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Epidemiologic Notes and Reports Multiple Measles Outbreaks on College Campuses -- Ohio, Massachusetts, Illinois

Since January 15, 1985, measles outbreaks have occurred on at least three college campuses in the United States, with probable spread to three additional campuses. The first outbreak, which occurred at The Ohio State University and involved 12 confirmed cases, has been reported previously (1). The index patient acquired measles while traveling to London and Sierra Leone. Three additional suspected cases are being investigated, and over 2,000 doses of measles vaccine have been administered to students as part of the control effort. Approximately 50,000 students are enrolled at this university.

Boston University, in Massachusetts, has been the site of a large outbreak that began at the end of January. The index patient was a student who had acquired measles while traveling in Venezuela and developed onset of rash on January 29, 1985. As of March 12, 82 confirmed cases have been reported among students at Boston University, which has approximately 28,000 students. In addition, related cases appear to have occurred in two students at the Massachusetts Institute of Technology, one student at Boston College, and two students at Northeastern University. To control the outbreak, Boston University required all students to provide proof of immunity to reenter school at the end of spring break on March 11. In addition, 5,000 doses of measles vaccine have been administered to students at college-based vaccination clinics. The Massachusetts Department of Public Health is also working with all other Boston-area colleges to adopt similar programs to review their students' immune status and vaccinate susceptibles. Eventually, all college campuses in Massachusetts will be contacted.

The largest outbreak has occurred at Principia College, a Christian Science college in Illinois with an enrollment of 712 students, with 128 confirmed or probable cases (113 among students and 15 among other residents) reported between January 15 and March 10. In addition, three deaths apparently related to respiratory complications from measles have occurred among students and residents at the college. Students are being required to remain on campus unless they receive vaccine or produce other evidence of immunity. To date, approximately 421 doses of vaccine have been given to students. Possible related cases have occurred in Indiana, Michigan, and New Jersey. One hundred thirty-nine students of 712 enrolled pupils had histories of previous immunity to measles. The source of the outbreak remains unknown. Reported by TJ Halpin, MD, State Epidemiologist, Ohio Dept of Health; MA Barry, MD, Boston Health and Hospitals, JW Taylor, MD, Boston University, PH Etkind, P Gallagher, GF Grady, MD, State Epidemiologist, Massachusetts Dept of Public Health; CR March, CE Jennings, RJ Martin, DVM, N Kramer, Jersey County Health Dept, BJ Francis, MD, State Epidemiologist, Illinois Dept of Public Health; Div of Immunization, Center for Prevention Svcs, CDC.

Editorial Note

Editorial Note: A major problem in controlling measles outbreaks in colleges relates to the inability to determine who truly needs vaccine, because immunization records are lacking. The presence of records would allow rapid determination of susceptibles. The current spring breaks provide an excellent opportunity for students to obtain their immunization records before returning to campus. An aggressive approach, like that being taken by Boston University, will help ensure high levels of immunity and should end the outbreak quickly. The requirement to provide proof of immunity, such as that at Boston University, is much more effective than a voluntary vaccination clinic in ensuring that susceptibles are vaccinated.

The high attack rate (15.9%) at Principia College is undoubtedly due to these students' very low immunization levels. This outbreak illustrates the potential severity of measles and the rapidity of spread in an unvaccinated population. The very high apparent death-to-case ratio (2.3%) is unusual in the United States, which usually has a reported death-to-case ratio of 0.1% or lower. The reasons for this high mortality are under investigation.

Since 1980, when data on measles in colleges first began to be collected, at least 14 campuses have reported measles cases each year. During 1983, the 296 cases reported among college students accounted for 19.8% of all measles cases reported. If the present trend continues, college students will again account for a substantial proportion of the remaining morbidity from measles. Because susceptibility among college students may be as high as 15%, the potential for sustained outbreaks exists. To try to prevent outbreaks, the American College Health Association and the Immunization Practices Advisory Committee have both recommended that colleges require proof of measles immunity as a criterion for matriculation. To date, few colleges have such requirements, and it appears likely that measles will remain a problem in this population. It should be recognized that, for the next 5-7 years, a cohort of college students will exist that will not have optimal vaccination levels because its members were children during the start of the vaccination programs. State health department and college/university authorities should carefully consider measures to help decrease the vulnerability of this special cohort.

Reference

  1. CDC. Measles on a college campus--Ohio. MMWR 1985;34:89-90.



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