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Epidemiologic Notes and Reports Measles Outbreak -- New York City

Thirty-four confirmed and probable cases of measles were identified among residents of East Harlem by the New York City Department of Health from February 8, to May 23, 1984. Eighteen cases occurred among females; ages of all patients ranged from 8 months to 24 years (median 5 years) (Figure 2). Thirty-one cases (91%) occurred among Hispanics. Onsets of rash occurred between February 8 and May 23. No additional suspected cases have occurred.

Measles was discovered simultaneously in two areas of East Harlem; a common source of infection was not identified. Exposure occurred in several hospitals and in the community but not in any single location; elementary schools were affected but had no concentrated outbreaks.

Nineteen cases were confirmed serologically or through confirmed epidemiologic links; other cases could not be conclusively linked. Thirteen cases were vaccine failures; nine occurred among children under 16 months old; and one occurred in a schoolchild who had not been vaccinated because of a history of physician-diagnosed measles. None of the cases was imported. Of the 11 (32%) preventable cases, five involved children under 6 years old who were not enrolled in day-care centers or preschool, and four involved adults 19-24 years old. These nine cases were defined as "hard-to-reach." Although conclusive epidemiologic links have been shown for only 19 (56%) of the 34 cases, this outbreak probably represents a single extended chain of transmission involving up to seven generations of spread.

Editorial Note

Editorial Note: nA previous large outbreak of measles, involving primarily preschool-aged and school-aged Hispanic children, occurred in the Bronx in the spring of 1983 (1). Unlike the current East Harlem outbreak, several Bronx cases were traced to an imported case from Puerto Rico.

In early April, to control the spread of measles, particularly among the young preschoolers involved in the current outbreak, the New York City Department of Health increased vaccination clinic hours from 3 to 24 hours of clinic time and recommended measles vaccination for children aged 6 months through 11 months in the outbreak area. Subsequent reimmunization with measles-mumps-rubella vaccine at 15 months of age was recommended for all children vaccinated before the first birthday. The New York City Department of Health also recommended that Harlem children 12 months old or older be vaccinated with combined measles-mumps-rubella vaccine (2). This early immunization policy was discontinued on June 20 after active surveillance revealed no new cases for 4 weeks (two incubation periods of measles). Reported by City Health Information, Vol. 3 (August 1-8, 1984), New York City Dept of Health; Div of Field Svcs, Epidemiology Program Office, CDC.

References

  1. Rutherford GW, Desilva JM, et al. The epidemiology of measles in New York City, 1983: the role of imported cases. 19th Annual Immunization Conference, Boston, Massachusetts, May 22, 1984.

  2. ACIP. Measles prevention. MMWR 1982;31:217-24, 229-31.

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