title: Measles Outbreak Associated With International Travel, Indiana, 2011.
abstract: BACKGROUND
  Endemic measles was declared eliminated in the United States in 2000, but imported measles cases continue to cause outbreaks. On June 20, 2011, 5 epidemiologically linked measles cases were reported to the Indiana State Department of Health. We investigated to identify additional cases and to prevent further spread.
  
  
  METHODS
  Case findings and contact investigations during the June 3, 2011-August 13, 2011 outbreak identified measles cases, exposed persons, and exposure settings. Laboratory confirmation included measles serology and reverse-transcription polymerase chain reaction. Control measures included evaluating measles immune status and providing post-exposure prophylaxis, isolation, and quarantine.
  
  
  RESULTS
  Fourteen confirmed measles illnesses were identified (10 [71%] females; median age, 11.5 years [range, 15 months-27 years]). The source patient was an unvaccinated US resident who recently traveled from Indonesia. Twelve patients were unvaccinated members of the source patient's extended family. Two hospitalizations and no deaths were reported. Among 868 exposed persons identified through contact investigation, 644 (74%) had documented measles immunity, 153 (18%) were lost to follow-up, and 71 (8%) lacked evidence of immunity.
  
  
  CONCLUSIONS
  Misdiagnosis of measles in an unvaccinated patient with recent travel history to a measles-endemic region resulted in the second largest measles outbreak in the United States during 2011. Clinicians should consider measles among patients presenting with febrile rash illness and history of recent travel, and clinicians should promptly report suspected illnesses. Early identification of infectious patients, rapid public health investigation, and maintenance of high vaccine coverage are critical for the prevention and control of measles outbreaks.
authors.affiliation: Indiana State Department of Health, Indianapolis Epidemic Intelligence Service, Office of Workforce and Career Development.
authors.forename: Melissa G
authors.initials: MG
authors.lastname: Collier
authors.affiliation: Indiana State Department of Health, Indianapolis.
authors.forename: Angela
authors.initials: A
authors.lastname: Cierzniewski
authors.affiliation: Indiana State Department of Health, Indianapolis.
authors.forename: Thomas
authors.initials: T
authors.lastname: Duszynski
authors.affiliation: Noble County Health Department, Albion, Indiana.
authors.forename: Cheryl
authors.initials: C
authors.lastname: Munson
authors.affiliation: Indiana State Department of Health, Indianapolis.
authors.forename: Mona
authors.initials: M
authors.lastname: Wenger
authors.affiliation: Indiana State Department of Health, Indianapolis.
authors.forename: Brad
authors.initials: B
authors.lastname: Beard
authors.affiliation: Indiana State Department of Health, Indianapolis.
authors.forename: Ryan
authors.initials: R
authors.lastname: Gentry
authors.affiliation: Indiana State Department of Health, Indianapolis.
authors.forename: Joan
authors.initials: J
authors.lastname: Duwve
authors.affiliation: Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Preeta K
authors.initials: PK
authors.lastname: Kutty
authors.affiliation: Indiana State Department of Health, Indianapolis.
authors.forename: Pamela
authors.initials: P
authors.lastname: Pontones
keywords: Disease Outbreaks; Epidemiology; Measles; Measles-Mumps-Rubella Vaccine