Both locally acquired and travel-associated cases of highly contagious measles continue to occur across the United States, according to a new report.

An article in the Morbidity & Mortality Weekly Report highlights that in 2019, the Pinellas County, Florida, Health Department Epidemiology Program was notified by a local hospital of a case of serologically confirmed measles in a 72-year-old man.

The case underscores the importance of the Advisory Committee on Immunization Practices (ACIP) recommendation that adults without documentation of measles immunity who are traveling internationally receive two documented doses of measles, mumps, and rubella virus vaccine before departure. 

The authors reported that the patient was evaluated in a hospital emergency department (ED) on April 15 with a 5-day history of fever, followed 2 days later by cough, and a maculopapular rash that started on his trunk. He ended up in the intensive care unit with pneumonia and sepsis. Commercial laboratories identified measles immunoglobulin (Ig) M and IgG via testing.

In determining patient history, investigators learned from the patient’s wife that the couple had returned from a month-long, multicountry trip to Asia. Their return trip included three flights, two of which landed at U.S. airports. 

The patient’s wife said that her husband had measles as a child, and, as a result, had  not been vaccinated against measles, although no documentation was available.

After measles was diagnosed, the Florida Department of Health notified the CDC Prevention Miami Quarantine Station, which identified 31 exposed contacts on the inbound international flight and the domestic flight and notified three countries and four U.S. state health departments for follow-up. 

Exposure also was an issue for the patient’s close, personal contacts including his wife, his mother-in-law, and a friend, all of whom were born before 1957. They were determined to have documented evidence of immunization or prior disease. However, while the patient was in the hospital ED, 432 other patients, visitors, and staff members were exposed. The hospital’s infection control program notified contacts exposed in the hospital by telephone and mail. 

Ultimately, none of his contacts developed measles, and no additional cases were identified through heightened surveillance.

The ACIP recommendation is important because a review of measles cases internationally imported into the U.S. during 2001–2016 found that 20 of 553 (4%) of the cases occurred in people born before 1957. While the cohort born prior to 1957 is presumed to be immune because of the likelihood of having been infected with measles during childhood, there is evidence that cases can occur.

“Health care providers should consider measles in all persons who returned from international travel and are evaluated with febrile rash illness, regardless of age,” the authors advise.
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