Measles noted among travelers

CDC. MMWR. 2011;60;397-400.

An outbreak in Minnesota and patients across a number of states are leading to rapidly increasing totals of measles, according to data from state and federal health officials.

Minnesota health officials are reporting 15 confirmed cases of measles, 13 of which have been linked to a case that acquired infection in Kenya. One patient acquired infection in Florida and one case acquired infection in India, health officials said in a press release.

In other parts of the country, during the first 2 months of 2011, 13 cases of measles were reported to the CDC, all of which were from travelers returning from overseas, according to data derived from the National Notifiable Disease Surveillance System.

In Minnesota, patients have ranged in age from 4 months to 51 years. Five of the patients were too young to receive vaccine, six were of age but were not vaccinated, one was vaccinated and three have unknown vaccine status. There have been eight hospitalizations and no deaths.

According to CDC data, seven of the 13 patients across the country — Massachusetts (two patients), Texas (one), New York (one), Pennsylvania (one), Washington (one), and California (one) — were reported in children aged 6 to 23 months, and none had received a measles-mumps-rubella vaccine (M-M-R II, Merck), although all were eligible to receive one. The reasons for the children not being vaccinated were not clear. All of the children recovered, but four required a brief stay at the hospital.

CDC researchers said there were 692 cases of measles during the study period of 2001 and February 2011. Among this group, 292 people contracted illness outside the United States, and more than half of these were in residents of the United States. Of those cases, 47 were in children aged 6 to 23 months. The cases in young children are of special concern because children are at greater risk for severe complications associated with measles, such as subacute sclerosing panencephalitis. All 47 of these children had been eligible for the MMR vaccine as well, but only three had received it.

The AAP recommends routine MMR vaccine for all US children at age 12 to 15 months, with a booster dose at 4 to 6 years. Children aged 12 months or older who will be traveling internationally should receive two doses of MMR separated by at least 28 days.

Minnesota health officials are urging pediatricians to:

Assess MMR vaccination status for every patient at every visit.
Recall and vaccinate children and adolescents aged 1 year and older who have not received the first dose of MMR.
Follow the second-dose recommendations of the Advisory Committee on Immunization Practices.
Give a second dose of MMR at 4-6 years of age.
For providers serving children living in Hennepin County, Minn., and Somali children living in the greater metropolitan area: Follow ACIP’s minimum age and interval recommendations for vaccination with MMR during a measles outbreak.

Give the first dose of MMR on (or as soon as possible after) the first birthday, followed by a second dose 28 days later.

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