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Epidemiologic Notes and Reports Interstate Importation of Measles Following Transmission in an Airport--California, Washington, 1982

Nine serologically confirmed measles cases in Washington State, with rash onsets from January 1 to January 26, 1982, were epidemiologically linked to an out-of-state importation from California.* The index case, a 27-year-old naval officer from San Diego, had rash onset on December 21, 1981. He had acquired measles in San Diego from a 2-year-old child who was not a military dependent. The officer traveled to Washington on December 20 and returned to California on December 23. His illness was diagnosed at a San Diego naval base and was reported to the San Diego County Health Department. California health officials reported the case to Washington health officials.

Ultimately, nine other cases, reported from five counties in western Washington, were epidemiologically linked to this officer. The seven first-generation cases occurred among persons from 9 to 37 years of age; one case occurred in a 30-year-old woman who managed the Bachelor Officers' Quarters (BOQ) where the officer stayed. Another occurred in a passenger on the officer's return flight to California. The remaining five cases occurred among persons who were at the Seattle-Tacoma airport on December 23. On that day, the officer had been in many parts of the airport. These five persons with measles visited at least one of the three departure gates visited by the officer that day. Thus, of the seven first-generation cases, only the BOQ manager could identify face-to-face contact with the index case. Reported by D Ramras, MD, S Ross, County of San Diego Dept of Health Svcs, L Dales, MD, J Chin, MD, State Epidemiologist, California Dept of Health Svcs; M O'Donnell, W Fisher, MD, Bremerton-Kitsap County Health Dept, S Garlick, MD, Clallam County Health Dept, K Johnson, C Nolan, MD, Seattle-King County Health Dept, K Carroll, C Hyatt, MD, Snohomish County Health Dept, E Peterson, R Nicola, MD, Tacoma-Pierce County Health Dept, K Cahill, J Kobayashi, MD, State Epidemiologist, Washington State Dept of Social and Health Svcs; Div of Immunization, Center for Prevention Svcs, CDC.

Editorial Note

Editorial Note: Interstate transmission of measles can be recognized when indigenous transmission is very low or absent (1) and when suspected cases are investigated thoroughly. The investigation of this outbreak was facilitated by efficient communication at many levels. The index case was reported from a military base to the local health department and then to California health officials. Their report to Washington health officials made it possible to epidemiologically link a small number of cases from several counties. Thus, Washington health officials could identify a chain of transmission and advise all local health departments to intensify surveillance.

Although measles is generally considered most contagious before rash onset (2), this outbreak illustrates that some patients are infectious up to 3 days after rash onset. Face-to-face contact with the index case was documented only for one of the seven secondary cases, suggesting that an infectious aerosol at the airport might have been the mode of transmission to the others (3,4). However, it is also possible that the persons unknowingly came in close contact with the index case.

During this outbreak, high immunity levels against measles were confirmed by reviews of school and day-care-center records in the five Washington counties where the cases occurred. Active surveillance and investigation of rash illnesses were intensified throughout Washington during the outbreak, and all suspected cases were investigated rapidly while laboratory confirmation was pending. No measles cases occurred more than two generations after the importation from California. Importations usually cause little morbidity when immunization levels are high (5).


  1. CDC. Transmission of measles across state lines--Kentucky, New Hampshire, Tennessee, Virginia. MMWR 1982;31(10):123-6.

  2. Krugman S, Katz SL. Measles (rubeola). In: Infectious diseases of children. 7th ed. St. Louis: Mosby 1981:144-61.

  3. Williams RE. Intramural spread of bacteria and viruses in human populations. Annu Rev Microbiol 1960;14:43-64.

  4. Langmuir AD. Changing concepts of airborne infection of acute contagious diseases: a reconsideration of classic epidemiologic theories. In: Airborne contagion. Kundsin RB, ed. New York: Annals of the New York Academy of Sciences 1980;353:35-44.

  5. Amler RW, Bloch AB, Orenstein WA, Bart KJ, Turner PM Jr, Hinman AR. Imported measles in the United States. JAMA 1982;248(17):2129-33.

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