Weeks 15-34, 2005 (No. 2) September 3, 2005 

MEASLES UPDATE 

National Immunization Program (NIP), Centers for Disease Control & Prevention 

Measles Activity in U.S. through Week 34 (August 27, 2005) 

 

No. of confirmed measles cases reported to MMWR by Week 34, 2005: 56 

No. of confirmed measles cases reported to NIP by Week 34, 2005: 55 

No. of confirmed measles cases reported for same period in 2004: 25 

Total No. of U.S. outbreaks (3 or more linked cases) in 2005: 1 

 

As of Week 34 (ending Aug 27, 2005), a total of 56 measles cases have been reported for the Morbidity and Mortality 
Weekly Report (MMWR) compared to 25 cases for the same period of last year. Five cases reported to the MMWR are error 
records to be deleted by: Utah (  4 ), NJ (  1) and NC ( 1). Five cases not yet reported to the MMWR include 2 from 
Oregon (imports from Egypt/Saudi Arabia), and recent imports from WA (1 from France); OH (1 from Nigeria) and MI (1 
from Yemen). All confirmed measles cases to date are listed in Table 1 by rash onset. A total of 55 confirmed measles 
cases have been reported to NIP by 13 states: Arizona - 1; California  3; Delaware  1; Hawaii  2; Indiana  33; Illinois  
2; New York  1; NYC  4; Oregon  2; Tennessee  1; Wisconsin  2; Ohio  1; Washington  1; and Michigan  1. Ninety-
six percent (53/55) of cases are import-associated which includes 17 imported cases and 36 cases that were epi-linked to 
an imported case. Source countries for the import-associated cases were: Armenia (1 case imported); India (2 cases 
imported); Indonesia (1 case imported and 1 secondary case); Egypt/Saudia Arabia (2 cases imported); Thailand (2 cases 
imported); Germany (1 case imported and 1 spread case); Romania  (1 import and 33 import-associated cases); China  1 
import; France  1 import; Nigeria  1 import; and Yemen  1 import. 


Measles Confirmed since last Update: 
 

NEW YORK CITY - 1 traceable to import 


The first measles case for 2005 was an importation from Indonesia in an 11-month-old Brooklyn resident, rash 
onset January 2. One spread case was also reported in a 1-year-old male from Manhattan, onset January 16. The 1-year-
old had been vaccinated after exposure to the 11-month-old in a medical setting. The 1-year-old received vaccine 9 days 
prior to rash onset. Other symptoms included fever of 102.7; conjunctivitis, coryza, cough and diarrhea. 


HAWAII  1 import and 1 unknown source 


Hawaii reported one imported case in a Maui resident (rash onset February 17), who had recently returned from Thailand. 
The 27-year-old male was unvaccinated because of personal beliefs. 
 

Hawaii also reported one confirmed case in a 10-month-old Maui resident, rash onset April 20. Symptoms included rash, 
cough, coryza, conjunctivitis, fever of 103 and diarrhea. Source of infection was unknown. 
 

DELAWARE  1 import 

 

New Castle County, Delaware reported a single import from Thailand/Laos, rash onset February 18. The foreign born 44-
year-old male (U.S. resident) had returned from southeast Asia 2 weeks prior to febrile rash. The case-patient gave a verbal 
history of having received measles vaccine in the U.S., and denied cough, coryza or conjunctivitis. A private lab reported 
positive IgM result. Rash was initially thought to be the result of a new medication. A second blood obtained on March 17 
was also positive (by direct capture) at the State lab. No secondary cases were identified. 


CALIFORNIA - 1 import and 1 traceable; 1 unknown source case 


San Diego confirmed a 2-case chain of measles in 2 siblings (U.S. residents), ages 33 and 25 years, with rash onsets 
February 26 and March 17, 2005. The first case was an import from Germany. Both brothers were unvaccinated because 
of personal beliefs. The March case was in Puerto Rico during his infectious period. No other cases were identified. 


