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Epidemiologic Notes and Reports Interstate Importation of
Measles Following Transmission in an Airport--California,
Washington, 1982
Nine serologically confirmed measles cases in Washington State,
with rash onsets from January 1 to January 26, 1982, were
epidemiologically linked to an out-of-state importation from
California.* The index case, a 27-year-old naval officer from San
Diego, had rash onset on December 21, 1981. He had acquired
measles
in San Diego from a 2-year-old child who was not a military
dependent. The officer traveled to Washington on December 20 and
returned to California on December 23. His illness was diagnosed
at a
San Diego naval base and was reported to the San Diego County
Health
Department. California health officials reported the case to
Washington health officials.
Ultimately, nine other cases, reported from five counties in
western Washington, were epidemiologically linked to this officer.
The seven first-generation cases occurred among persons from 9 to
37
years of age; one case occurred in a 30-year-old woman who managed
the
Bachelor Officers' Quarters (BOQ) where the officer stayed.
Another
occurred in a passenger on the officer's return flight to
California.
The remaining five cases occurred among persons who were at the
Seattle-Tacoma airport on December 23. On that day, the officer
had
been in many parts of the airport. These five persons with measles
visited at least one of the three departure gates visited by the
officer that day. Thus, of the seven first-generation cases, only
the
BOQ manager could identify face-to-face contact with the index
case.
Reported by D Ramras, MD, S Ross, County of San Diego Dept of
Health
Svcs, L Dales, MD, J Chin, MD, State Epidemiologist, California
Dept
of Health Svcs; M O'Donnell, W Fisher, MD, Bremerton-Kitsap County
Health Dept, S Garlick, MD, Clallam County Health Dept, K Johnson,
C
Nolan, MD, Seattle-King County Health Dept, K Carroll, C Hyatt, MD,
Snohomish County Health Dept, E Peterson, R Nicola, MD,
Tacoma-Pierce
County Health Dept, K Cahill, J Kobayashi, MD, State
Epidemiologist,
Washington State Dept of Social and Health Svcs; Div of
Immunization,
Center for Prevention Svcs, CDC. Editorial Note
Editorial Note: Interstate transmission of measles can be
recognized
when indigenous transmission is very low or absent (1) and when
suspected cases are investigated thoroughly. The investigation of
this outbreak was facilitated by efficient communication at many
levels. The index case was reported from a military base to the
local
health department and then to California health officials. Their
report to Washington health officials made it possible to
epidemiologically link a small number of cases from several
counties.
Thus, Washington health officials could identify a chain of
transmission and advise all local health departments to intensify
surveillance.
Although measles is generally considered most contagious before
rash onset (2), this outbreak illustrates that some patients are
infectious up to 3 days after rash onset. Face-to-face contact
with
the index case was documented only for one of the seven secondary
cases, suggesting that an infectious aerosol at the airport might
have
been the mode of transmission to the others (3,4). However, it is
also possible that the persons unknowingly came in close contact
with
the index case.
During this outbreak, high immunity levels against measles were
confirmed by reviews of school and day-care-center records in the
five
Washington counties where the cases occurred. Active surveillance
and
investigation of rash illnesses were intensified throughout
Washington
during the outbreak, and all suspected cases were investigated
rapidly
while laboratory confirmation was pending. No measles cases
occurred
more than two generations after the importation from California.
Importations usually cause little morbidity when immunization
levels
are high (5).
References
CDC. Transmission of measles across state lines--Kentucky, New
Hampshire, Tennessee, Virginia. MMWR 1982;31(10):123-6.
Krugman S, Katz SL. Measles (rubeola). In: Infectious diseases
of
children. 7th ed. St. Louis: Mosby 1981:144-61.
Williams RE. Intramural spread of bacteria and viruses in
human
populations. Annu Rev Microbiol 1960;14:43-64.
Langmuir AD. Changing concepts of airborne infection of acute
contagious diseases: a reconsideration of classic epidemiologic
theories. In: Airborne contagion. Kundsin RB, ed. New York:
Annals
of the New York Academy of Sciences 1980;353:35-44.
Amler RW, Bloch AB, Orenstein WA, Bart KJ, Turner PM Jr, Hinman
AR. Imported measles in the United States. JAMA
1982;248(17):2129-33.
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