Measles in Central Ohio, 2022: 85 Cases, Mostly in Unvaccinated Young Children

On November 5, 2022, a hospital in central Ohio admitted two 2-year-olds with rash, fever, cough and congestion. Both were being treated for other causes before anyone thought of measles. Neither had been vaccinated against measles, mumps and rubella (MMR), neither had traveled abroad, and neither had any known contact with a measles patient — yet both tested positive. By Christmas, 85 people had caught measles locally.

How it spread

Between June and October 2022, four measles cases had been confirmed in unvaccinated Franklin County residents who had traveled to parts of East Africa with ongoing outbreaks, but no definite link to the new cases was found. Columbus Public Health and the Ohio Department of Health confirmed a community outbreak on November 9. Rash onsets ran from October 22 to December 24, and the outbreak was declared over on February 4, 2023 — 42 days, or two incubation periods, after the last case.

Measles cases by date of rash onset and where exposure happened, central Ohio, October–December 2022. Credit: CDC, Morbidity and Mortality Weekly Report.

Who got sick

• Where: 78 cases in Franklin County, two in Madison County, and one each in Clark, Fairfield, Richland, Ross and Union Counties.
• Confirmed how: 74 by laboratory test, 11 by link to a confirmed case. All 65 genotyped specimens were genotype B3.
• Age: a median of 1 year, from 6 months to 15 years.
• Vaccination: 80 (94%) had never had an MMR dose. Of the 60 who were old enough for routine vaccination, only 3 had a documented dose.

How sick

• 44 (52%) had complications: ear infections (33), diarrhea (22) and pneumonia (7).
• 36 (42%) were hospitalized, mostly for dehydration, for a median of 3 days.
• 12 of those hospitalized also had another respiratory infection, such as RSV.
• No one died.

Stopping it

The county health departments identified 739 local contacts who were unvaccinated or whose status was unknown and who needed to be quarantined. They enrolled 446 in active monitoring; 43 of them developed measles in quarantine, and 28 of those were reached before the rash appeared. Of 59 contacts given protection after exposure, 8 received MMR vaccine and 51 immune globulin. Two of the vaccinated children later got measles; none of those given immune globulin did.

Why it matters

Ohio had a measles outbreak in 2014 as well. In 2021–2022, 88.3 percent of Ohio kindergartners had two MMR doses, against 93.0 percent nationally. Measles was declared eliminated in the United States in 2000, but it is still endemic in many countries, and imported cases keep sparking outbreaks in close-knit, undervaccinated communities. This one stood out for its very young patients, low vaccination, frequent respiratory co-infections and a hospitalization rate twice that of earlier U.S. measles cases. Health care and child care facilities that serve undervaccinated families should stay alert for measles and stress timely vaccination; keeping measles eliminated depends on high two-dose MMR coverage everywhere.

Sources

Based on "Notes from the Field: Measles Outbreak — Central Ohio, 2022–2023," by Elizabeth C. Tiller and colleagues (CDC; Columbus Public Health; Ohio Department of Health; Franklin County Public Health; Nationwide Children's Hospital), Morbidity and Mortality Weekly Report, Centers for Disease Control and Prevention; a work of the United States government in the public domain.