A military hospital in Santa Barbara reported confirmed measles in a 9-month-old military dependent, 

rash onset April 23. Source of infection was unknown. 

 

New call from California: A hospital in Riverside reported measles in a 48-year-old U.S. citizen with international travel 
historyHong Kong, Cambodia and Thailand July 1July 28. Patient developed fever on Aug 6 (up to 104), followed by 
rash onset Aug 8. Diffuse maculopapular rash spread from neck to all over body, cough, watery eyes, diarrhea, nausea and 


vomiting. Patient was hospitalized for 6 days. Commercial lab results from specimens collected Aug 16 were IgM positive, 
IgG negative. The State Lab will retest the specimen(s). This case is not yet included in Table 1. 

 

WISCONSIN  1 traceable 

 

Serum and viral specimens from a 15-year-old contact to a previously reported import from Germany (rash April 3rd) were 
collected and forwarded to CDC on April 20. Serologic results for the contact case were IgM positive and sequencing was 
Genotype D4. The NETSS record for the secondary case was transmitted during Week 34. 

 

INDIANA/Illinois Outbreak 

Rash Onset Dates: May 16  June 24, 2005 

34 confirmed cases 

Source: Romania 

 

On May 29, 2005, the Indiana State Department of Health (ISDH) was notified of a 7 year old female (Indiana resident 
hospitalized in Cincinnati with suspected measles. Serological analysis confirmed the measles diagnosis. The childs 
parents informed the ISDH that she had been in northwestern Indiana, on May 15, 2005 when a community member (had 
returning from Romania) had been ill with rash and fever (the index case). The investigation that followed identified an 
additional 33 cases. 

IMAGE HERE
IMAGE TEXT FOLLOWS:

Transmission Generation
Index Case:
Woman aged 17 years.
Not vacinnated.
Rash onset: 16 May.
Travel to Romania 4 May - 14 May.

First Generation - 19 cases*
Second Generation - 12 cases
Third Generation - 2 cases
 

33 confirmed measles cases were reported by the State of Indiana and 1 in Illinois with rash onset dates between 16 May and 24 June. All but 
one of the cases occurred within a community group that does not routinely accept vaccinations. Twenty-eight cases were not vaccinated; two 
cases were vaccinated with one or two doses; one case was <1 year of age; one was born prior to 1957; and vaccination status could not be 
documented for 2 cases. Measles virus of genotype D4 was detected. Source: Indiana State Department of Health 

 

ILLINOIS - 1 traceable and 1 import 

 

Grundy County, Illinois reported one 1st generation case (rash onset May 29) linked to the Indiana outbreak. The IL case 
was an unvaccinated 12-year-old Illinois resident exposed in Indiana on May 15, 2005. 

 

Chicago reported 1 import from Pakistan in an 8-year-old child with rash onset May 31. The U.S. resident had documented 
history of 1 MMR in the U.S. at 15 months of age. Her return date to the U.S. was May 23, after 7 months in Pakistan; was 
prodromal May 26. She met case definition and was IgM positive at State and private labs. Viral specimens were collected 
and sent to the State lab and will be forwarded to CDC if isolation is successful. Several exposures include E.R. visits on 
May 26 and May 29; and a doctor's office on May 28. She was hospitalized 4 days, admitted for dehydration and high fever. 

 

TENNESSEE  1 import 

 

Tennessee reported an imported measles in a 24-year-old Nashville resident. He traveled to China from June 29- July 14. 
Fever began July 19 and rash began on July 21. Specimens drawn on July 22 and July 26 were both IgM positive. He was 
hospitalized July 24-26 for dehydration, mild thrombocytopenia and increased liver enzymes. According to his father he had 
received 1 dose of measles-containing vaccine at 9 months after 1 year of age; however, the vaccination card could not be 
checked. No specimens for viral isolation were taken. 

