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Published Date: 2008-05-05 20:00:21
Subject: PRO/EDR> Measles - Worldwide: Peru ex India, USA
Archive Number: 20080505.1539

MEASLES - WORLDWIDE: PERU ex INDIA, USA
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In this update:
[1] Measles - Peru ex India
[2] Measles - family cluster, USA (WA)
[3] Measles - USA, CDC statement

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[1] Measles - Peru ex India
Date: Mon 5 May 2008
Source: Peruvian General Direction of Epidemiology [trans. Mod.JGM, edited]
<http://www.oge.sld.pe/index.php>

On Thu 1 May 2008, Vesalio Clinic (a private clinic) in San Borja
District in Lima reported a probable case of measles, and
International Maritime Sanitation, the Callao (main Peruvian port)
Epidemiology Office and the General Direction of Epidemiology started
an epidemiological investigation.

The case is a 19-year-old male patient coming from India who departed
on 19 Apr 2008 from Bombay heading to Guayaquil, with stops in London
and Miami. On 21 Apr 2008, he arrived in Guayaquil and the same day
went to Puerto Bolivar, where he boarded a tanker, Berge Nantong. The
vessel set sail to Callao on 28 Apr 2008 and arrived there on 30 Apr
2008.

Symptoms began on 28 Apr 2008 with malaise, cough, and sore throat.
On 30 Apr 2008, he became febrile, with a rash on 1 May 2008, so it
was decided to send the patient to a private clinic in Lima (Vesalio
clinic), where it was determined that it was a probable case of
measles, and they notified the case to the General Direction of
Epidemiology. The patient did not leave the ship from 21 Apr to 1 May
2008, when he was taken to Vesalio clinic.

Initial investigations determined that the notified case corresponded
to a probable case of measles, so samples were taken for laboratory
confirmation. On 2 May 2008, the Peruvian National Institute of
Health reported the results of ELISA tests, positive IgM and negative
IgG for measles in serum.

When the case was confirmed, a multidisciplinary team was brought
together in order to assess and control the risk for measles
transmission from this imported case already identified.
Epidemiological investigation determined that this confirmed case of
measles is an imported case, and the team prioritized contact
identification and the implementation of interventional measures for
reducing the risk of measles transmission in Peru. After the patient
was notified as a probable case of measles, he was isolated, 1st in
Vesalio clinic and later in Carrion Hospital, where he will stay for
one week, when it is expected that the patient will no longer be
infectious.

International Maritime Sanitation stated on 1 May 2008 that the crew
and every person on the ship must stay in quarantine while
investigations are carried out for determining their immune status
for measles and their risk is assessed as a preventive measure
against possible transmission of measles through contacts.

Two places were identified in which the patient had contact with
different persons whose immune status for measles was not initially
known: Berge Nantong vessel and Vesalio Clinic, where the patient was
initially seen. 38 contacts were identified in the vessel, including
the crew members and persons who boarded the ship after she arrived
to Callao. 191 persons were identified and vaccinated in Vesalio
clinic, including health care personnel who took care of the patient
and other patients who were in the clinic while the measles case was
hospitalized there.

On 2 May 2008, a clinical examination of all crew members of Berge
Nantong ship was performed. No febrile cases were found; nobody with
a rash was found, so everybody was considered to be in an apparent
good health condition.

On 2 May 2008, blood samples were taken from 24 persons in the ship
(20 crew members and 4 Peruvian citizens who boarded the ship). The
samples were processed by the Peruvian National Institute of Health,
and all of them were negative for measles IgM and positive for IgG,
so it was interpreted that this population is immune for measles and
that the quarantine period should be terminated.

--
Communicated by:
ProMED-ESP Mod.JGM

[This is a confirmed case of measles, an imported case. The probable
time of the infection is somewhere between 10-24 Apr 2008, so the
patient might have become infected in India, London, or Miami. The
most likely place for acquiring the infection may be India. The
patient must continue on isolation for one more week, when it is
estimated that he is no longer infectious.

The crew members are immunologically protected against measles, so the
quarantine period established while investigations were performed must
be finished. (A report in the Spanish language press confirms it has
been lifted. - Mod.JW). According to the decision algorithm of the
International Health Regulations, this situation does not correspond
to an event representing any danger for international public health
with the information available until now.

