On Tuesday, Oregon’s first measles case of the year was reported in Multnomah County, joining a slew of other states who have had reported cases this year. The individual who tested positive is an adult who is believed to have acquired the disease while traveling abroad and was hospitalized in Portland. The highly contagious disease is transmitted through the air via coughs and sneezes, with symptoms including fever, cough and a rash appearing from seven to 21 days after exposure. Paul Cieslak is the medical director for communicable disease and immunizations at Oregon Health Authority. He joins us to share more.
Note: The following transcript was transcribed digitally and validated for accuracy, readability and formatting by an OPB volunteer.
Jenn Chávez: This is Think Out Loud on OPB. I’m Jenn Chávez, in today for Dave Miller. Happy Friday, y’all. On Tuesday, the Oregon Health Authority confirmed the state’s first measles case of 2025. Health officials said they’re investigating a Multnomah County case and a person who recently returned to Oregon from an international trip.
Here to give us the latest details is Dr. Paul Cieslak. He’s the medical director for communicable diseases and immunizations at OHA’s Public Health Division. Dr. Cieslak, welcome back to Think Out Loud.
Dr. Paul Cieslak: Thank you for having me.
Chávez: Yeah, absolutely, and thank you for joining us to keep everyone informed on this. So, like I said, recently, Oregon had its first measles case of the year of 2025 emerge. What are the basic details of this particular case that was recently confirmed by OHA?
Dr. Cieslak: Well, like many of our measles introductions, this case came from overseas and contracted measles, obviously, while over there, arrived on June 17 on a Brussels Air flight from Brussels, Belgium. Actually, it was coming from Chicago, operated by United, arrived at about 6:30 p.m., broke out in a rash, I think that day, and was subsequently confirmed as having measles. So, what the local Public Health Authority does is go back and try to find out where that person has been and where people might have been exposed. That includes on the plane, at PDX, and then other places that the patient visited thereafter. Fortunately, most of the time that he was in Oregon, he was aware he had a rash, and staying at home and not exposing people; but we did identify a pharmacy that he had visited, while presumably contagious.
So, we want to make sure that, if people were potentially exposed, they know about it. In case they were to develop a rash illness, they could tell their doctor, “I may have been exposed to measles.” Then we want physicians to know, in addition, that measles is in the area. When measles is not around, any given rash is very unlikely to be measles. That’s the beauty of herd immunity, so-called herd immunity – community immunity is another way we talk about it. But when measles is in the area, the likelihood that a rash is measles goes way up, so we want physicians to be aware of that.
And then finally, we want people with a rash to know that they should not just drop in on a physician’s office; they should call beforehand and arrange to be evaluated where they won’t be exposing other people. Measles is perhaps the most contagious disease known, so we don’t want lots of people exposed if we can avoid it.
Chávez: Of course. So, like you said, there was at least one location where this person had been during the time that they had measles. I’d love to be able to inform our audience in case anyone was also there. Could you share more information about the locations and times of potential exposure?
Dr. Cieslak: Yes, that was at a Safeway pharmacy in Lake Oswego. That’s on A Avenue – 401 A Avenue. And we’re worried about people who might have been there anytime from 11:30 in the morning until 3:00 in the afternoon on Sunday, the 22nd of June.
Chávez: I know that you have that information on your website as well if folks want to go check out the Oregon Health Authority website.
So, measles is known for causing a rash on the skin but is preceded by other symptoms. And I imagine it’s possible to mistake those non-rash symptoms for something else, like the flu or some other common illness. So what are the symptoms of measles that people should be on the lookout for? And, if you have these symptoms, what should you do?
Dr. Cieslak: Right. Well, the early symptoms are … we call it non-specific, meaning they don’t tell you that you have a certain disease. And you’re right, they could reflect even the common cold – but fever, cough, nasal congestion. One thing that I think makes it more likely to be measles: red eyes or inflammation of the eyes, conjunctivitis. So we talk about the three C’s: cough, coryza, conjunctivitis – coryza, meaning nasal congestion. And then usually the rash breaks out two to three days after that.