 

WASHINGTON  1 import 

 

Washington State reported (to NIP) confirmed measles in a 43-year-old resident who was infected while in France. He 
attended a systems information event in Paris during week of July 31 - Aug 5. He toured France several days before and 
after the event. He returned to the U.S. on Aug 8; with rash onset Aug 20, 2005. M.D. reported continuing cough, watery 
eyes, temp of 102, slight coryza, and Koplick's spots on the buccal mucosa Aug 22. A blood specimen drawn Aug 22 was 
IgM negative and IgG negative; a second draw on Aug 24 was IgM positive and IgG negative. Viral specimen is being 
processed at CDC. 

 

Rounded Rectangle: UINDEX CASE
Woman aged 17 years
Not vaccinated
Rash onset: U16 MayU
Travel to Romania 4May- 14May 

 

MICHIGAN  1 import 

 

Michigan reported confirmed measles in a 12 year-old male from Yemen. He flew from Frankfurt into Detroit on Lufthansa 
422, arriving in Detroit on August 13. Rash onset date was August 15, 2005, accompanied by fever of 39C, conjunctivitis, 
cough, coryza, vomiting, and diarrhea. The initial lab work was done at a commercial lab. Div of Quarantine was notified. 
The State was unable to get any serum (positive at ARUP) but a respiratory specimen (throat swab) was forwarded to 
CDC. 

 

OHIO  1 import (possible new outbreak) 

 

One imported case from Nigeria was reported by Ohio State Health Department in a 6-year-old child from Nigeria, arriving 
August 13, 2005. The child flew from Amsterdam to Detroit to Dayton. He was febrile at a county fair August 17; rash 
onset August 18. He was hospitalized. Two other measles like illnesses are currently under investigation in 2 hospital 
employees (not yet included in Table 1). 

 

 Table 1 

 

U.S. MEASLES cases reported (N=55) by rash onset: 

