From Kyrgyzstan to Atlanta – A Case of Measles on the Move

April 6, 2015

Each year, the first week of April marks National Public Health Week – a time to recognize the work and achievements of public health professionals everywhere. In Georgia, thousands of public health employees are dedicated to protecting the health and well-being of all Georgians. There are dozens of ways public health impacts lives every day – from restaurant inspections to immunizations to detecting and preventing disease. The following story is just one example of the positive effect of public health on an entire community.

There is an infant in Georgia who may one day learn what a stir he created with his arrival in Atlanta from Kyrgyzstan a few weeks ago. He brought with him the state’s first reported case of measles in three years.

Measles is easily spread when an infected person coughs or sneezes. Droplets from the nose or mouth become airborne, where they can remain infectious for up to two hours. A person with measles doesn’t have to be present for someone else to be infected.

Anyone can get measles if they are not vaccinated or if they don’t have measles immunity. Measles is serious and can lead to dangerous complications such as pneumonia, encephalitis, or death.

That’s the reason the DeKalb County Board of Health (District 3-5), the Georgia Department of Public Health (DPH), Children’s Healthcare of Atlanta (CHOA) at Egleston and the Centers for Disease Control and Prevention (CDC) mobilized as soon as lab tests done at the Georgia Public Health Lab (GPHL) confirmed the measles diagnosis. The work began immediately to trace the child’s whereabouts while he was symptomatic and identify anyone who may have been exposed and who might be at risk for measles.

The contact investigation began with the trip from Kyrgyzstan. With the assistance of a translator, as the parents did not speak English, it was determined that the infant was exposed to measles in a clinic in Kyrgyzstan on Jan. 25. By the time the family arrived in Atlanta on February 5 after making connecting flights in Istanbul and Chicago - where the family spent the night in a hotel - the infant had developed a full body rash, congestion, conjunctivitis and a high fever.

The family was met at Hartsfield Jackson International Airport by staff members of a refugee agency working to help them move into an apartment in DeKalb County. The next day, the family visited a health clinic in DeKalb County, and eventually brought their very sick infant to the Emergency Department at Children’s Healthcare of Atlanta.

“The hospital staff suspected measles and immediately placed the infant in airborne isolation and requested assistance from public health to perform testing to confirm their preliminary diagnosis,” said State Epidemiologist Cherie L. Drenzek, DVM, MS. “Specimens were collected and hand carried to the Georgia Public Health Laboratory and within hours, the lab confirmed the state’s first case of measles since 2012.”

The contact investigation was substantial and involved the CDC, the Illinois Department of Public Health, the Cook County Health Department, Georgia DPH, the DeKalb County BOH (District 3-5) and CHOA.

The flight manifest for the Chicago to Atlanta trip was obtained with the help of the CDC’s Division of Migration and Quarantine. Passengers seated in rows directly in front of, in back of and across from the sick infant had to be contacted, notified of exposure and evaluated for immunity.

Public health employees collected the same information from the health clinic, the refugee agency and neighbors living near the family’s new apartment. Infection control personnel from CHOA provided a list of all clients and employees who were in the Egleston emergency department from the time the patient arrived until two hours after he was placed in airborne isolation.

Already this 9 month old had exposed more than 300 people in Georgia to measles - 163 individuals at the hospital, 149 people at the health clinic, 13 passengers on the flight from Chicago, and 8 staff members of the refugee agency and neighbors at the apartment. Of those, 33 individuals were determined to be susceptible or lacked immunity to measles.

With the help of the DPH Office of Pharmacy and DPH Immunization section, outpatient clinics were set up for prophylaxis treatment at CHOA and at the DeKalb County Board of Health. Measles, Mumps, Rubella vaccine (MMR) can serve as post-exposure prophylaxis if given within three days of exposure. Individuals who can’t have MMR vaccine because of the live virus it contains, or individuals who can’t be contacted within three days, are given immunoglobulin up to six days after exposure.

Ten children who were identified as at risk for measles failed to keep their appointments for prophylaxis. Epidemiologists actively monitored them daily by telephone throughout the remaining two weeks of their incubation period. They were asked to stay home from daycare and remain away from other susceptible people to prevent further spread of the disease.

Out of an abundance of caution, even the children who received prophylaxis were monitored twice weekly and asked to remain out of the daycare setting.

February 27 was the last day of the measles incubation period and Georgia did not document any secondary measles cases. Also by this time, the little guy from Kyrgyzstan who started it all had been released from the hospital and was reportedly doing fine.

This investigation highlights the large public health burden associated with investigation of a single measles case. Even with high vaccination levels, susceptible persons such as infants and immunosuppressed individuals will continue to exist in our communities. Extensive collaboration and communication between healthcare providers, local and state public health, and other agencies are critical to rapidly identify, provide prophylaxis, and monitor susceptible persons.       

“Events like this test the public health system and its response. Watching the seamless coordination between DPH, Children’s Healthcare of Atlanta, CDC, and District 3.5 demonstrates that when it comes to infectious disease tracking, investigation, and response, these agencies are up to the task,” said District 3-5 Health Director, S. Elizabeth Ford, M.D., MBA.

In this global community of constant travel, new cases of infectious disease can become outbreaks in a matter of hours. We can stop outbreaks before they happen - vaccination is our best protection against measles and a host of other infectious diseases.

To learn more about measles and MMR vaccine visit dph.georgia.gov/measles.

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February 16, 2015

The Georgia Department of Public Health (DPH) has confirmed the state’s first reported case of measles since 2012. The infected infant arrived in Atlanta from outside of the U.S. and was taken to Egleston at Children's Healthcare of Atlanta (CHOA). The child was released from the hospital last week. DPH is working with CHOA, the DeKalb Board of Health, and the Centers for Disease Control and Prevention (CDC) to identify anyone who may have been exposed to the patient and to prevent further spread of measles.