So, those early symptoms, you may not know that you have it, but you are contagious. That’s one of the big concerns about measles. I don’t think you need to run to the doctor, especially if you’re vaccinated. If you’re vaccinated with the recommended two doses of vaccine, you have a very low likelihood of contracting measles. This is one of our most successful vaccines. Two doses are 97% protective against the disease and probably for life. So, if you’ve had two doses, I wouldn’t worry about it. But, if you’re unvaccinated and you’re having those symptoms, and then, especially if you’ve been in one of these areas where you may have been exposed, stay home, call your doctor.
Chávez: Do you have increased concerns about exposure or even the potential for an outbreak when you look at and when you think about vaccination rates for children these days in Oregon? To be clear, the person with this case is an adult, not a child, but how does that factor into your thinking at the OHA?
Dr. Cieslak: Well, it concerns me that we have rising rates of people declining vaccination for their children. We measure this in kindergarten and we have one of the highest exemption rates to school-required vaccination in the country. I wanna say, last I looked, we were second worst in the country in terms of people choosing not to have their child vaccinated. The latest figure for the most recent school year was 9.7% of kindergartners were claiming exemption for non-medical reasons to one or more of the required vaccinations.
We had eradicated measles, meaning stopped transmission of measles in the United States back in the year 2000. And that meant we had enough herd immunity that measles just couldn’t go anywhere. We’ve had lots of introductions from other countries, but it runs into a wall of vaccinated people, if you will, and can’t go anywhere. But if there’s a lot of unvaccinated people around, and especially if it arrives in what we call a close-knit community of people who tend not to be vaccinated, then it’ll spread like wildfire. I mean, it’ll spread to many, many people before public health even becomes aware that there’s a problem. And that’s why the number one thing to do is to make sure that your population is highly vaccinated.
Chávez: And what would you say to anyone who might be listening, who’s worried about getting the measles vaccine for themselves or their family for whatever reason – what message would you send to them about that vaccine?
Dr. Cieslak: Well, it’s a very, very safe and well-tried vaccine. This particular version of the vaccine has been around since 1978, so we’re pushing 50 years of experience with it. And literally tens of billions of doses of this vaccine have been administered around the world. So, very, very safe, and an effective vaccine. If you have a severe immunocompromising disease, if you’re pregnant, and infants less than a year of age are not supposed to get this vaccine, because it is a live attenuated vaccine – so, kind of a weakened virus, but a live virus. So we don’t give it to immunocompromised people. If you’ve had a bad reaction to it before, then you wouldn’t get another dose of it. But other than that, it’s very safe.
Chávez: OK, I have a question for myself personally and also for everyone else listening. I know I was vaccinated for measles as a child – not to date myself too much, but that was in the 1980s. And I know for many people there’s this question of, “Do I need to get a booster shot now, based on my age, based on all these factors?” So like, do I need to get a booster shot, and in general, who should be considering doing something like that?
Dr. Cieslak: Yeah, that’s a good question. The recommendation for the second dose of measles vaccine came around in the early 1990s when there was a resurgence of measles predominantly among adolescents, college students, that kind of age people. So it is recommended for children anyway, that they all get two doses. A single dose of measles-containing vaccine will immunize about 93% of people. And because that’s not quite enough to achieve herd immunity, a second dose of measles vaccine was recommended, which gets you up to about 97% likelihood of being protected, even if you’re exposed. But if you’ve had one dose, you’ve got 93% protection. It’s pretty good. And in a normal situation, I don’t spend a lot of time fretting about it, because there isn’t a lot of measles being transmitted and you’re 93% protected anyway.
Now, if measles [is] in the area, it’s reasonable to consider it. I wouldn’t push it on you, but it’s reasonable to consider it. However, if you’re going to travel to a place where measles is circulating, especially other countries – although, nowadays I would, at this particular moment in time, I’d probably put Texas on the list as being a place where a lot of measles has been circulating – then yeah, go ahead and get that booster dose to get yourself up to 97% protected.
Chávez: Well, Dr. Paul Cieslak, thank you so much for helping keep everyone informed and safe, and taking the time to join us today.
Dr. Cieslak: Thanks very much.
Chávez: I’ve been speaking with Dr. Paul Cieslak, the medical director for communicable diseases and immunizations at OHA’s Public Health Division.
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