Measles in Georgia, 2002 - 2012

BACKGROUND: Measles elimination has been maintained in the U.S. over the past decade through population immunity due to high vaccination coverage. However, despite greater than 90% coverage with one dose of measles, mumps, and rubella (MMR) vaccine nationally and an estimated 92% coverage among GA children aged 19-35 months, sporadic cases and outbreaks linked with international travel from measles endemic areas continue to occur. A review of measles cases in GA over the past decade supports these findings.

METHODS: Georgia healthcare providers are required by law to immediately report patients with measles to public health authorities.  We analyzed the notifiable disease database for measles cases from 2002 through 2012. A measles case was considered confirmed if it was laboratory confirmed, or met the clinical case definition and was epidemiologically linked to a confirmed case. Laboratory confirmation was made by detection in serum of measles-specific IgM, isolation of measles virus, or detection of measles virus by nucleic acid amplification. Cases were considered imported if the measles exposure occurred outside of the U.S. in the 7-21 days before rash onset, rash occurred within 21 days of entering the country, and there was no known exposure to measles in the U.S. during that time.

RESULTS: All ten measles cases confirmed in Georgia between 2002 and 2012 were associated with importations.  Six cases were directly imported from measles endemic areas – 2 were U.S. residents returning from overseas, 2 were foreign visitors, and 2 were recent immigrants. Four cases were U.S. residents with no history of travel. Two non-travelers visited an international airport in the 21 days prior to rash onset, and two non-travelers were epidemiologically linked to laboratory confirmed import associated cases. The median age of case-patients was 26.5 years (range 7 months to 54 years). Six case-patients were unvaccinated, one had unknown vaccination status, and three were partially vaccinated. Eight patients were MMR vaccine eligible. Three patients were hospitalized.

CONCLUSIONS: The epidemiology of confirmed measles cases in GA over the past decade mirrors national patterns. Importation of measles and the existence of susceptible residents in GA remain two key factors contributing to measles transmission. Most cases were associated with foreign travel and occurred in unvaccinated or under vaccinated persons. Timely reporting, isolation of suspect cases, and vaccination of all eligible persons, including travelers, with measles- containing vaccine are important preventive measures healthcare providers can implement in GA.