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Measles Outbreak in Illinois

Posted By Andrew Beron, Whitney Clegg, and Justin Albertson, Friday, March 20, 2015
Updated: Friday, March 20, 2015
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Measles is a highly contagious vaccine-preventable disease that typically presents with a high fever and characteristic rash. Although it was declared eliminated from the United States in 2000, measles outbreaks still occur among unvaccinated children and adults due to importation of cases from countries where the disease remains endemic. As CDC/CSTE Applied Epidemiology fellows at the Illinois Department of Public Health, along with former CSTE fellowship alum Kelley Bemis, we had the unusual opportunity to respond to a measles outbreak connected to a suburban Chicago childcare center.

In January 2015, Illinois public health officials were notified of an adult with a febrile rash who tested positive for measles. This individual reported an unknown vaccination history and denied recent travel or exposure to ill individuals. By the middle of February, 14 additional measles cases had been identified. Twelve of these cases were infants that attended the same childcare center and were not old enough to receive the measles, mumps, and rubella (MMR) vaccine. Although no definite link to the index case was established, all cases resided in the same geographic area or attended childcare there. Of the 14 cases that were laboratory-confirmed PCR positive by the Illinois State Public Health Laboratory, nine were genotyped and found to be measles genotype B3. This genotype was also identified in a recent multistate outbreak linked to a Disney theme park in California and a large outbreak in the Philippines. The genotype has been detected in at least 14 countries and six U.S. states in recent months..

After the first case was identified, a public health investigation was initiated to prevent further spread of the virus in the affected communities. Because measles is highly infectious, it was necessary to perform extensive contact tracing and obtain thorough travel histories for each infected individual. We worked to determine locations each of the individuals visited during their infectious period. Identified exposure settings included places of employment, pediatric clinics, grocery stores, and other public settings.

Each location was notified about the potential measles exposure, and lists of potentially exposed individuals were compiled. For public locations, such as grocery stores, where it was difficult to identify exposed individuals, press releases were issued to notify the public. All identified contacts were asked about their vaccination status and educated about the signs and symptoms of measles. The incubation period of measles is seven to 21 days, so susceptible individuals were monitored via phone or email for three weeks following their last measles exposure.

Another critical component of the investigation involved determining the vaccination history of individuals that work with a susceptible population(s), which included employees at the implicated childcare center and healthcare workers at the exposed pediatric clinics and community hospital. We found that not all employees knew their MMR vaccination status. Not only did this lead to difficulties for the investigators, but determining employee vaccination history was a large task for the staff of the childcare center, community hospital, and affected pediatric clinics.

As a result of our investigation, we were able to coordinate and implement appropriate control measures to prevent further spread of the disease. This included isolating cases during their infectious period, excluding susceptible contacts from high-risk settings, coordinating community vaccination clinics, and providing post-exposure prophylaxis to contacts when applicable.

A majority of the cases in this outbreak were among a vulnerable population. Infants are not recommended to be vaccinated with their first dose of MMR until they are 12 to 15 months of age, leaving them susceptible to measles. Young children are also at a higher risk of developing measles-related complications, such as pneumonia or encephalitis. For these reasons, vaccination of children and adults with the MMR vaccine following the recommended schedule is pivotal for protecting vulnerable individuals. Additionally, this outbreak highlights the need for those who have regular contact with vulnerable populations, such as healthcare workers and staff of childcare centers, to be properly vaccinated with documentation readily available to their employers. With the guidance and support from our mentors and colleagues, the work we accomplished in this outbreak has given us a unique and invaluable experience in the field of applied epidemiology.

Andrew Beron, MPH, Whitney Clegg, MD, MPH, and Justin Albertson, MS, are CDC/CSTE Applied Epidemiology fellows at the Illinois Department of Public Health. Visit the CSTE website to learn more about information about the CDC/CSTE Applied Epidemiology Fellowship. For more information on measles, mumps, and rubella, learn about the CSTE Vaccine Preventable Diseases Subcommittee.

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