Measles investigation

Current investigation - updated 4/29/2019

Clark County Public Health has declared the local measles outbreak over, after six weeks with no new cases.

Public Health confirmed 71 cases of measles during the months-long outbreak. Two confirmed cases previously included in the Clark County totals have been removed. Those two individuals moved to Georgia during the outbreak and are being counted in that state’s measles case numbers. The Clark County total does not include King County and Oregon cases that have been linked to the local outbreak.

The outbreak began Jan. 3, when laboratory testing confirmed measles in a child who traveled to Clark County from Ukraine. Based on the information gathered during the investigation, Public Health could not determine whether this case was the source of the outbreak.

The local outbreak predominantly affected children – 93 percent of cases were 1 to 18 years old – and people who were not immunized. One person was hospitalized.

Here are the details of the 71 confirmed cases:

Age
- 1 to 10 years: 52 cases
- 11 to 18 years: 14 cases
- 19 to 29 years: one case
- 30 to 39 years: four cases
Immunization status
- Unimmunized: 61 cases
- Unverified: seven cases
- 1 MMR vaccine: three cases

“We’re grateful to see this outbreak come to an end without any deaths or serious complications,” said Dr. Alan Melnick, Clark County health officer and Public Health director. “But as long as measles exists elsewhere in the world and people continue travel, we’re at risk of seeing another outbreak. We must improve our immunization rates to prevent future outbreaks and keep our children and other vulnerable people safe.”

Public Health identified 53 public sites where confirmed cases may have exposed others to the measles virus. Exposure sites included 13 health care facilities, 15 schools and child care centers, one workplace and 24 other public places, such as grocery stores, retail establishments and churches.

Based on Public Health’s investigation, the 71 confirmed cases most likely contracted measles within the household (51 percent); at a general public location, such as a grocery store, retail establishment or church (25 percent); or at a school or child care center (16 percent). One case (1 percent) was most likely exposed during international travel. Public Health could not determine the likely site of exposure for the remaining 7 percent of cases.

During the outbreak investigation, Public Health identified and contacted more than 4,100 people who were exposed to measles and made daily monitoring phone calls to more than 800 people considered susceptible to contracting measles. Local schools identified and excluded 849 susceptible students who were exposed to measles.

Immunoglobulin – antibodies that can help prevent measles infection – was administered to 44 infants, pregnant women and other children younger than 5 years old who were exposed to measles. Immunoglobulin must be administered within six days of exposure.

Public Health activated its incident management teams to respond to the measles outbreak on Jan. 15 and spent 63 days in incident response. More than 230 people worked on the incident, including 89 Public Health staff, 57 Washington Department of Health staff, 50 Medical Reserve Corps volunteers and three Centers for Disease Control and Prevention staff, as well as partners from other health departments and local volunteers.

Responders worked more than 19,000 hours on the measles outbreak, with Public Health staff clocking 12,684 hours on the outbreak. Public Health’s total cost for the outbreak is $864,679, with staffing costs accounting for the largest share ($616,265 for Public Health staff).

Investigation notes

During the outbreak, Public Health identified suspect cases who were unimmunized when exposed to measles and received the measles-mumps-rubella (MMR) vaccine more than 72 hours after exposure. To prevent illness, one dose of MMR vaccine must be given to unimmunized people within 72 hours of exposure.

About 5 percent of previously unvaccinated people will develop a rash after being immunized. When administered after 72 hours, the vaccine is less likely to prevent illness, and if the person develops a rash, there is a small chance that the rash is due to the vaccine. People who experience these mild vaccine-associated rashes cannot transmit the virus to other people.

However, in these situations, it is difficult to determine whether the rash is a benign vaccine reaction or measles illness. Specimens for these suspect cases were sent to a specialized laboratory out of state to confirm measles, but results can take more than a week. In those cases, pending lab results, Public Health treated the suspect cases as it would treat confirmed cases and released information about public locations the cases visited while potentially contagious with measles. Public Health removed those locations if the cases are ruled out.

On Feb. 12, Public Health removed one previously confirmed case after additional testing revealed the case was actually experiencing benign vaccine rash. That case – an unimmunized child 1 to 10 years old – received one dose of measles-mumps-rubella, or MMR. Public Health also removed the exposure locations associated with this case since the vaccine virus cannot be transmitted to others.

Clark County Council Chair Eileen Quiring declared on Friday, Jan. 18 a public health emergency in response to the measles outbreak. On Friday, Jan. 25, Gov. Jay Inslee declared a state of emergency in response to the measles outbreak in Washington.

