Japan is currently experiencing a large measles outbreak and 2 U.S. states have reported confirmed cases in persons returning from Japan. The cumulative number of pediatric measles cases in Japan in 2007 is 282 to date, including cases from: Saitama (93), Tokyo (53), Chiba (26), Kanagawa (24), Osaka (14), Aichi (10) and others.  43.3% of cases were reported from the age group 0-4 years and 30.1% of cases were reported from the age group 10-14 years. The cumulative number of adult measles cases in Japan in 2007 is 102 to date; Tokyo (38), Saitama (12), Kanagawa (12), Nagano (9), Miyagi (8), Ibaraki (5) and others.

• Measles is characterized by a prodromal illness with fever, cough, coryza, and conjunctivitis followed in 2-4 days by a maculopapular rash. The red rash usually begins on the face and spreads to the rest of the body. Koplik spots, which look like grains of sand, appear on the oral and/or buccal mucosa 1-2 days prior to rash onset and last a few days. Koplik spots are pathognomonic for measles, but their absence does not rule out the diagnosis. Measles patients often feel ill enough to seek medical care before the onset of rash. Possibly exposed persons with symptoms compatible with measles should be evaluated immediately. Complications of measles can include otitis media, bronchopneumonia, laryngotracheobronchitis, diarrhea, and encephalitis.
• Measles cases are contagious from 1-2 days before onset of symptoms (typically 4 days before rash onset) through 4 days after rash onset. The incubation period is approximately 10 days (14 days to rash onset; range 7-21 days).
• Suspected measles cases should be instructed to wear a mask covering the nose and mouth, avoid public places, minimize contact with others, and stay out of patient waiting rooms. Reception staff should be instructed how to identify and isolate patients who present with these symptoms.

If you suspect measles and/or would like assistance with diagnosis, please contact Public Health promptly by calling (206) 296-4774.  We can help facilitate specimen collection and rapid testing at a Public Health laboratory.  To avoid a delay in diagnosis, report suspected cases immediately; do not send specimens to a commercial lab and do not wait for serologic confirmation.

For exposed susceptible persons: Measles vaccine can be given within 72 hours of exposure to a person with measles to prevent disease. For high risk persons (infants under 12 months, susceptible pregnant women, immune compromised) and those for whom vaccine is contraindicated, immune globulin can be given within 6 days of exposure to prevent measles.