Measles in a Traveler Born Before 1957: A 2019 Florida Case

Measles is a highly contagious respiratory disease, and both locally acquired and travel-related cases keep occurring in the United States. People born before 1957 are usually presumed immune, because most of that generation caught measles as children. A 2019 case in Pinellas County, Florida, shows why that assumption has limits.

The case

On April 19, 2019, a local hospital told the Pinellas County Health Department of a confirmed measles case in a 72-year-old man. He had come to the emergency department on April 15 after five days of fever, followed by a cough and then a rash that began on his trunk. He had trouble breathing and was admitted, was diagnosed with pneumonia, developed sepsis and was moved to intensive care. Blood tests found measles antibodies, and state laboratory tests of urine and nasopharyngeal swabs confirmed the virus.

His wife said they had returned on April 12 from a month-long trip through several countries in Asia, taking three flights home, two of which landed at U.S. airports. He had stayed home until going to the hospital. She said he had had measles as a child and so had never been vaccinated — but there was no record to prove it.

Tracing the contacts

• Flights. Because he had flown while infectious, CDC was notified and identified 31 exposed passengers on the international and domestic flights, alerting three countries and four state health departments, and the destination country of the third flight. No cases were linked to the flights.
• Home. His wife, mother-in-law and a friend were all born before 1957 or had proof of immunity.
• Hospital. 432 other patients, visitors and staff were exposed in the emergency department. The hospital contacted them by phone and mail to check their immunity. Two patients and a visitor, identified more than 72 hours after exposure, were advised to receive immune globulin, and two received it within six days. One infant who could not receive it in time had their temperature checked daily for 21 days, one full incubation period.

The patient recovered and went home on April 27. None of his contacts developed measles, and heightened surveillance — including monitoring emergency department data and asking providers to report suspected cases for 21 days — found no other cases.

The lessons

• The Advisory Committee on Immunization Practices recommends that adults traveling internationally without documented measles immunity get two documented doses of MMR vaccine before they leave.
• Of 553 measles cases imported into the United States in 2001–2016, 20 (4%) were in people born before 1957.
• Health care providers should consider measles in any returning international traveler with fever and rash, whatever their age.

Sources

Based on Baker KM, Laureano-Rosario AE, Edwards S, "Notes from the Field: Travel-Associated Measles in a Person Born Before 1957 — Pinellas County, Florida, 2019," Morbidity and Mortality Weekly Report, Centers for Disease Control and Prevention; written by the Florida Department of Health in Pinellas County and rewritten in hubnx’s own words.