Additional information

For information about measles cases in Oregon, visit the Oregon Health Authority measles webpage. For information about other measles cases in Washington, visit the Washington State Department of Health measles webpage.

For information about measles cases and outbreaks in the U.S., visit the Centers for Disease Control and Prevention website.

If you're unsure of your family's immunization status, you can view, download and print your family's immunization information online at MyIR or request a copy of your immunization record from the Washington State Department of Health.

Anyone with questions about measles immunity or the measles vaccine should contact their primary care provider. Clark County Public Health does not provide immunizations or testing for immunity.

Anyone with questions about measles infection or the measles vaccine should call their primary care provider or their local county health department:

Clark County Public Health, 564.397.8182
Multnomah County Public Health, 503.988.3406
Washington County Public Health, 503.846.3594
Clackamas County Public Health, 503.655.8411

Additional resources

Measles fact sheet - English
Measles fact sheet - Spanish
Measles fact sheet - Ukraine
Measles fact sheet - Russian

Provider advisories

Frequently Asked Questions

What places have been identified as exposure sites?

The following is a list of exposure sites identified during the measles outbreak. These are places that confirmed measles cases visited while contagious with measles.

Health care facilities:

PeaceHealth Urgent Care – Memorial, 3400 Main St.
- Noon to 5:30 pm Monday, Dec. 31.
- 4:30 to 7:50 pm Saturday, Jan. 19.
Magnolia Family Clinic, 2207 NE Broadway, Suite 200, Portland from 11:30 am to 3 pm Tuesday, Jan. 8.
The Vancouver Clinic, 700 NE 87th Ave., Vancouver
- 3:30 to 7 pm Friday, Jan. 11.
- 10:45 am to 1:30 pm Saturday Jan. 12.
- 4:30 to 7:30 pm Sunday, Jan. 13.
- 9:30 am to 1 pm Monday, Jan. 14.
- 1:50 to 6 pm Monday, Feb. 18.
- 3:30 to 9:30 pm Friday, March 1.
- 9:50 am to 1:10 pm Saturday, March 2 (timeframe for this exposure was changed 03/04/19).
Kaiser Cascade Park Medical Office, 12607 SE Mill Plain Blvd., Vancouver
- 1 to 8:30 pm Saturday, Jan. 12.
- 7 pm Tuesday, Jan. 15 to 2 am Wednesday, Jan. 16.
- 12:30 to 7:30 pm Saturday, Jan. 19.
PeaceHealth Southwest Medical Center Emergency Department, 400 NE Mother Joseph Place, Vancouver
- 10 pm Saturday, Jan. 12 to 4 am Sunday, Jan. 13.
- 12:30 to 8:30 pm Sunday, Jan. 13.
- 7:45 to 11:05 pm Saturday, Feb. 16.
- 8:45 pm Sunday, March 3 to 1:45 am Monday, March 4.
Legacy Salmon Creek Medical Center Emergency Department, 2211 NE 139th St., Vancouver
- 8:30 pm Saturday, Jan. 12 to 1 am Sunday, Jan. 13.
- 5:45 pm Sunday, Jan. 13 and 12:30 am Monday, Jan. 14.
- 11:40 pm Monday, Jan. 14 to 5:10 am Tuesday, Jan. 15.
Rose Urgent Care and Family Practice, 18 NW 20th Ave., Battle Ground from 3:45 to 8 pm Monday, Jan. 14.
Kaiser Orchards Medical Office, 7101 NE 137th Ave., Vancouver
- 1:55 to 6:10 pm Monday, Jan. 14.
- 1:50 to 7:30 pm Thursday, Jan. 24.
The Vancouver Clinic Salmon Creek, 2525 NE 139th St., Vancouver
- 8:15 am to noon Friday, Jan. 18.
- 7 to 10 pm Thursday, Feb. 14.
- 10:30 am to 3:45 pm Friday, Feb. 15.
Legacy GoHealth Urgent Care Cascade Park, 305 SE Chkalov Drive, Vancouver from 6:25 to 10:15 pm Tuesday, Jan. 22.
Sea Mar Medical Clinic East Vancouver, 19005 SE 34th St., Vancouver from 1:50 to 5:50 pm Tuesday, Feb. 5.
The Vancouver Clinic Washougal, 291 C St., Washougal from 7:10 to 10:35 am Thursday, Feb. 14.

The Jan. 12 exposure at Randall Children’s Hospital at Legacy Emanuel in Portland has been removed from the list of potential exposure sites. Public Health learned Randall Children’s Hospital was notified in advance of the potential measles patient and was able to take prevention measures to ensure others were not exposed to the patient.

