Bureau of Epidemiology
Bureau of Epidemiology May 2000 Utah Department of Health
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Measles Outbreak in Summit County Associated with an International Traveler

The Bureau of Epidemiology has recently completed investigations on three confirmed measles cases in Summit County. These are the first reported cases of measles since 1996. Results of the investigations indicated that the first case whose onset was March 14, may have been exposed at an international snowboarding competition on March 4. Previously, the Bureau received a report of a suspected case of measles in a member of the U.S. snowboarding team at the same competition who became symptomatic while in Utah and was later lab confirmed in her home state. The other two Utah cases were employees of the healthcare clinic at which the first case was diagnosed. None of the cases have a history of receiving two doses of measles vaccine. As stated in the CDC Publication MMWR, dated September 3, 1999, “epidemiologic data for 1998 suggests measles is no longer an indigenous disease in the United States”. However, this outbreak emphasizes the fact that importations of measles with secondary spread continue to occur in the United States, which is what we must be prepared for with the Olympics just around the corner.

Measles is an acute, highly communicable disease characterized by a prodrome of fever and malaise, cough, coryza, and conjunctivitis, followed by a maculopapular rash. The incubation period is usually 10 to 14 days but can range from 7 to 18 days. Persons with measles are infectious from the time cold symptoms and fever begin (about 3-5 days before rash) and remain contagious for 4 days after rash onset. Measles should be included in the differential diagnosis of patients presenting with the following:

  • generalized, maculopapular rash

  • fever >38.3o (>101oF)

  • cough, coryza, or conjunctivitis

Measles infection is confirmed by serology or isolation of measles virus. The following are reliable confirmatory criteria for acute measles infection:

  • presence of measles specific IgM antibody in a single serum specimen
    -sera should be obtained at least 72 hours after rash on- set, if possible

  • significant rise in IgG antibody from paired acute and convalescent sera

  • positive viral culture for measles
    -specimens should be ob- tained during the febrile phase of the illness

Suspected cases of measles should be immediately reported by telephone to the Bureau of Epidemiology at (801) 538-6191.

Anyone exposed to measles should be evaluated for susceptibility. Those individuals who have had measles disease, were born before January 1, 1957, or have received two doses of MMR vaccine after 1967 are considered immune. Susceptible persons, including those who have received only one dose of measles vaccine, should be given measles vaccine (MMR) within 72 hours of exposure; or IG within six days of exposure, if possible, to prevent measles. Those who receive IG should be vaccinated five to six months later. Exposed, susceptible persons who do not receive MMR vaccine or IG to prevent measles should be isolated at home from 5 through 21 days following exposure.

The MMR vaccine is recommended for anyone born in the U.S. after January 1, 1957 who has not had two doses of measles vaccine after 12 months of age. Those who were immunized in 1963 through 1967 who received inactivated measles vaccine may be susceptible to atypical measles and should be revaccinated with live measles vaccine given in two doses one month apart.

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Influenza Surveillance for the 1999-2000 Season

To identify the virus type(s) associated with influenza morbidity and define the beginning and end of the influenza season, the Bureau of Epidemiology conducts surveillance each influenza season. “Influenza” is the category used in Utah’s morbidity reporting system to record cases of laboratory confirmed influenza. “Influenza-like illness” is the category used to report similar upper respiratory illnesses based on a physician’s clinical impression. Viral respiratory diseases dominate this category, with illness due to influenza, parainfluenza, respiratory syncytial virus and adenoviruses comprising the majority of morbidity. Symptoms associated with influenza and influenza-like illnesses include fever of 101 degrees or greater, malaise, chills, sore throat, myalgia, cough and coryza. Severity of illness varies, depending on a patient’s age and previous immunity. Surveillance for the 1999-2000 influenza season began the week of October 18, 1999, and continued weekly through March 11, 2000 . Surveillance participants included physicians’ offices, clinics, and university health centers. Various schools and school districts throughout the state also reported the number of students absent per week during the surveillance period.

