EVERETT — A visiting California woman contagious with measles potentially exposed at least 173 people in Snohomish County to the virus over a three-day period in late December and early January, health officials say.
A look back at her case shows that Snohomish County narrowly missed a major measles outbreak.
The woman had visited Disneyland, which has become synonymous with the ongoing national measles outbreak. Nationally, 141 people in 17 states have come down with the disease, including six in Washington.
The woman, in her 20s, wasn’t vaccinated. She had no telltale rash at the time she visited Snohomish County. She exposed people to the virus for an estimated 13½ hours in Edmonds and Everett.
The virus is so contagious that people can catch measles up to two hours after an infected person has left a room.
Health officials say the California woman wasn’t diagnosed until Jan. 8, after she returned home. She was infectious beginning on Dec. 28.
The Snohomish Health District spent more than 100 hours investigating who may have been in contact with the woman. Of the 173 people who were potentially exposed, 45 were tested for immunity to the measles virus.
“We are really fortunate that no one became infected, despite the fact we had about a dozen people who were susceptible — they did not have immunity,” said Dr. Gary Goldbaum, health officer for the Snohomish Health District.
Nevertheless, 11 people were restricted from work at three Snohomish County businesses to see if they developed symptoms, most for a week. One person missed 10 days of work. Overall, precautions taken after the California woman’s visit resulted in 80 missed days of work, said Heather Thomas, a spokeswoman for the Snohomish Health District.
“That’s incredibly disruptive for both employees and the companies they work for and creates real concerns for people about the possibility of infecting families and friends,” Goldbaum said.
On Dec. 30, the measles-contagious woman went to Bethany at Pacific, a 111-bed nursing and rehabilitation center on Pacific Avenue in Everett. She potentially exposed people to the virus for six hours.
That evening, she went to Anthony’s HomePort on the Edmonds waterfront, where the window of exposure was four hours.
On New Year’s Day, she wasn’t feeling well and was examined at the emergency room of Swedish Edmonds hospital, where the potential measles exposure time hit three-and-a-half hours.
Medical staff had no reason to believe she had measles, however. And it would have been easy for her symptoms to be mistaken for those of a general winter virus. Measles symptoms can include a fever and runny nose.
“That was one of the very early cases,” said Will Shelton, director of infection control for Swedish Medical Center. “There was no rash, no spots inside the mouth.”
Nevertheless, the potential to spread the disease to others was there. People typically are contagious starting about four days before a rash starts, and they can spread the disease for four days afterward.
No one at the Edmonds hospital was sickened with measles, but one health care worker had to remain at home and get vaccinated, Shelton said.
Nine staff members at Bethany at Pacific were told to stay home for about a week each, said Debra James, the organization’s administrator. Some didn’t have vacation or sick time, so the company allowed them to borrow from time off they would accrue this year so they could get paid, she said.
Susan Elias, Bethany’s social services director, was one of those affected. She remembers getting a call from Bethany’s infection control nurse.
“You need to leave the building immediately; grab your stuff and go home,” Elias was told. She said tests showed her immunity to measles was low, even though she had been vaccinated as a child.
Elias said health district employees told her that she was not to leave the house for seven days and that she had to check in daily with them.
“It was the weirdest feeling to know I was healthy, but to know you can’t leave the house,” Elias said. “I felt kind of cooped up in the house, going stir crazy.”
Swedish Edmonds checked on the immunization status of all employees and contacted every patient who was in the emergency room during the time the California woman was there, or up to two hours afterward, said Shelton.
The measles-contagious California women potentially exposed diners at the Edmonds restaurant to the disease for an estimated four hours.
“Can’t you just imagine if someone had gone to dinner that night with a six-month-old who hadn’t be vaccinated and that infant had been exposed and developed measles?” Goldbaum said.
Children 4 years old and younger are particularly at risk from measles, according to the federal Centers for Disease Control and Prevention. Once infected, 28 percent of children in this age group have to be hospitalized, leaving some with health problems including pneumonia, lifelong brain damage, deafness and, in some cases, leading to death, according to a recent study.
It’s likely that more people were exposed that night at the restaurant than the 173 people the health district was able to track down. Health investigators weren’t able to identify everyone who ate there the night the California woman was there, Goldbaum said.
The measles virus is very small and travels easily through the air. Think of it like someone smoking a cigarette, Goldbaum said.
“Will you be able to smell it at the end of the room? This virus will move just as easily as smoke.”
The case of the California woman is an example of how important it is for people to help protect each other through immunizations, he said.
“Through a single individual, almost 200 people were exposed” to measles, Goldbaum said. “This could have been much worse. We dodged the bullet locally.”
“We do not have any other disease in our country that you can catch so easily from someone who isn’t even in your presence any more,” said Paul Throne, manager for health promotion and communication at the state Department of Health. “If you’ve never had measles and never had the vaccine, you have a 90 percent chance of getting measles if you’re exposed to it.”
Sharon Salyer: 425-339-3486 or firstname.lastname@example.org
Children should get two doses of the combined measles, mumps and rubella vaccine, with the first dose at age 12 through 15 months and the second dose at age 4 through 6 years.
Adults who do not have evidence of immunity against measles through a blood test should get at least one dose of the combined measles, mumps and rubella vaccine. People born before 1957 are assumed to have been exposed to measles and thus have immunity.
More information is available at www.cdc.gov/measles/vaccination.html.
Source: Centers for Disease Control and Prevention