CDC HEALTH ADVISORY
MARCH 18, 2004

Imported Case of Measles Identified on Airline Flight into Detroit and Cedar Rapids

On March 13, 2004, the Iowa Department of Health reported to CDC a case of measles in the infectious stage in Cedar Rapids, Iowa. The index case flew from New Delhi through the Detroit Metro Airport to Cedar Rapids Iowa on March 12th. Flight numbers: Northwest 039 from Amsterdam to Detroit, MI and Northwest 3786 from Detroit to Cedar Rapids. The Iowa Department of Health and the Michigan Department of Health have been contacting passengers to alert them to the possible exposure. On March 15, the Wayne County Health Department visited the Detroit Metro Airport to vaccinate the Customs and Border Protection personnel, airline personnel, and anyone else who was exposed.

CDC estimates that exposures to measles in a commercial aircraft occur an average 10-12 times per year in the United States. Over the past ten years, CDC has identified only three cases of measles, which apparently resulted from exposure in a commercial aircraft.

The case, which is now laboratory confirmed, occurred in a 19 year old male who is a US resident returning from travel to India where measles is endemic. The student not been vaccinated against measles.

Post exposure prophylaxis
Persons who might have been exposed, or who are at high risk of exposure to measles, should be evaluated to assure they are immune to measles. Persons generally can be presumed immune to measles if they have documentation of 2 doses of measles vaccine, laboratory evidence of immunity to measles, documentation of physician-diagnosed measles, or were born before 1957. Persons who are not immune should be given MMR vaccine or immune globulin according to ACIP recommendations.

Surveillance for potential secondary cases
State Public Health Departments should be alert to possible cases of measles in persons who traveled on Northwest # 039 and 3786 or their contacts. Measles is an acute disease characterized by fever, cough, coryza, an erythematous maculopapular rash and a pathognomonic enanthem (Koplik spots). Measles has an incubation period of 7-21 days and infected people are considered contagious from 4 days before to 4 days after the appearance of rash. Serologic (Measles IgM) testing is required to confirm the diagnosis. In addition to serologic specimens, programs should collect throat swabs or urine for viral isolation.

Further information on measles can be found at http://www.cdc.gov/ncidod/diseases/submenus/sub_measles.htm
http://www.cdc.gov/nip/publications/acip-list.htm

Categories of CDC Health Alert messages:
Health Alert: conveys the highest level of importance; warrants immediate action or attention.
Health Advisory: provides important information for a specific incident or situation; may not require immediate action.
Health Update: provides updated information regarding an incident or situation; unlikely to require immediate action.

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