Cases in Bold are those reported since last Update 


#  01  imp  Proj  NYC  Age  /dob  11 mo old  male  Rash onset  Date  1/2/05  Vacc  No  Spread  Cases?  Yes, 1  Reported  To MMWR?  Yes  Viral Specimens  Received  Yes, D9  MEASLES as of Sep 3, 2005  Comments / Source Information  IMPORT, Brooklyn resident returning Jan 1 after 1 month family visit to Indonesia.  1 nosocomial spread below.  
#  02  trac  Proj  NYC  Age  /dob  1 yr old  male  Rash onset  Date  1/16/05  Vacc  After  Exposure to case 1  Spread  Cases?  No  Reported  To MMWR?  Yes  Viral Specimens  Received  No  MEASLES as of Sep 3, 2005  Comments / Source Information  Bold  Reported since last update. This child from Manhattan was vaccinated after ER exposure to the import from Indonesia. He received vaccine on 1/7/05, 9 days prior to rash onset. Symptoms included rash, fever 102.7; conjunctivitis, coryza, cough & diarrhea.  
#  03  imp  Proj  NYC  Age  /dob  70 yr old  male  Rash onset  Date  1/10/05  Vacc  No  Spread  Cases?  No  Reported  To MMWR?  Yes  Viral Specimens  Received  Yes, D8  MEASLES as of Sep 3, 2005  Comments / Source Information  Single IMPORT, India  U.S. resident returned from India on Jan 5  
#  04  imp  Proj  AZ  Age  /dob  28 yr old  male  Rash onset  Date  1/17/05  Vacc  No  Spread  Cases?  No  Reported  To MMWR?  Yes,  Not coded as import  Viral Specimens  Received  Yes, D6  MEASLES as of Sep 3, 2005  Comments / Source Information  Visiting scholar arrived 1/17 from Armenia  Foreign visitor  This case needs to be flagged as import in NETSS; currently listed as indigenous  
#  05  imp  Proj  NYS  Age  /dob  12 mo old  male  Rash onset  Date  2/26/05  Vacc  No  Spread  Cases?  No  Reported  To MMWR?  Yes  Viral Specimens  Received  Yes, D8  MEASLES as of Sep 3, 2005  Comments / Source Information  Westchester County resident  Returned form India on 2/22/05  
#  06  imp  Proj  OR  Age  /dob  33 yr old  male  Rash onset  Date  2/11/05  Vacc  Yes,  Accepted verbal dates  Spread  Cases?  No  Reported  To MMWR?  No  Viral Specimens  Received  No  MEASLES as of Sep 3, 2005  Comments / Source Information  Import in foreign born college student returning from trip to Cairo/Saudi Arabia on 1/29/05 ; could have infected brother below but both are classified as imports; vaccinated in Egypt at 11 mos and 12 mos. Residing in U.S. for over 1 year  
#  07  imp  Proj  OR  Age  /dob  35 yr old  male  Rash onset  Date  2/18/05  Vacc  Unk,  No dates  Spread  Cases?  No  Reported  To MMWR?  No  Viral Specimens  Received  No  MEASLES as of Sep 3, 2005  Comments / Source Information  Import from Cairo/Saudi Arabia  Verbal history of vaccination while a child in Egypt; no documentation.  Traveled w/brother above.  Residing in U.S. for over 1 year  
#  08  imp  Proj  HI  Age  /dob  27 yr old  male  Rash onset  Date  2/17/05  Vacc  No,  PBE  Spread  Cases?  No  Reported  To MMWR?  Yes  Viral Specimens  Received  No  MEASLES as of Sep 3, 2005  Comments / Source Information  Bold  Reported since last update. Import from Thailand  U.S. Resident / Maui  Personal Belief Exemption  
#  09  imp  Proj  DE  Age  /dob  44 yr old  Rash onset  Date  2/18/05  Vacc  Unk  Spread  Cases?  No  Reported  To MMWR?  Yes  Viral Specimens  Received  No  MEASLES as of Sep 3, 2005  Comments / Source Information  Bold  Reported since last update. Import from Thailand/ Laos  Foreign born U.S. resident,  Verbal history of vaccine  
#  10  Imp  Proj  CA  Age  /dob  33 yr old  male  Rash onset  Date  2/26/05  Vacc  No,  PBE  Spread  Cases?  Yes, 1  Reported  To MMWR?  Yes  Viral Specimens  Received  No  MEASLES as of Sep 3, 2005  Comments / Source Information  Bold  Reported since last update. San Diego  Import (U.S. resident) source Germany  Infected his 25 year old brother.  Not vaccinated due to personal beliefs.  
#  11  Trac  Proj  CA  Age  /dob  25 yr old  male  Rash onset  Date  3/17/05  Vacc  No,  PBE  Spread  Cases?  No  Reported  To MMWR?  Yes  Viral Specimens  Received  No  MEASLES as of Sep 3, 2005  Comments / Source Information  Bold  Reported since last update. Brother to above case  Traceable to Import / Germany  This case was vacationing in Puerto Rico during his infectious period . No known spread. Not vacc due to personal beliefs.  
#  12  imp  Proj  NYC  Age  /dob  40-year-old  male  Rash onset  Date  3/3/05  Vacc  No  Spread  Cases?  No  Reported  To MMWR?  Yes  Viral Specimens  Received  Yes,  unsuccessful  MEASLES as of Sep 3, 2005  Comments / Source Information  I Bold  Reported since last update. mport Thailand; foreign born U.S. resident; returned to U.S. on 3/1/05  
#  13  imp  Proj  WI  Age  /dob  47 yr old  male  Rash onset  Date  4/3/05  Vacc  No  Spread  Cases?  