Hundreds might have been exposed to measles

By Warren King
Seattle Times medical reporter

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Seven children from King and Snohomish counties have confirmed or probable cases of red measles and may have exposed hundreds of people in 21 public places in King and Snohomish counties.

All of the children were recently adopted from China and came to the United States with their new families on March 26.

Health officials are urging people who have been in any of the locations at certain times and have not been immunized, or are unsure of their immunization status, to contact their doctors.

Possible measles exposure Children with confirmed or probable cases of measles may have exposed others at a number of locations in King and Snohomish counties. Health officials said no danger of infection remains at the locations. Here are the dates and times of possible exposures. March 27, 2-6 p.m.: Illusionz in Issaquah March 27, 5-6:30 p.m.: Target, Westwood Village, West Seattle March 28, unknown time: Church of Christ, Shoreline March 29, 9-9:30 a.m.: Thriftway, West Seattle March 29, 5:25 p.m.: Meridian 16 movie theater, Seattle (Movie: "Scooby Doo II") March 29, 10-10:30 a.m.: Toys R Us, Lynnwood March 29, time uncertain : Gallery Frames, Second Avenue, Seattle March 29, .: U Frame It, West Seattle March 31, 7-8 p.m.: Zoopa restaurant, Northgate March 31, 8:30 p.m.: Target, Northgate March 31, 1-2 p.m.: Mountlake Terrace Recreation Pavilion March 31, 3-4 p.m.: PCC, West Seattle, California Avenue March 31, 2:50 p.m.: Terrace Park Elementary School, Mountlake Terrace April 2, 3-4 p.m.: Baskin-Robbins, Sandpoint Way, Seattle April 3, 8:30-9:30 p.m.: Canlis restaurant, Seattle April 3, 8-8:30 p.m.: Bartell Drugs, University Village April 3, 2-3 p.m.: Babies R Us and Bed, Bath & Beyond, Lynnwood April 3, 3:30-4:30 p.m.: Hanna Andersson, Pottery Barn Kids, Kids Club, University Village

Measles is highly contagious but uncommon in the United States. It can have serious complications and is sometimes fatal. Children younger than 1, pregnant women and people with suppressed immune systems are especially at risk.

"I would not be at all surprised if there are more cases," said Dr. Jeff Duchin, director of communicable disease control for Public Health — Seattle & King County.

Centers for Disease Control and Prevention (CDC) officials are investigating whether two of the children exposed airline passengers on their trips. Several flights were involved, health authorities said. An infected person can be communicable five days before the appearance of the characteristic rash.

One child each from King and Snohomish counties have confirmed cases of the disease. Five others from King County have probable cases. All are recovering or are expected to recover.

The children are all younger than 2 and returned with 12 families, some from Alaska, Florida, Maryland and New York. One Maryland child also has been diagnosed with measles. None of the children was identified, for privacy reasons.

The King County cases are the first reported measles here since 2001, when there were 12 cases that started with a person who had been in Korea. Snohomish County had not had a case since 1991. An average of one to five cases a year are reported in Washington state.

Places where the children might have exposed others varied from West Seattle to Issaquah and included stores, restaurants and a movie theater. Health authorities are working to identify those who were exposed and are not vaccinated. They will be offered immunizations or treatment with antibodies, said Dr. Alonzo Plough, director of Public Health.

Measles is a potentially deadly, highly communicable viral disease, causing complications including pneumonia and brain swelling. Among vaccine-preventable diseases, it is the leading cause of death in children worldwide. About 800,000 people a year die of the disease.

Are you at risk? If you were born before 1957, you probably had measles as a child and are immune for life. If you were born later, you should have a record of at least one dose of vaccine given in 1968 or later, and given when you were at least age 1. Health officials recommend that children receive two doses of the vaccine. It is usually given in a combination shot for measles, mumps and rubella. The first dose is given at 12 to 15 months, the second at entry to school or entry to sixth grade. The shots are available at most physicians' offices or at the clinics of Public Health — Seattle & King County. If you have had contact with someone with confirmed or probable measles, discuss it with your physician. Even if you believe you have been immunized, be alert for symptoms for 21 days after the contact. Symptoms begin eight to 21 days after exposure. A cold, cough and fever typically begin two to four days before a red rash appears. The rash usually begins on the face and spreads to the rest of the body. The person is contagious through four days after the rash appears. People with symptoms should call their physician or Public Health at 206-296-4774. For more information: www.metrokc.gov/health/ prevcont/measles.htm

King County health officials said about 95 percent of area children are immunized against the disease by the time they enter school, where immunizations are required by state law. Those who are not vaccinated have medical reasons, or their parents are philosophically opposed to the vaccinations and can legally opt out.

The vast majority of adults also are immune because of vaccinations or because they had the disease before the vaccine became available.

"We are concerned there are susceptible children because a number of parents do opt out," Plough, the director of Public Health, said at a news conference yesterday.

Officials would not reveal details about the measles cases because of federal laws requiring confidentiality. But Donn Moyer, spokesman for the state Department of Health, said the first rash in the group appeared on March 22.

That case still has not been confirmed by tests as being measles; other viral illnesses can also produce a rash.

The child flew to the United States, along with the others, four days later. The disease is contagious for about four days after the rash appears. A Chinese physician there was responsible for saying the child was medically qualified to leave, Moyer said.

"Every day that passes beyond the rash, the chance of infection is less and less," said Dr. Vincent Hsu, an epidemiologist with Public Health and a preventive medicine resident with the CDC.

Most of the children being adopted stay at the same hotel in Guangzhou, Guangdong Province, where they are processed, adoption agency officials say.

Plough and Duchin said the cases show that people should not be complacent about infectious diseases that are uncommon in the U.S. Recommended childhood immunizations are very effective, they said.

"It's a small world," said Duchin.

"We have an international airport and lots of travelers. A lot of diseases can make it to Seattle in a matter of hours."

Warren King: 206-464-2247 or wking@seattletimes.com

Copyright © 2004 The Seattle Times Company