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%).

Measles and Appropriate Infection Prevention Precautions

Connie Jones

The first measles outbreak to occur in North Carolina in more than 20 years began on April 4, 2013 (described above).During this outbreak, questions were raised as to the appropriate type of Infection Prevention Precautions to follow. According to the Centers for Disease Control and Prevention (CDC), airborne precautions should be used in the healthcare setting for patients known or suspected to be infected with diseases transmitted via the airborne route.  These diseases include Measles, Severe Acute Respiratory Syndrome (SARS), Varicella (chickenpox), and Mycobacterium tuberculosis.

Precautions should be initiated and maintained for all patients suspected of having measles.  Persons with measles are contagious from 4 days prior to rash onset through 4 days after rash onset.

Airborne isolation precautions consist of:

1. Standard Precautions, including appropriate:

·                 Hand hygiene

          Gloves

·                 Gowns

·                 Mask, face shield, eye protection

2. Personal respiratory protection:

·                  N95 Respirator OR Powered Air-Purifying Respirator (PAPR)

3. Airborne Infection Isolation Room (AIIR)

It is important to note that there are no CDC recommendations for patient care outside of the healthcare setting. SPICE and APIC-NC support the suggestion that public health staff or other persons enter housing areas where patients suspected of having measles (e.g., under quarantine) are located may use these same precautions.