There were 96 culture confirmed cases for the 1999-2000 surveillance season which is an increase over last season’s 84 culture confirmed cases. The first case was reported on November 12, nearly a month earlier than the first case was reported last season. Influenza activity peaked the week ending January 1, 2000. Of the 96 cultures, 95 were type A with 47 subtype H3N2 and one type B. Of the 84 culture confirmed cases seen during the 1998-99 season, 67 were type A with one subtype H3N2, and 17 were type B. Weekly rates of absenteeism among participating schools were calculated using student enrollment numbers and number of school days per week. Slight increases in absenteeism rates were seen during the weeks of the Thanksgiving and Christmas holidays but remained fairly consistent throughout the rest of the surveillance period. Similar to last season, absenteeism did not have the same increases that were seen in “influenza-like illness” reported by physicians. We wish to thank the following participants in the influenza surveillance project:

Mountain View Pediatrics
Coalville Health Center
Dr. Von S. Pratt
Canyon View Clinic
Dr. Barton Avery
Dr. Gary Harris
Sandy Instacare
Rose Park Instacare
Bountiful Instacare
Summit Health Center
Dr. Robert Frampton
Health Clinics of Utah
Medical Mall Instacare
Dr. Anthony Musci
Hurricane Family Clinic
USU Student Health Center
Box Elder Jr. High
Delta North Elementary
South Sanpete School District
Windridge Elementary
JA Taylor Elementary
Elkridge Middle School
West Jordan High School
Carbon School District
Washington School District
South Summit Elementary
Provo School District
Spanish Fork Junior High
Spanish Fork Middle School
Wasatch Middle School
Midland Elementary
Logan High School

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Early Rabies!!

Utah’s first reported case of bat rabies in 2000 occurred April 25th, nearly six weeks earlier than in 1999. The second rabid bat was reported on May 30th.

Rabies is an invariably fatal disease caused by a viral infection transmitted in the saliva of infected mammals. The virus enters the central nervous system of the host, whereupon reaching the brain, the infection may cause hydrophobia, intense thirst, paralysis, coma, confusion, disorientation, and respiratory failure. Meanwhile, the virus crosses into the mucous-producing cells of the salivary glands, enabling an animal to introduce infected saliva into a bite or scratch.

Extensive supportive care has rarely enabled some people to survive a rabies infection. Twenty-seven people in the U.S. died from the disease between 1990 and 1998. Dogs are the principal reservoir for the virus in undeveloped countries. However, in the U.S., the disease is primarily found among wild animals including raccoons, skunks, bats, foxes, and occasionally, in coyotes, wolves, and other carnivorous animals. These wild animals are responsible for infecting domestic animals like dogs, cats, and ferrets. In Utah, rabies is enzootic in the bat population.

Immunizing domestic dogs, cats, and ferrets; controlling stray and feral cats and dogs; and rapid follow-up on all human and animal exposures can accomplish prevention and control of rabies. If exposure to an animal has occurred, the steps in the algorithm should be followed. Call the Bureau of Epidemiology at (801) 538-6191 for a consultation, if needed.

For Rabies Algorithm click here

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Utah Department of Health, Bureau of Epidemiology
Monthly Morbidity Summary - May 2000 - Provisional Data

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The Epidemiology Newsletter is published monthly by the Utah Department of Health, Division of Epidemiology and Laboratory Services, Bureau of Epidemiology, to disseminate epidemiologic information to the health care professional and the general public.

Send comments to:  The Bureau of Epidemiology, Box 142104, Salt Lake City, UT 84114-2104, or call (801) 538-6191

Approval 8000008:  Appropriation 3705

Rod Betit, Executive Director, Utah Department of Health
Charles Brokopp, Dr.P.H., Division of Epidemiology and Laboratory Services
Craig R Nichols, MPA, Editor, State Epidemiologist, Director Bureau of Epidemiology
Gerrie Dowdle, MSPH, Managing Editor
Connie Dean, Production Assistant

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