No  Reported  To MMWR?  Yes  Viral Specimens  Received  No  MEASLES as of Sep 3, 2005  Comments / Source Information  Bold  Reported since last update. U.S. resident, import from Frankfurt, Germany. Went to Germany on 3/17; returned to U.S. on 3/29. Prodromal 3/31.  One unimmuniz contact w/symptoms  Is pending lab work. Virals collected.  
#  14  Trac  Proj  WI  Age  /dob  15 yr old  female  Rash onset  Date  4/16/05  Vacc  No  Spread  Cases?  No  Reported  To MMWR?  Yes  Viral Specimens  Received  Yes,  D4  MEASLES as of Sep 3, 2005  Comments / Source Information  Bold  Reported since last update. Traceable to import from Germany  
#  15  Unk  Proj  HI  Age  /dob  10 mo old  male  Rash onset  Date  4/23/05  Vacc  No  Spread  Cases?  No  Reported  To MMWR?  Yes  Viral Specimens  Received  No  MEASLES as of Sep 3, 2005  Comments / Source Information  Bold  Reported since last update. Unknown source  
#  16  Unk  Proj  CA  Age  /dob  9 mo old  female  Rash onset  Date  4/23/05  Vacc  No  Spread  Cases?  No  Reported  To MMWR?  Yes  Viral Specimens  Received  No  MEASLES as of Sep 3, 2005  Comments / Source Information  Bold  Reported since last update. Military Dependent reported by AFB  Source unknown  
#  17  IMP  Proj  IN  Age  /dob  17 yr old  female  Rash onset  Date  5/16/05  Vacc  No.  PBE  Spread  Cases?  Yes, 19  cases in first generation  Reported  To MMWR?  Yes  Viral Specimens  Received  Yes, D4  for the outbreak  MEASLES as of Sep 3, 2005  Comments / Source Information  Bold  Reported since last update. Index case in a 34 case outbreak  Indiana (33 ) and IL (1)  U.S. resident unimmunized for  Personal beliefs visited Romania  Source: Romania  
#  18- 49  Trac  Proj  IN  Age  /dob  9 mos to  45 years  Rash onset  Date  5/26   6/24/05  Vacc  2 of 34  had hx of vax  Spread  Cases?  12 cases  in 2nd  2 cases  in 3rd  Reported  To MMWR?  Yes  Viral Specimens  Received  Yes   D4 for x cases  In outbreak  MEASLES as of Sep 3, 2005  Comments / Source Information  Bold  Reported since last update. 34 case outbreak among a group not routinely accepting vaccinations. Only one case occurred outside of the community.  Two of 34 cases were vaccinated.  Health care worker survived but was in ICU w/complications; History of 1 MMR.  
#  50  Trac  Proj  IL  Age  /dob  12 year old  Rash onset  Date  5/29/05  Vacc  No  Spread  Cases?  No  Reported  To MMWR?  Yes  Viral Specimens  Received  Yes,  D4  MEASLES as of Sep 3, 2005  Comments / Source Information  Bold  Reported since last update. Exposed to index while visiting family in Indiana  
#  51  IMP  Proj  IL  Age  /dob  8 year old  female  Rash onset  Date  5/31/05  Vacc  1 MMR  @ 15mos  Spread  Cases?  No  Reported  To MMWR?  Yes, but  Not as import  Viral Specimens  Received  Virals sent to  State lab  MEASLES as of Sep 3, 2005  Comments / Source Information  Bold  Reported since last update. Import in Chicago from Pakistan  U.S. Resident had been with family inPakistan 7 months, returned 5/23/05. Needs to be coded as import in NETSS; child was hospitalized  5/29-6/3. Rubella IgG was negative  vax failure. Never got second dose.  
#  52  IMP  Proj  TN  Age  /dob  24 yr old  male  Rash onset  Date  7/21/05  Vacc  Yes,  at 9 mos & 1 yr  Spread  Cases?  No  Reported  To MMWR?  Yes  Viral Specimens  Received  No  MEASLES as of Sep 3, 2005  Comments / Source Information  Bold  Reported since last update. U.S. Resident Source is CHINA  Returned 6/29/05  
#  53  IMP  Proj  WA  Age  /dob  43 yr old  male  Rash onset  Date  8/20/05  Vacc  Unk  Spread  Cases?  Unk  Reported  To MMWR?  No  Viral Specimens  Received  Obtained  MEASLES as of Sep 3, 2005  Comments / Source Information  Bold  Reported since last update. U.S. Resident  Source is France  Mtg in France July 31  Aug 5  Tourist few days prior and after the event  Meets case definition. IgM positive on 8/24  
#  54  IMP  Proj  OH  Age  /dob  6 yr old  male  Rash onset  Date  8/18/05  Vacc  Unk  Spread  Cases?  2 under  investig  Reported  To MMWR?  Yes  Viral Specimens  Received  No  MEASLES as of Sep 3, 2005  Comments / Source Information  Bold  Reported since last update. Import from Nigeria arrived 8/13/05  Hospitalized 8/22  Flew Amsterdam Detroit-Dayton  
#  55  IMP  Proj  MI  Age  /dob  12 yr old  male  Rash onset  Date  8/15/05  Vacc  Unk  Spread  Cases?  Unk  Reported  To MMWR?  No  Viral Specimens  Received  Obtained,  Being processed at CDC  MEASLES as of Sep 3, 2005  Comments / Source Information  Bold  Reported since last update. Import from Yemen  Infectious on flights Frankfurt into Detroit    