The Feb. 4 exposure at The Vancouver Clinic Salmon Creek has been removed from the list of potential exposure sites. Public Health learned the clinic was notified in advance of the potential measles patient and was able to take prevention measures to ensure others were not exposed to the patient.

Schools and child care centers:

Cornerstone Christian Academy, 10818 NE 117th Ave., Vancouver on Friday, Jan. 4.
Vancouver Home Connection, 301 S. Lieser Road, Vancouver on Monday, Jan. 7; Wednesday, Jan. 9; and Friday, Jan. 11.
Hearthwood Elementary School, 801 NE Hearthwood Blvd., Vancouver on Monday, Jan. 7; Tuesday, Jan. 8; and Wednesday, Jan. 9.
Slavic Christian Academy, 7300 MacArthur Blvd., Vancouver on Monday, Jan. 7.
Image Elementary School, 4400 NE 122nd Ave., Vancouver on Tuesday, Jan. 8 and Wednesday, Jan. 9.
Eisenhower Elementary School, 9201 NW Ninth Ave., Vancouver on Tuesday, Jan. 8 and Wednesday, Jan. 9.
Tukes Valley Primary School, 20601 NE 167th Ave., Battle Ground on Tuesday, Jan. 8.
Tukes Valley Middle School, 20601 NE 167th Ave., Battle Ground on Tuesday, Jan. 8
Maple Grove School, 601B SW Eaton Blvd., Battle Ground on Tuesday, Jan. 8 and Wednesday, Jan. 9.
River HomeLink, 601 SW Eaton Blvd., Battle Ground on Tuesday, Jan. 8 and Wednesday, Jan. 9.
Evergreen High School, 14300 NE 18th St., Vancouver on Wednesday, Jan. 9.
Orchards Elementary School, 11405 NE 69th St., Vancouver on Monday, Jan. 14.
Minnehaha Elementary School, 2800 NE 54th St., Vancouver from 3:45 to 7:45 pm Thursday, Jan. 17. (Given the concern of overlap between the exposure period and the end of the regular school day, Public Health is requiring exclusion of students and staff without documented immunity to measles who were at the school anytime on Jan. 17.)
Yelena’s Daycare, 17007 NE 23rd St., Vancouver Tuesday, Jan. 22.; Wednesday, Jan. 23.
Image Elementary School, 4400 NE 122nd Ave., Vancouver on Monday, Feb. 11; Tuesday, Feb. 12; Wednesday, Feb. 13; Thursday, Feb. 14 and Friday, Feb. 15.
Pacific Middle School, 2017 NE 172nd Ave., Vancouver on Monday, Feb. 11; Tuesday, Feb. 12; and Wednesday, Feb. 13. On Tuesday, Feb. 12 the exposure period is all day until 4:30 pm, including after-school activities.
Burton Elementary School, 14015 NE 28th St., Vancouver on Monday, Feb. 11; Tuesday, Feb. 12; Wednesday, Feb. 13.

Public Health required exclusion of students and staff without documented immunity to measles from only those schools identified as possible exposure sites. Students and staff excluded from those identified schools were also excluded from other schools, child care and other congregate settings. Students and staff at schools where measles exposure did not occur were not impacted by exclusions.

Other locations:

