Measles alert began with flight from Malaysia to U.S.

Report cites unvaccinated refugee from Myanmar

By Mark Johnson of the Journal Sentinel

The measles alert in Milwaukee began when an unvaccinated 23-month-old refugee from Myanmar flew here from Malaysia, according to a report Thursday by the Centers for Disease Control and Prevention in Atlanta.

The child flew to Wisconsin on Aug. 24 and was reported to have laboratory-confirmed measles on Sept. 7. Since then measles have been confirmed in two more people in Milwaukee, both of whom appear to have acquired the disease through exposure to the refugee patient, said Paul Biedrzycki, the city's director of disease control and environmental health.

Biedrzycki stressed that some of the three cases are still undergoing laboratory testing by CDC.

The CDC's report in "Morbidity and Mortality Weekly," said a case reported a little earlier, Aug. 26 in California, also involved an unvaccinated Burmese refugee, a 15-year-old boy, who had flown to the U.S. on the same day as the Milwaukee refugee.

The patients in Wisconsin and California flew on different flights. However, three other unvaccinated refugee children who were on the same flight as the boy in California have also come down with confirmed cases of measles: two very young children in Maryland and a 14-year-old in North Carolina.

"Whether these three patients were exposed to measles in Malaysia or during travel to the United States is unclear," according to the CDC report.

Thirty-one refugees flew on the same flight from Malaysia as the California patient, arriving in seven other states: Maryland, North Carolina, New Hampshire, Oklahoma, Texas, Washington and Wisconsin. To prevent further transmission of measles, refugee travel from Malaysia to the U.S. has been suspended.

Biedrzycki said the new report raises several key points for public health officials: Imported measles cases are on an upswing in the U.S. at the moment; air travel is increasing the speed, efficiency and geographical range that viruses such as measles can spread; and finally the appearance of cases in refugee populations brings its own challenges.

When tracking viruses among refugee populations, health officials sometimes encounter language barriers and cultural issues having to do with refugees' access to American health care and their comfort and familiarity with the system.

Biedrzycki said Milwaukee health workers are working with refugee resettlement agencies such as Lutheran Social Services and Catholic Charities, as part of an outreach effort to identify and control the spread of measles. He said the city was able to alert local health care workers very early to be on the lookout for cases with symptoms that match those of measles. The symptoms are cold-like in the beginning, followed by a red, blotchy rash that starts at the hairline and migrates down the arms and legs.

Biedrzycki and the CDC have recommended that clinicians who see patients with suspected measles cases should be isolated and have blood samples and nasal swabs taken.

The CDC report recommended that U.S.-bound refugees in Malaysia who show no evidence of immunity be vaccinated for measles, mumps and rubella, and have their travel to the U.S. postponed for 21 days after vaccination.

Source : jsonline.com