2005 Measles Outbreaks (3 or more linked cases) Shaded= IMPORTED source  
1  Proj INDIANA  Location(s)  Linn County/  Johnson County  1st & Last Rash Onsets  May 16-  June 24, 2005  # Conf  Cases  34  Ages  (or range)  9 mos  45 yr  Comments  Shaded  imported source. Source is Romania  Outbreak among group not routinely accepting vaccinations.    

Visit REVBs Molecular Surveillance Website at: 
http://www.cdc.gov/ncidod/dvrd/revb/measles/index.htm

US Genotyping Results 2005 

State  IN, OH  First & last rash date  5/16-6/24/05  Geno type  D4  Comments  Import: Romania  No. cases identified  33  
State  IL  First & last rash date  5/26/05  Geno type  D4  Comments  Spread from IN  No. cases identified  1  
State  WI  First & last rash date  4/16/05  Geno type  D4  Comments  Import: Germany  No. cases identified  2  
State  NYS  First & last rash date  2/26/05  Geno type  D8  Comments  Import: India  No. cases identified  1  
State  AZ  First & last rash date  1/17/05  Geno type  D6  Comments  Import: Armenia  No. cases identified  1  
State  NYC  First & last rash date  1/10/05  Geno type  D8  Comments Import: India  No. cases identified  1  
State  NYC  First & last rash date  1/2/05  Geno type  D9  Comments  Import: Indonesia  No. cases identified  2   

Rubella 

As of Week 34, 8 cases of rubella had been reported to MMWR compared to 9 cases for the 
same period of last year. NIP is aware of 8 confirmed rubella cases this year: Michigan (1); 
Maryland (1); NYS (1 import/France); NYC (1 import from Malaysia, 1E genotype); MA (1); OR 
(1); NH (2 epi-linked). 

New York City - 1 import from Malaysia, Genotype 1E 

Rubella was imported in a 39-year-old U.S. resident (foreign born) with travel to Malaysia. He had 
a rash, fever of 101, lymphadenopathy. CDC received 2 serum samples on this case in April, as 
well as throat swab and urine specimen. The sera were IgM positive for rubella. Culture results on 
the clinical specimens were negative (collected 2 weeks post rash); the RT-PCR and throat swab 
was positive for rubella RNA. The genotype was 1E. 
 