Church of Christ Our Savior, 3612 F St., Vancouver
- 9:30 am to noon Sunday, Jan. 6.
- 6 to 11:30 pm Sunday, Jan. 6.
- 9:10 am to 3 pm Sunday, Jan. 13.
Church of Truth, 7250 NE 41st St., Vancouver from 11 am to 4:30 pm Sunday, Jan. 6.
Portland International Airport, 7000 NE Airport Way, Portland
- 10:45 am to 3:45 pm on Monday, Jan. 7. More specifically, anyone who spent time in Concourse D and the Delta Sky Lounge during that time period.
- 7:30 to 11 pm Tuesday, Jan.15. More specifically, baggage claim and south end of the ticket counter (near Alaska Airlines and Starbucks).
GracePoint Christian Church, 7300 MacArthur Blvd., Vancouver from 6:30 am to 5:30 pm Monday, Jan. 7.
Costco, 4849 NE 138th Ave., Portland
- 1 to 5:30 pm Tuesday, Jan. 8.
- 5:30 to 8:40 pm Wednesday, Jan. 16.
A Children's Dentist, 101 NW 12th Ave., Battle Ground from 1:30 to 6 pm Tuesday, Jan. 8.
Fisher Investments, 5525 NW Fisher Creek Drive, Camas
- 6:20 am to 7 pm Thursday, Jan. 10.
- 6:20 am to 7 pm Friday, Jan. 11.
- 6:20 am to 7 pm Monday, Jan. 14.
- 6:20 am to 7 pm Tuesday, Jan. 15.
Amazon Lockers, 1131 SW Jefferson St., Portland from 3:30 pm to 7 pm Thursday, Jan. 10.
Rejuvenation, 1100 SE Grand Ave. Portland from 3:30 to 7:30 pm Thursday, Jan. 10.
Pho Green Papaya, 13215 SE Mill Plain Blvd., Vancouver from 7:30 to 10:30 pm Thursday, Jan. 10.
Chuck's Produce, 13215 SE Mill Plain Blvd., Vancouver from 8 to 11:45 pm Thursday, Jan. 10 and 2:30 to 5:30 pm Friday, Jan. 11.
Moda Center (Trail Blazers game), 1 N Center Court St., Portland from 5:30 to 11:30 pm Friday, Jan. 11.
Ikea, 10280 NE Cascades Parkway, Portland from 4:30 to 8:30 pm Friday, Jan. 11.
Verizon Wireless at Cascade Station, 10103 NE Cascades Parkway, Portland from 5 to 11 pm Monday, Jan. 14.
Dollar Tree, 7809-B Vancouver Plaza Drive, Vancouver from 6:30 to 9:10 pm Tuesday, Jan. 15.
Dollar Tree, 11501 NE 76th St., Vancouver from 8:10 to 10:50 pm Tuesday, Jan. 15.
God Will Provide Church, 7321 NE 110th St., Vancouver from 7 to 11 pm Friday, Jan. 18.
Mountain Air Trampoline Park, 20495 Murray Road, Bend, Ore., 9:30 am to 2:30 pm Saturday, Jan. 19.
Oregon Museum of Science and Industry (OMSI), 1945 SE Water Ave., Portland from 2:30 to 7 pm Saturday, Jan. 19.
New Life Missionary Church, 3300 NE 172nd Place, Portland from 9:30 am to 2 pm Sunday, Jan. 20.
Juniper Swim and Fitness, 800 NE Sixth St., Bend, Ore., 9:30 am to 4 pm Sunday, Jan. 20.
Word of Grace Bible Church, 1317 NW 12th Ave., Battle Ground from 9:30 am to 2 pm, Jan. 20.
Trader Joe's, 305 SE Chkalov Drive, Vancouver from 12:30 to 3:40 pm Monday, Jan. 21.
Dollar Tree, 305 SE Chkalov Drive, Vancouver from 1:10 to 4 pm Monday, Jan. 21.
Walmart Supercenter, 14505 NE Fourth Plain Blvd., Vancouver 1:30 to 5 pm Monday, Jan. 21.
Fred Meyer, 401 NW 12th Ave., Battle Ground from 3:30 to 10 pm Wednesday, Feb. 13.

Public Health removed public exposure locations associated with cases determined to be experiencing benign measles vaccine rash since the vaccine virus cannot be transmitted to others. The removed exposure locations are: Sea Mar Medical Clinic Salmon Creek (Feb. 1 and Feb. 4), The Vancouver Clinic Salmon Creek (Jan. 23 and Jan. 30), Legacy Salmon Creek Medical Center Emergency Department (Feb. 2), St. Paul Christian Daycare Jan. 16, Jan. 17, Jan. 18 and Jan. 23), Golden Corral (Jan. 19), Vancouver Division of Children, Youth and Families (Jan. 18), Vancouver Women, Infant and Children (WIC) office (Jan. 23), Tower Mall public areas (Jan. 23).

What is measles?

Measles is a highly contagious and potentially serious illness caused by a virus. Measles is spread through the air after a person with measles coughs or sneezes. The virus can linger in the air for up to two hours after someone who is infectious has left.

What are the symptoms of measles?

Measles symptoms begin with a high fever, cough, runny nose and red eyes, followed by a rash that usually begins at the head and spreads to the rest of the body. A person can spread the virus before they show symptoms. People are contagious with measles for up to four days before and up to four days after the rash appears.

After someone is exposed to measles, illness develops in about one to three weeks.

How contagious is measles?

Measles is extremely contagious. The virus travels through the air and can stay up to two hours in the air of a room where a person with measles has been. If other people breathe the contaminated air or touch a contaminated surface, then touch their eyes, noses or mouths, they can become infected. Measles is so contagious that if one person has it, 90 percent of the people close to that person who are not immune will also become infected.

