Brief Report: Measles Outbreak Associated with a Traveler to India—North Carolina, April-May 2013

Kristin Sullivan

On April 14, 2013, local and state public health officials were notified of suspected measles infections among unvaccinated members of a family residing in Stokes County, North Carolina. The index patient had developed symptoms after returning to the US from a 3-month visit to India. Measles was not suspected until two weeks later when two unvaccinated household contacts sought evaluation for similar symptoms. Measles was first confirmed by laboratory testing at the State Laboratory of Public Health on April 16, 2013.

Overall, 23 cases of measles were identified in 3 NC counties as part of this outbreak, with the last onset occurring on May 7, 2013. Patients ranged in age from 1-59 years. Two patients were hospitalized, including the index patient and one other adult patient with respiratory complications. Eighteen cases (78%) occurred among unvaccinated persons, with a majority of these being members of the index patient’s community. Three patients (13%) had documentation of a complete 2-dose series of MMR vaccination. Vaccination status could not be determined for 2 patients (9%).

This outbreak required extensive resources from the state and local levels. Over 1,000 persons were identified as having been exposed to confirmed or suspected measles cases over the course of the outbreak, including exposures in a variety of healthcare and school settings. Exposures also occurred in several public venues, including a large music festival, requiring broad public notifications. All identified contacts had to be reached and notified of the potential exposure. When indicated, MMR and IG were administered as post-exposure prophylaxis (PEP) to these contacts. Approximately 70 susceptible contacts who did not receive MMR within 72 hours of exposure were issued verbal or written quarantine orders instructing them to stay home for 21 days following their last exposure. In addition, several exposed healthcare workers were unable to provide documentation of immunity to measles, resulting in exclusion from work until 21 days after exposure or until they were able to provide serologic confirmation of immunity.

Although measles is no longer endemic in the United States,¹  importation of measles virus continues to occur.  The cost associated with limiting transmission can be substantial and diverts resources from public health agencies for prolonged periods, as occurred in this North Carolina outbreak. High vaccination rates, rapid case identification and efficient, timely control measure implementation are essential in minimizing transmission of imported measles cases.

References

1.      http://www.cdc.gov/vaccines/pubs/surv-manual/chpt07-measles.pdf