Clinician Update: Measles case with public exposures

November 21, 2019

An unimmunized child got sick with measles while traveling outside the country and may have exposed members of the public at the following locations:

Portland International Airport

  • Thursday Nov. 14, from 10:30 a.m. to 12 p.m. 
  • Specifically Concourse E, north end of lower level including restrooms and baggage claim.    

PeaceHealth Southwest Medical Center, Vancouver

  • Thursday, Nov. 14, from 12:45 p.m. to 5:05 p.m. 

Randall Children’s Hospital

  • Saturday, Nov. 16, from 11:50 p.m. to Sunday, Nov. 17 at 4:25 a.m.
  • Legacy's thorough review of this exposure shows very low risk to the public.

If additional cases occur, the onset is expected between November 18th and December 9th, 2019. Keep measles on your differential for acute, febrile, respiratory illness with or without rash. 


The window for post-exposure prophylaxis with immunoglobulin(IG) is six days after the last exposure. The window for IG has closed for the airport and PeaceHealth exposures and remains open until the end of the day Friday Nov 22 for the Legacy exposure.

In general, immunoglobulin is prioritized for susceptible individuals at risk for severe disease including:

  • Infants under age 12 months (intramuscular IG 0.5 mL/kg, max 15 mL)

  • Pregnant women without evidence of immunity (400 mg/kg IVIG)

  • Severely immunocompromised persons regardless of vaccination history (400 mg/kg IVIG)

Measles is best prevented by 2 doses of MMR or MMRV. 

Testing for measles

Laboratory confirmation of measles is critical to track spread and prioritize prevention efforts. Traditional measles IgM has poor sensitivity until 72 or more hours after rash onset. The Oregon State Public Health Laboratory (OSPHL) offers a sensitive RT-PCR test for measles that is more reliable early in illness. This test can be requested by contacting the local health department of the patient if their evaluation shows:

  • A compatible illness; AND

  • Likely susceptibility to measles AND

  • Known or likely exposure

County Health department approval is required for this test, numbers below:

  • Multnomah County Public Health: 503-988-3406

  • Clark County Public Health: 564-397-8182 

  • Washington County Public Health: 503-846-3594

  • Clackamas County Public Health: 503-655-8411

Specimen Collection Guidance here.

About Measles 

Measles is a highly contagious, severe, febrile viral respiratory illness that is preventable by vaccination.  In addition to prominent fever, respiratory symptoms and malaise, measles is characterized by cough, conjunctivitis and an extensive rash that typically begins the 2nd to 4th day of illness. The fever tends to persist into the rash phase. Infants, susceptible pregnant women and immunocompromised hosts may be at greater risk for serious complications of measles. Measles spreads easily in healthcare settings; your diligence and awareness will help prevent additional cases.

Healthcare Infection Control

Measles primarily spreads to close and household contacts through large droplets but can also be transmitted through the airborne route. According to the CDC the virus can be transmitted through the latter route up to 2 hours after a contagious patient coughs or sneezes. Preventing healthcare exposures is critical to keep high-risk groups safe.  When possible, use phone triage and assessment to determine if patients who might have measles need to be seen in-person.

If patients or caregivers are concerned about measles, inquire whether they could have been exposed at the locations above. Up-to-date vaccination status makes measles much less likely. Please implement these interventions in your clinical settings to minimize exposure to others:

  • If a patient with possible measles arrives unexpectedly, mask the patient and room promptly.

  • Report possible measles cases immediately to the county health department.

  • If possible, schedule possible measles patients as the last patient of the day.

  • If feasible, consider patient evaluation outdoors at least 30 feet away from

  • others. Once patient is masked, escort patient into the building for rooming.

  • If possible, suspected measles patients should be escorted into the building via an entrance that allows them to access an exam room without exposing others. 

  • Minimize the number of health care workers interacting with the patient; caregivers should have documented measles immunity and wear an N-95 mask or PAPR.

  • If the patient is already in the clinic/waiting room, room them immediately 

  • Use a negative pressure room if available; regardless keep exam room door closed.

  • Perform all labs and clinical interventions in the exam room if possible.

  • The exam room should not be used for 2 hours after the patient has left.

  • Local Health Departments can facilitate testing for possible cases who have no rash or rash for less than 3 days

  • Patients who are under evaluation for measles should isolate at home until the diagnosis is clarified.