Emerging Diseases and ConditionsMeasles

Measles Diagnosis Information

By February 12, 2019 February 15th, 2019 No Comments

Most people in the United States are protected against measles through vaccination, so local measles cases are uncommon. However, every year measles is brought into the United States by unvaccinated travelers (Americans or foreign visitors) who get measles while they are in other countries. They can spread measles to other people who are not protected against measles, which sometimes leads to outbreaks. It is important for healthcare clinics to ask patients about recent travel history.

2019 Measles Outbreak Information

As Clark County’s Measles Outbreak grows, more and more local providers are mindful that measles is in our state.  With each new patient suspected of having measles, please check this page for updates on clinical guidance.

Provider Communications for Region 4 (Cowlitz, Clark, Skamania and Wahkiakum Counties) can be found here.

Clark County Measles Investigation information (including the most up-to-date list of exposure sites) can be found here.

The clinical presentation of measles is usually predictable

  • Two to four day prodrome of fever (usually 101° or higher) plus cough, coryza and conjunctivitis (the “three Cs”).
  • After two to four days of fever and the 3Cs, eruption of a red, maculo-papular rash that may become confluent, typically starting at the hairline, then face, then rapidly spreading downward.

The following tool may help you evaluate rash illness for measles (click image to open PDF)

If you suspect measles, immediately

  1. Mask and isolate the patient (in negative air pressure room when possible).
  2. Collect ALL of the following specimens (see below for more detailed information):
    • Nasopharyngeal (NP) Swab
    • Urine
    • Serum
  3. After steps 1 and 2 are completed, call Cowlitz County Health Department (CCHD) to report the suspected measles case
    • M-F, 8:30am-4:30pm (closed 12p-1p for lunch): (360) 414-5599.1.6431
    • After-hours answering service: (360) 636-9595

Specimen collection & submission instructions

Specimens can be collected while the patient is in clinic, then patient may return home while provider seeks verbal authorization from Cowlitz County Health Department to have NP swab and urine specimen’s shipped to PHL for testing.  At this time, serum specimens are to be tested by facility’s regular lab mechanism.

NOTE: NP Swab and Urine specimens being sent to Washington State Public Health Lab (PHL) must ARRIVE at PHL within 72hrs of collection if shipped cold on ice packs, OR be frozen as outlined below (≤ -70°C) and shipped on dry ice.  Failure to follow this requirement will result in rejection to test specimen(s).