It is necessary to continue clinical follow up of contacts for a time
period similar to the longest incubation period of the disease,
depending on their current immune status. More than 90 percent of all
identified contacts had been vaccinated.

It is important to point out that in 2006, a national measles and
rubella vaccination campaign took place, and nearly 20 million persons
from 2 to 39 years old were vaccinated, reaching a 98.24 percent
coverage, certified by WHO/PAHO; so the likelihood for developing a
measles outbreak (in Peru) is minimal (except in children aged less
than 2. - Mod.JW); however, every safety measure was taken with this
case. - Mod.JGM

In answer to the puzzle of why a tanker company would fly a young crew
member from India to Latin America at great expense, a contact in
shipping informs me that it is possible the crew is all-Indian and
English speaking, difficult to find in Puerto Bolivar, and he may have
special skills -- modern tankers are highly computerized.

Is anyone tracing contacts in London, Miami, Guayaquil & Puerto
Bolivar who may not have been vaccinated? - Mod.JW

The interactive HealthMap of Peru can be accessed at
<http:// healthmap.org/promed?v=-9.2,-75.9>.
- Mod.CP]

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[2] Measles - family cluster, USA (WA)
Date: Sat 3 May 2008
Source: Seattlepi.com, Associated Press report [edited]
<http://seattlepi.nwsource.com/local/6420ap_wa_measles.html>

A 9th case of measles has been confirmed in Grant County in Eastern
Washington, and it's possible some people in King County also may
have been exposed.

The latest case is in a female student at Moses Lake Christian
Academy. All activities at the school have been cancelled until
further notice while officials work to identify students and school
staff who may be at risk of infection. The girl traveled to western
Washington on Tuesday [29 Apr 2008] as part of a school trip and
would have been contagious at the time.

The other 8 cases were in members of a family from Grant County who
attended a "Generation Church Conference" in Kirkland in late March
2008 and developed symptoms afterwards.

Measles is a serious, highly contagious disease spread largely
through coughing and sneezing. Symptoms include a runny nose, cough
and a fever that consistently rises each day, until a red, blotchy
rash appears on the body. It can lead to more serious complications.
Symptoms usually appear 10-12 days after exposure. Measles can be
easily transmitted through the air in many indoor settings, officials
say.

Those who suspect they or a family member has the measles should
contact their health care provider or the Grant County Public Health
District at 509-766-7960.

[Byline: Paula Horton]

--
Communicated by:
ProMED-mail <promed@promedmail.org>

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[3] Measles - USA, CDC statement
Date: Mon 5 May 2008
Source: WZZM13 News mymitten.com [edited]
<http://www.wzzm13.com/news/news_article.aspx?storyid=91664>

In 2000, the Centers For Disease Control (CDC) declared measles had
been eliminated in the US, but now the CDC says 64 cases have been
reported in 9 states this year [2008].

The agency says that's the highest number they've seen in 7 years.
All of the patients except one weren't vaccinated. States most
affected were Wisconsin, Arizona, Michigan and New York.

The CDC is asking parents to inoculate their children to protect them
in case there are more outbreaks.

Measles is one of the most contagious diseases there is. Anne
Schuchat of the CDC said: "If a child has the measles and is in a
waiting room, the measles virus can still be in the doctor's office 2
hours after the child has left." Measles can cause pneumonia, brain
damage, even death.

--
Communicated by:
ProMED-mail <promed@promedmail.org>

[These reports are posted as a public service to alert people to the
need to maintain their immune status. Un-immunized, partially
immunized and immune-compromised individuals are at risk of
contracting measles. Even in countries such as the United States
where measles has been eradicated, there is an increasing risk of
exposure to measles virus infection as a byproduct of international
travel. The occurrence of 8 cases in one family in Washington state
is an indication of the extent of the risk.

The MMWR Early Release document (MMWR 1 May 2008/57(Early release);
1-4) entitled "Measles - United States, January 1 to April 25 2008"
provides an up-to-date statement of the current situation in the
United States; see
<http://www.cdc.gov/mmwr/preview/mmwrhtml/mm57e501a1.htm?s_cid=mm57e501a1_e>.

The interactive HealthMap of the United States can used to locate the
state of Washington in the northwest. - Mod.CP]

See Also