LB-15. Measles Outbreak The Importance of Knowing Your Imported Diseases, Indiana, 2011
Session: Poster Abstract Session: Late Breaker Posters
Saturday, October 22, 2011
Room: Poster Hall B1
  • IDSA measles poster_final.pdf (487.1 kB)
  • Background: Endemic measles has been eliminated in the United States, but imported cases are a continuing problem. On June 20, 2011, five epidemiologically linked measles cases were reported to the Indiana State Department of Health. We investigated to identify persons at risk for infection and to institute control measures.

    Method: Epidemiologic, clinical, immunity, and transmission data were collected.

    Result: We identified 14 confirmed cases: 10 laboratory-confirmed and 4 household contacts of laboratory-confirmed cases. Ten (71%) patients were female; median age was 11.5 years (range: 15 months–27 years). Thirteen cases occurred among unvaccinated members of one extended family. The index case was in an unvaccinated U.S. resident aged 24 years who experienced chills and full-body maculopapular rash on June 3 during a return flight from Indonesia, where measles is endemic. The patient was hospitalized in Indiana during June 7–9 with a diagnosis of dengue fever; measles was not considered and the patient was not isolated. Of the additional 13 patients, 10 exposed others in healthcare facilities (HCFs), five because measles was never considered, and five were isolated only after measles was diagnosed. Contact investigation identified >780 persons, including exposures in a church, factory, and school bus.  HCF exposures included 3 physician offices, 2 emergency departments, 1 urgent-care facility, and 2 hospitals. Of 64 exposed healthcare personnel (HCP), 45 (70%) had readily accessible evidence of measles immunity; the remaining HCP were excluded from work until tested and found to have positive measles IgG titers.

    Conclusion: The index case was not identified until secondary cases were reported, causing additional exposures and a delay in the contact investigation.  Clinicians should consider measles in any patient with rash, fever, and history of recent international travel.  Although all exposed HCP were immune, HCFs should maintain records of HCP measles immunity to avoid the need for exclusion and testing after an exposure. This outbreak is the second largest reported in the United States in 2011, a year with the most measles cases since 1996.  With ongoing importation and presence of susceptible subgroups, measles outbreaks may continue to occur.

    Subject Category: N. Hospital-acquired and surgical infections, infection control, and health outcomes including general public health and health services research

    Melissa G Collier, MD, MPH1,2, Angela Cierzniewski, MPH2, Tom Duszynski, MPH, REHS2, Joan Duwve, MD, MPH2, Preeta Kutty, MD3 and Pamela Pontones, MA, RM2, (1)Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, (2)Indiana State Department of Health, Indianapolis, IN, (3)Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA


    M. G. Collier, None

    A. Cierzniewski, None

    T. Duszynski, None

    J. Duwve, None

    P. Kutty, None

    P. Pontones, None

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