Massachusetts - 1 unknown 

Massachusetts reported a laboratory confirmed rubella case in a 44-year old U.S. born resident 
with unknown vaccination history. The individual worked at an international company in 
Worcester County. Rash onset was May 15, 2005, occurring while on a bus trip back from 
Montreal. Symptoms included fever of 100.5, rash which started on face and spread to the rest of 
body, fading 6 days later, joint pain, sore eyes. The IgM on June 3 was positive at State lab. No 
clinical specimens were collected for viral isolation due to late notification. The case was 
infectious while visiting and traveling to and from Montreal. Health Canada was notified. 



Oregon  1 unknown source 

Oregon confirmed rubella in a resident who visited Boston during his exposure period. This U.S. 
born 46 year-old male was exposed while in Boston on May 24-26 while attending a large 
international conference. His vaccine history is unknown. Rash onset was 6/10, with red eyes, 
cough, lymphadenopathy, 104 temp. Blood collected appropriately on 6/14 was IgM 
strong positive at CDC and the IgG was positive but low positive. CDC requested additional 
serum. CDC also tested the avidity of the IgG - it was low, which is consistent with an acute case 
of rubella. Case flew to Atlanta and Boston during infectious period. NIP notified Div of 
Quarantine about the 5 flights involved during the 4 days prior to his rash (he flew from Portland 
to Atlanta on 6/6; to Boston on 6/7 and returned to Portland on 6/10). Contact names were 
shared with MA and GA. A viral specimen was obtained but was unsuccessful. A NH case were 
identified as result of the investigation of attendees at same conference. 

New Hampshire  2 cases 

New Hampshire confirmed rubella in a NH resident in an adult male who also attended the same 
meeting as the Oregon case above (both attended conference in Boston in late May). New 
Hampshire attendee had rash onset June 11. The wife of the New Hampshire case was also 
confirmed, rash onset June 28. 

 

Rubella, Congenital Syndrome (CRS) 

The current total for CRS in Week 34 remains 1 case compared to 0 cases for same period last 
year. The 2005 report is a child born in New Hampshire on November 4, 2004. This 10-week old 
infant had congenital cataract, patent ductus arteriosus, congenital heart disease; hearing 
loss, microcephaly, enlarged spleen, enlarged liver; and failure to thrive. Parents were Liberian 
refugees who came to the U.S. in February 2004 (they had been in Abidjan, Ivory Coast where 
rubella was occurring). The 25-year-old mother was vaccinated with rubella-containing vaccine on 
March 1--very early in her pregnancy. Date of mother's first prenatal care in U.S. was April 9 (her 
3rd child). CDC received clinical samples (throat swab and urine) and serum. The virus was not 
vaccine virus. Results from direct RNA extraction and RT-PCR were positive. The strain was 
closely related to the Uganda sequence. 

 

CRS from 2003 confirmed - import from Nigeria born in California 

California received a call in January 2005 from a geneticist who had just evaluated a 21 month 
old child with bilateral hearing loss. The child also had pulmonic stenosis and the mother, who 
was born in Nigeria and became pregnant in that country, recalled having had a febrile rash 
illness ("like heat rash") while in her first trimester of pregnancy (in Nigeria). The mother was 
uncertain of her vaccination history. She delivered at a Los Angeles hospital and the hospital 
requested both the mother's labor and delivery record and the infant's newborn record. 
The geneticist asked California to arrange rubella PCR testing on the newborn screening 
card. The infant had received an MMR at about 16 months of age so serology would not provide 
any useful information. CDC Rubella lab has completed testing of the blood spot from this 
potential CRS case and believes the results show that this patient was rubella IgM positive at 
birth and is a CRS case. CDC was unable to obtain a positive result for rubella RNA, probably 
because the viral RNA was degraded. The case was entered into the CRS registry for 2003 and 
will be included in Californias morbidity for CY2005. 

 

Mumps 

Sullivan County Summer Camp Outbreak - 31 cases 

Source: England (Epi-X posted Aug 1, 2005) 

New York State reported large MUMPS outbreak involving cases among international counselors 
and campers at summer camp in Sullivan County. Many of the campers had documentation of 2 
MMR doses. The index case was identified as a camp counselor from England. Four of 5 
serology specimens tested in the CDC lab were mumps IgM positive. 

