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LAC DPH Health Alert
First LA County Measles Case
February 1, 2024
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This message is intended for all healthcare providers.
Please distribute as appropriate.
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Key Messages
- Since January 31st, the Los Angeles County Department of Public Health has been investigating a confirmed measles case in a resident with multiple potential sites of exposure to others. This is the first case in LA County since 2020.
- LA County healthcare providers should be on alert for additional measles cases.
- Healthcare providers should 1) assure that their patients are up to date on measles-containing vaccine (MMR or MMRV) or are otherwise immune, 2) immunize all international travelers aged 6 months or older for whom there is no documentation of immunity, and 3) immediately report suspect measles to Public Health.
- All healthcare personnel should have documentation of immunity to measles.
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Situation
An under-immunized LA County resident was confirmed to have measles on January 31, 2024. The individual was infected during an international trip and traveled to LA County during their infectious period. This is the first case of measles in LA County since February 2020.
Public Health is currently investigating multiple exposures related to this case. Locations where people may have been exposed include the airplane, the Tom Bradley International Terminal, and a chain restaurant in Northridge. Additional locations where possible exposures may have occurred are being investigated. See press release for more details.
Measles is a highly contagious, vaccine-preventable disease that requires high population immunity (95%) for transmission to be interrupted. Similar to this case, domestic measles cases often originate from unvaccinated or under-vaccinated U.S. residents who travel internationally and then transmit the disease to people who are not immune to measles. One person infected by measles can infect up to 90% of their close contacts who are not immune.
This measles case reflects the real threat of measles importation to LA County due to the ongoing global and domestic outbreaks. The Centers for Disease Control and Prevention (CDC) has reported a recent rise in domestic measles cases. Between December 1, 2023, and January 23, 2024, the CDC was notified of 23 confirmed U.S. cases of measles, including seven direct importations of measles by international travelers and two outbreaks with more than five cases each. See CDC clinician communication Stay Alert for Measles Cases (1-25-24).
All county residents who lack measles immunity are at elevated risk of infection, this includes adults, adolescents, and children. Among all children in LA County who entered kindergarten in the 2022-23 school year, 97% were up to date with measles vaccination. However, there was a significant proportion of schools (16%) reporting kindergarten measles vaccination coverage below 95%, creating pockets of susceptible students where measles transmission can occur. See the School Immunization Dashboard for more information about vaccine uptake in your community.
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Actions Requested of Providers
Interrupting measles transmission in LA County requires high community vaccination rates, health care provider vigilance in suspecting and diagnosing measles, and isolating cases from susceptible individuals.
- Vaccinate: Make sure that all patients and healthcare staff are either up to date with their measles vaccinations or immune to measles. All persons who do not have presumptive evidence of immunity should be vaccinated.
- All healthcare personnel should have 2 documented doses of MMR or laboratory demonstration of immunity.
- Prior to any international travel, travelers 6 months of age and older should be protected against measles, regardless of their destination.
- If you do not offer measles vaccines in your practice:
- For uninsured patients and patients whose insurance does not cover the full cost of vaccines, please reference the LA County Department of Public Health’s vaccine clinic locations website to identify nearby free and low-cost immunization clinics.
- For insured patients, please refer the patient to a provider or pharmacy who can provide MMR vaccine as these patients will be ineligible to receive vaccine at the above immunization clinics.
- Suspect: Consider measles in any patient who presents with a febrile rash and clinically compatible measles symptoms (e.g., cough, coryza, conjunctivitis), especially if they are unvaccinated or under-vaccinated or have any of the following risk factors in the past 4 weeks:
- Travel, especially international or domestic through an international airport.
- Contact with someone with a febrile rash illness.
- Exposure to a known or possible measles case.
See the DPH Information for Providers to review symptoms and typical presentations of measles.
- Isolate: Any patients with a febrile rash illness should be immediately identified and separated from other patients prior to or as soon as possible after entry into the facility.
- Display posters at facility entrances advising patients with fever, rash, or cough to immediately notify facility staff prior to entering the building.
- The patient should immediately don a well-fitting medical mask or respirator, be removed from waiting rooms and other common areas, and placed in a private room with a closed door on airborne precautions.
- Any room used to accommodate a suspect measles case should not be used for at least two hours after the patient has left.
- Do not send suspect measles cases to the Emergency Department (ED) for measles testing unless they require a higher level of care. If ED referral is necessary, be sure to notify the ED first.
- Notify: Public Health should be contacted immediately, while the patient with suspect measles is still at the facility. Public Health will guide you through collection of specimens for testing (throat swab and urine samples for PCR and blood sample for serology) and management of the patient under investigation as well as asymptomatic contacts of a suspected or confirmed case. See the LA County specimen collection instructions for more details on quantities, storage, labeling, and shipping.
- Los Angeles County Department of Public Health
- Weekdays 8:30 am–5:00 pm: call 213-351-7800.
- After-hours: call 213-974-1234 and ask for the physician on call.
- Long Beach Health and Human Services:
- Weekdays 8:00 am-5:00 pm: call 562-570-4302.
- After hours: call the duty officer at 562-500-5537.
- Pasadena Public Health Department:
- Weekdays 8:00 am-5:00 pm: call 626-744-6089.
- After hours: call 626-744-6043.
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Additional Resources
CDC
CDPH
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This communication was sent by Nava Yeganeh, MD, Medical Director, Vaccine Preventable Disease Control Program, Los Angeles County Department of Public Health.
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To view this and other communications or to sign-up to receive LAHANs, please visitph.lacounty.gov/lahan.
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