What should I do if I think I have the measles?

Anyone who has been exposed and believes they have symptoms of measles should call their health care provider before visiting the medical office. This will enable the clinic to develop a plan for providing care without exposing others at the clinic.

How serious is measles?

Measles can be serious in all age groups. However, children younger than 5 years and adults older than 20 years are more likely to suffer from measles complications. Common complications of measles include ear infection, pneumonia and diarrhea. As many as one out of every 20 children with measles gets pneumonia, the most common cause of death from measles in young children. About one child out of every 1,000 who get measles will develop encephalitis (swelling of the brain) that can lead to convulsions and can leave the child deaf or with intellectual disability. Measles may cause pregnant women to give birth prematurely or to have a low-birth-weight baby.

In 2017, there were 110,000 measles deaths worldwide, mostly among children younger than 5, according to the World Health Organization.

How is measles treated?

There is no specific treatment for measles.

How can I prevent measles?

Immunization is the best prevention for measles. The measles vaccine is very effective. One dose of the measles vaccine is about 93 percent effective at preventing measles. Two doses are about 97 percent effective, according to the Centers for Disease Control and Prevention.

How many doses of the measles vaccine do I need?

Children should receive two doses of the MMR (measles-mumps-rubella) vaccine, with the first dose given at age 12 to 15 months and a second dose at age 4 to 6 years.

Adults born after 1956 should get at least one dose of MMR vaccine, unless they have other evidence of immunity (see below). Health care personnel, college students and international travelers without other evidence of immunity should receive two appropriately spaced doses of MMR vaccine.

Immunization doses may be different for international travelers. Talk to your health care provider for immunization recommendations.

Persons are considered immune (not susceptible) to measles if any of the following apply:

They were born before 1957.
They are certain they have had measles.
They are up to date on measles vaccines (one dose for children 12 months through 3 years old, two doses for anyone 4 years and older).

How common is measles?

While measles is rare in the United States, it is still commonly transmitted elsewhere in the world. In 2018, there were 349 confirmed cases of measles in people from 26 states and the District of Columbia, according to the Centers for Disease Control and Prevention (CDC). Measles immunization resulted in an 80 percent decrease in measles deaths worldwide between 2000 and 2017 (from 545,000 deaths in 2000 to 110,000 deaths in 2017), according to the World Health Organization (WHO). During that timeframe, measles immunization prevented an estimated 21.1 million deaths, according to WHO.

Before the measles vaccination program began in the U.S. in 1963, about 3 to 4 million people in the U.S. got measles every year. Of those, 400 to 500 people died and 48,000 were hospitalized, according to the CDC.

What are the immunization rates for children in Clark County?

As of Dec. 31, 2018, 78 percent of Clark County 6- to 18-year-olds have received two doses of MMR (measles-mumps-rubella) vaccine, which is the age-appropriate number of doses. As of Dec. 31, 2018, 81 percent of 1- to 5-year-olds have received one dose of MMR, which is the age-appropriate number of doses.

Source: Washington State Immunization Information System

Where does Public Health get its immunization data?

There are two sources of immunization data typically used in Washington: the Washington Immunization Information System (WAIIS) and the Washington Department of Health School Immunization Reports.

During the measles outbreak, Public Health relied on the WAIIS data to determine immunization rates among Clark County youth. Public Health and the state Department of Health consider WAIIS data to be the best source to calculate childhood immunization rates.

The WAIIS is the state immunization registry. All children are entered into the registry at the time of birth. The data are entered by providers and pharmacists at the time they administer vaccines, so the dataset is continuously updated.

The numbers and percentages in the WAIIS dataset have been confirmed during our outbreak investigation. When we responded to affected schools, the documentation that parents were able (or not able) to produce confirmed that the WAIIS data were accurate.

The School Immunization Reports data is not as accurate as the WAIIS data. The school reports only include preschool and school-aged children. Data for the reports are collected annually in the fall and are based on parent reports to schools that may not be verified by health care providers.

According to both data sources – the WAIIS and the School Immunization Reports – Clark County immunization rates are consistently lower than statewide rates.

What does "unimmunized" and "unverified" immunization status mean?

Unimmunized means the person has not received any doses of the MMR (measles-mumps-rubella) vaccine. Unverified means Public Health was unable to obtain documentation of immunization.

Where can I learn more about measles?

Centers for Disease Control and Prevention

Washington State Department of Health