 

U.S. mumps morbidity to date: 

A total of 23 of the 31 New York State mumps cases from a Sullivan County camp outbreak had 
been officially reported to MMWR by Week 33. The current U.S. total for mumps reported to 
MMWR by Week 34 (ending Aug 26) was 183 cases reported (from 31 grantees) compared to 
136 cases for same period of 2004. Eighty-one (42%) of cases are <15 years of age. For the 150 
cases (82%) where case status is known, 100 are confirmed and 50 are probable. Forty-five 
cases (24%) are laboratory confirmed. Of the 78 cases (43%) with known importation status; 65 
are indigenous and 13 are imported. A new import in Week 33 is the index (camp counselor from 
U.K.) in Sullivan County, NY outbreak. Of the 76 cases (41%) with known vaccination status, 58 
were vaccinated and 18 were not; or 32% of 183 cases are reported as vaccinated. Of the 103 
cases (56%) where race is known, 81 are White, 10 are Asian, and 8 are African American, 1 is 
Native American, & 3 are other. Of the 80 cases where Hispanic ethnicity is known, 6 are 
Hispanic. 

 

New York State - one possible mumps case at a second summer camp in Sullivan County 
(Florida resident). 

This patient may be lost to follow up per Florida but if possible CDC Measles Lab will test 
convalescent specimen on a possible mumps identified in August at a summer camper in Sullivan 
County, NYS. The probable case was a 9-year-old Florida resident (vaccinated) who was 
diagnosed on August 11 with otitis media and given augmentin. On August 16, he developed 
parotitis and was seen by an ENT on August 17. The serology sent to CDC by NYS was IgM 
indeterminate and IgG weakly positive at CDC. Seven of 8 boys in the same cabin with the sick 
boy had documentation of 2 MMRs. There was no known source of infection. 

 

Massachusetts reported 4 cases of mumps were laboratory confirmed among employees at 
a Boston Hotel (w/large international clientele). The index case was a 27-year-old Swedish born 
female with parotitis onset July 28, 2005, confirmed by positive IgM at a commercial lab. No history 
of travel during her exposure period. Three of her 14 direct contacts developed parotitis and 
fever during Aug 14-16 (now also confirmed by IgM). The secondary cases are co-workers aged 
25 to 36 years w/unknown vaccination histories. Of interest, the index case had at least 5 outpatient 
visits, receiving extensive testing including a CT scan before mumps was considered. Viral 
specimens were requested. Local board of health held 2 vaccine clinics where approximately 58 
persons were given MMR. Four refused and one was not able to be reached. There was one 
asymptomatic pregnant woman with unknown vaccination status who was referred to her physician 
for follow up. 

 

Pennsylvania - One mumps import from the U.K. 

On May 31, a 20 year old unvaccinated woman took a British Airways flight from Heathrow to JFK. 
She traveled by ground transportation to a camp in the Poconos where she is to work as a 
counselor. The following day, June1, she developed first unilateral then bilateral parotitis, an IgM 
was drawn was positive. No children were present, but 31 counselors had serum was drawn, 3 
were found to be susceptible and were vaccinated. No evidence of secondary spread to date, 2 
weeks later. The woman recovered uneventfully. JFK Quarantine Station was notified. 

Nassau County, New York reported a 4 year old girl with parotitis in day care, history of 1-dose 
MMR; source is her 41year old father with parotitis/orchitis (very high IgM). Growth from viral 
specimens collected on the child within 4 days of onset was unsuccessful. 

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Please send questions or comments to Gustavo Dayan M.D. , MMR Activity at NIP; or to Ms. Susan B. Redd at 
sbr1@cdc.gov; fax (404) 639-8665 or ph (404) 639-8763. We appreciate being informed of measles, rubella or 
mumps activity in your project area.