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Officials with Montgomery County and Shady Grove Adventist Hospital in Rockville are contacting approximately 250 people that may have been exposed to the measles virus after a fourth patient in less than one month was diagnosed with the disease in the county last week.

"Because the United States declared itself measles free in 2000, even one case is considered an outbreak," said Carol S. Jordan, director of communicable disease, epidemiology and public health emergency preparedness and response at the county's Department of Health and Human Services, during a press conference today.

The outbreak began last month when a patient identified as infected with the rubeola virus, which causes the highly infectious respiratory disease, was treated March 12 and the early morning hours of March 13 by emergency department staff at Shady Grove Adventist Hospital. A co-worker of the patient and an infant at the hospital who shared air space with the patient also became infected, officials reported.

Hospital officials then notified about 100 patients who were in the emergency unit during that time who could have been exposed to the patient with measles, Adventist officials said.

A fourth person was diagnosed last week, prompting Adventist and county officials to hold the press conference.

The first patient was someone who had traveled to a foreign country where he became infected, Jordan said. Both that patient and the co-worker who became infected are foreign born and had not been vaccinated against measles as children, Jordan said.

An infant too young to have received the vaccination was infected when the first patient was treated in the Shady Grove emergency room, officials said.

The fourth case appears to be unrelated to the first three and hospital officials are investigating possible sources of the infection, Jordan said.

Fourteen cases of measles also have recently been reported in Pennsylvania, said Dr. Gaurov Dayal, chief medical officer at Shady Grove Adventist Hospital.

The measles, mumps and rubella vaccine, or MMR, has virtually eliminated measles in most developed countries, but there has been an uptick in occurrences reported in the United States over the past year, according hospital officials.

The Centers for Disease Control and Prevention reported 63 cases of measles in the United States between 2000 and 2007 and 131 cased between January and July of 2008.

The last reported case of measles reported in Montgomery County was in 1993. Two patients were identified in 2006 in two other counties, marking the last time measles appeared in Maryland, officials said.

The rubeola virus becomes airborne when an infected person sneezes or coughs or comes in close contact with another person. Surfaces and air can remain contaminated for up to two hours after contact or a sneeze or cough.

"High-risk groups include anyone not vaccinated, 12- to 15-month-old infants, foreign-born people, pregnant women, elderly people or anyone with a compromised immune system," Dayal said.

He said measles "is pretty much 100 percent preventable by vaccine."

Symptoms can take up to 21 days after exposure to the virus to develop, according to officials. There is no cure, only treatments for the symptoms.

Symptoms include a rash that starts on the face and neck before spreading to other parts of the body, high fever, runny nose, red watery eyes, coughing and small red spots with blue and white centers inside the mouth, according to hospital officials.

Dayal urged anyone who thinks he may be experiencing measles-like symptoms to call his health care provider before visiting in person in order to help prevent the spread of the virus.