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Measles among Members of a Drum and Bugle Corps -- Arkansas, California, Kansas

Five cases of measles were reported among 150 members of a drum and bugle corps on summer performance tour of the United States. Rash onsets ranged from June 19, to July 17, 1983. Four cases were confirmed serologically.

The corps members were students from 16 states and England, who ranged in age from 14 to approximately 26 years. All were participating in local, regional, and national performance competitions with more than 100 other drum and bugle corps (with approximately 13,000 members) from the United States, Canada, and England.

The chain of transmission began with an international importation in a 17-year-old English citizen who arrived in the United States on June 17 and joined the drum and bugle corps in Hutchinson, Kansas. Although he gave a history of having received measles vaccine in England, no documentation was available. He had temporary lodging at the home of an American corps member in Kansas and had rash onset June 19. On June 22, he left Hutchinson with the corps as it began its 10,339-mile tour through 24 states (Figure 3). On June 30 and July 2, two additional cases occurred while the corps was in California; one of these patients was the American corps member with whom the English corps member had lodged. On July 17, two additional cases occurred while the corps was in Arkansas. The tour ended on August 19 in Miami, Florida, and the corps dispersed. No additional cases were reported among the other 100 drum and bugle corps.

When the first cases were reported, it was recognized that extensive transmission might occur among members of different corps throughout the country. To interrupt transmission, state immunization programs provided emergency immunization clinics at three competition sites: Arkadelphia, Arkansas, July 19; Cleburne, Texas, July 20; and Whitewater, Wisconsin, July 30 (Figure 3). Vaccine was offered to corps members at the competition as each corps completed its performance; these clinics lasted until 1-2 a.m. Approximately 1,000 corps members received either measles or combined measles-rubella (MR) vaccine, and over 500 additional members showed proof of immunity to measles.* In addition, 28 states established special surveillance for suspected measles cases at the sites of scheduled competitions. Reported by C Beets, J Miller, JP Lofgren, MD, State Epidemiologist, Arkansas Dept of Health; LG Dales, MD, J Chin, MD, State Epidemiologist, California Dept of Health Svcs; DE Wilcox, MD, State Epidemiologist, Kansas Dept of Health and Environment; Immunization Programs of the following states: Alabama, Arkansas, California, Colorado, Florida, Georgia, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Nebraska, New Jersey, North Carolina, Ohio, Oklahoma, Pennsylvania, South Carolina, Tennessee, Texas, Utah, Virginia, West Virginia, Wisconsin, Wyoming; Div of Immunization, Center for Prevention Svcs, CDC.

Editorial Note

Editorial Note: Although only four secondary measles cases occurred, this outbreak illustrates the potential for more extensive transmission across state lines when measles occurs in a highly mobile population, as has been reported previously (1). In this instance, although the originally affected group traveled over 10,000 miles in 8 weeks, extensive transmission did not occur. Most of the states they visited continued to be free of measles transmission.

At the competition sites, it was difficult to assess the immunity status of these teenagers and young adults; most could not show documentation of immunity to measles. Considering the high communicability of measles and the frequent face-to-face contact of corps members who traveled together, the limited extent of the outbreak probably resulted from preexisting high immunity levels among the corps members, rather than from the vaccination clinics. However, this was only known in retrospect. It is estimated that, nationally, 5%-15% of young adults may be susceptible to measles (2)--sufficient to sustain transmission for several generations, given adequate exposure. Since many of the corps members were in this age group, it was important to provide immunizations to members who might have been exposed to measles. The emergency immunization clinics were held until after midnight--when the corps members were returning to their buses--to maximize participation and minimize interference with the competitions. If documentation of measles immunity had been required of members before participation, such clinics would have been unnecessary.

Outbreaks from measles importations have been described previously (3), and imported measles cases continue to cause limited transmission in the United States. Communities can protect themselves from importations by achieving and maintaining high immunization levels. Investigations of imported cases should include a search for susceptible contacts at all points of the traveler's itinerary, as well as in the local community. Rapid, effective communication between many states and a highly motivated and responsive staff played a major role in the containment of this outbreak.

References

  1. CDC. Transmission of measles across state lines--Kentucky, New Hampshire, Tennessee, Virginia. MMWR 1982;31:123-5.

  2. CDC. Measles outbreaks on university campuses--Indiana, Ohio, Texas. MMWR 1983;32:193-5.

  3. Amler RW, Bloch AB, Orenstein WA, Bart KJ, Turner PM, Hinman AR. Imported measles in the United States. JAMA 1982;248:2129-33.

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