pm Beth’s Café, 7311 Aurora Avenue North 9:45am–12:15pm Aurora Suzuki, 7409 Aurora Ave North, 11:15am–2pm Starbucks Coffee, 102 Pike Street 11:45am–2:45pm Pike Place Market 03/30/2014: 4:00pm-8:00pm Safeway, Seattle (9620 28th Ave SW) 4:00pm-8:00pm Marshalls, Seattle (2600 SW Barton St) Kitsap County: 04/09/2014: 10:30am-4:00pm Virginia Mason Bainbridge Island Medical Center, Bainbridge Island (380 Winslow Way E) Pierce County: 03/29/2014: 2:30pm–4:45pm Celebrity Cake Studio, 214 E. 26th Street 2:45pm–7pm LeMay Car Museum, 2702 E. D Street (closed at 5) 5:15pm–8:45pm Harmon Brewing Co. and Eatery, 1938 Pacific Ave 7pm–9:15pm Safeway, 1624 72nd Street East 7:15pm–9:30pm Kmart, 1414 72nd Street East San Juan County: 04/04/2014 8:00am-7:00pm Bakery San Juan, Friday Harbor 9:30am-3:00pm Friday Harbor Marina 11:00am-12:10am Cask and Schooner Restaurant, Friday Harbor 1:00pm-5:30pm San Juan County Department of Community Development and Planning, Friday Harbor COMMUNITY HEALTH DEVELOPMENTAL DISABILITIES MAIN: (360) 385-9400 FAX: (360) 385-9401 ENVIRONMENTAL HEALTH WATER QUALITY MAIN: (360) 385-9444 FAX: (360) 379-4487 385 - - - 447 379 - - 940 385 - 9401 385 - - 385 - - - 447 379 - - 940 385 - 9401 385 - - MAIN: (360) 385-9400 E FAX: (360) 385-9401 - ENVIRONMENTAL HEALTH WATER QUALITY MAIN: (360) 385-9444 FAX: (360) 379-4487 - San Juan County continued: 04/05/2014 10:00am-12:00pm Friday Harbor Elementary School Baseball Diamond (outdoors only) 1:00pm-3:30pm Friday Harbor Drug 12:00pm-11:30pm Cask and Schooner Restaurant, Friday Harbor 04/06/2014 9:00am-12:00pm Catholic St. Francis Church, Friday Harbor 3:00pm-5:15pm The Little Store at the Shell Gas Station, Friday Harbor 3:30pm-6:00pm Kings Market, Friday Harbor 5:45pm-9:45pm Palace Theatre, Friday Harbor 04/07/2014 8:15am-2:00pm Bakery San Juan, Friday Harbor 12:00pm-12:00am Cask and Schooner Restaurant, Friday Harbor 6:30pm-8:45pm China Pearl Restaurant, Friday Harbor 04/08/2014 8:00am-10:30am Life Care Center, Friday Harbor 8:45am-7:00pm Bakery San Juan, Friday Harbor 3:00pm-7:45pm Marketplace, Friday Harbor Whatcom County: 03/28/2014: 7am–5:00 pm: work at Lynden Dutch Bakery 4:55–6:55pm: Lynden Wine and Spirits (610 Front St, Lynden) 5:15pm–7:15pm: Shell Gas Station: 6895 Guide Meridian; corner of Pole Road Sea-Tac Airport: 03/31/2014: 4:30pm-8:30pm Sea-Tac Airport, Concourse B Washington State Ferry: 04/04/2014: 6:00am-8:20am Washington State Ferry passenger walk-on terminal, Bainbridge Island 6:20am sailing Washington State Ferry “Tacoma,” Bainbridge Island to Seattle – passenger area 6:45am-9:15am Washington State Ferry passenger terminal, Seattle 7:05am sailing Washington State Ferry “Tacoma,” Seattle to Bainbridge Island—passenger area 7:55am sailing Washington State Ferry “Tacoma,” Bainbridge Island to Seattle - passenger area 8:45am sailing Washington State Ferry “Tacoma,” Seattle to Bainbridge Island - passenger area 4/17/2014