  • Nasopharyngeal (NP) swab (preferred respiratory specimen) for measles PCR:
    • Collection Time:
      • At illness. For optimal isolation, collect within 72 hours of symptom onset.
    • Collection Procedures: 
      • Swab the posterior nasal passage only using synthetic tip swabs (ex. Dacron™, Nylon, Polyester) with non-wooden shaft
      • Immediately after collection, place swab directly in 2-3ml of Viral Transport Media (VTM).
      • Minimum volume: 2ml of VTM
      • Storage: Refrigerate.  If arriving at WAPHL after 72hrs of collection, or if testing will not be completed within 72hrs of collection, freeze at ≤ -70°C.
    • Transport Media:
      • Viral Transport Media (VTM)
    • Shipping & Handling (all specimens must be shipped meeting IATA, OSHA, and USPS requirements):
      • Storage: Refrigerate.  If arriving at WAPHL after 72hrs of collection, or if testing will not be completed within 72hrs of collection, freeze at ≤ -70°C.
      • Transport device: Sterile leak-proof container
      • Rejection criteria: Not transported in VTM.  Swab on wooden shaft. Not refrigerated or frozen properly. Did not obtain CCHD approval. Failure to follow specific S&H requirements.
      • Transport: Ship as Category B, cold (2-8°C) on ice packs to arrive at WAPHL during business hours within 72hrs of collection. Otherwise or if previously frozen, ship on dry ice.
      • EACH specimen being sent to PHL must have it’s own WA DOH PHL Requisition Form – Serology/Virology/HIV (PDF)
      • For additional information, please refer to WA DOH Specimen Collection & Submission Instructions for Measles PCR (PDF)
    • REQUIRED: After specimen(s) have been collected, call CCHD for verbal authorization to ship specimen(s) to Washington State Public Health Lab (PHL) for testing.
      • M-F, 8:30am-4:30pm (closed 12p-1p for lunch): (360) 414-5599.1.6431
      • After-hours answering service: (360) 636-9595
  • Urine for measles PCR:
    •  Collection Time:
      • Collect ≤ 10 days post symptom onset.
    • Collection Procedures: 
      • Collect clean voided urine in sterile screw capped specimen container.
      • Minimum volume: 10mL of urine (50mL preferred).
    • Shipping & Handling (all specimens must be shipped meeting IATA, OSHA, and USPS requirements):
      • Storage: Refrigerate.  If arriving at WAPHL after 72hrs of collection, or if testing will not be completed within 72hrs of collection, freeze at ≤ -70°C.
      • Transport device: Sterile leak-proof container
      • Rejection criteria: Insufficient specimen volume. Leaky specimen. Not refrigerated or frozen properly. Did not obtain CCHD approval. Failure to follow specific S&H requirements. Make sure the urine container is leak-proof and in a separate bag from the NP swab. If urine leaks on the respiratory specimens, they will not be tested.
      • Transport: Ship as Category B, cold (2-8°C) on ice packs to arrive at WAPHL during business hours within 72hrs of collection. Otherwise or if previously frozen, ship on dry ice.
      • EACH specimen being sent to PHL must have it’s own WA DOH PHL Requisition Form – Serology/Virology/HIV (PDF)
      • For additional information, please refer to WA DOH Specimen Collection & Submission Instructions for Measles PCR (PDF)
    • REQUIRED: After specimen(s) have been collected, call CCHD for verbal authorization to ship specimen(s) to Washington State Public Health Lab (PHL) for testing.
      • M-F, 8:30am-4:30pm (closed 12p-1p for lunch): (360) 414-5599.1.6431
      • After-hours answering service: (360) 636-9595
  • Serum for anti-measles IgM and IgG testing
    • Rubeola IgM and IgG should be collected at the discretion of the healthcare provider, and tested by the facility’s regular lab mechanism.

Frequently Asked Questions

What guidance should we tell a patient (or parent/guardian) who is being tested for measles?

Anyone being tested for measles should be advised to stay home until the results of the test(s) are back, and to not have any visitors (especially visitors who are unimmunized or immunization status is unknown).  This means the patient should not go to work, school, daycare, or any other public place until measles has been ruled out.

What is the turn-around time for measles specimens sent to Washington State Public Health Lab (PHL)?

The current turn-around time is about 24 hours after PHL receives the specimens. When PHL receives the specimens depends on when specimens were collected and shipping speed, but typically results are available 3-4 days after specimens are collected.  Note: specimens being sent to PHL must arrive within 72hrs of collection.

If we know what the process is for measles specimen collection and shipping, do we still have to call our Local Health Jurisdiction (LHJ)?

YES! For any specimen(s) being sent to Washington State Public Health Lab (PHL), the LHJ MUST verbally approve the specimens before PHL will accept and test the specimen(s).  Once specimen(s) have been verbally approved by the LHJ, the facility collecting the specimens must inform the LHJ of shipping information (what specimen(s) were collected, what shipping carrier is being used, what the tracking number is, and estimated date of arrival), then the LHJ will inform DOH of when to expect the specimen(s).

If the patient doesn’t have a rash, but has all other symptoms of measles, can they still be tested?

If the patient does not have a rash, but the provider strongly suspects measles, testing can still be performed by the usual means of testing at the commercial lab the facility normally uses.

 

Questions? Contact Cowlitz County Health & Human Services at (360) 414-5599.