Measles in Universities -- Indiana, 1983

During the first 2 months of 1983, 85 clinical measles cases were reported among university students in Indiana. Four had been serologically confirmed as of February 25. The cases occurred on two of the largest campuses in the state.

At Indiana University (enrollment 32,000), 67 cases have been reported, with rash onset ranging from February 11 through February 28. Two students required stays at the Student Health Center for observation. A voluntary immunization program was initiated on February 15, and over 9,000 students had been vaccinated by February 27. At Purdue University (enrollment 32,000), 18 cases have been reported, with rash onset from January 19 to February 18. Two students required hospitalization, and two other students' illnesses were consistent with atypical measles syndrome (1). A voluntary immunization program was initiated on February 3, and over 9,000 students had been vaccinated by February 27.

As a result of these measles outbreaks the State Board of Health, in cooperation with local health departments and university officials, has begun a state-wide immunization campaign to increase the level of measles immunity among the approximately 200,000 college and university students. Twenty-one of the 65 independent and public colleges and universities, which contain more than 90% of Indiana's college student population, currently have active vaccination programs. Reported by D Lotz, R Hongen, MD, Student Health Service, Indiana University; TW Sharp, MD, Monroe County Health Dept, G Chastain, CL Barrett, MD, State Epidemiologist, Indiana State Board of Health; Div of Immunization, Center for Prevention Svcs, CDC.

Editorial Note

Editorial Note: Measles outbreaks have been and continue to be reported from places where young adults are concentrated, such as colleges and universities. In 1980, more than 200 measles cases were reported from at least 36 colleges (2). In 1981, 101 cases were reported in 19 colleges in 11 states. In 1982, 115 cases were reported in 14 colleges in eight states, including an outbreak at Baylor University in Waco, Texas, with at least 80 confirmed measles cases (3). These outbreaks indicate that sufficient numbers of susceptibles may exist in college and university populations to sustain transmission when measles is introduced.

While past serologic studies have indicated that overall susceptibility to measles is low, there can be considerable variation within college population subgroups. In 1977, as many as 20% of University of California-Los Angeles students in some dormitories lacked detectable measles antibody (4). The high susceptibility rate in some college and university subpopulations is probably the result of four interactive factors: 1) many children growing up in the mid-1960s may have missed measles vaccination in the first years following licensure; 2) many students may not have been immunized under comprehensive school laws now in effect in many states involving students in kindergarten through 12th grade; 3) many colleges and universities lacked immunization requirements; 4) many students may have escaped natural measles infection because of decreasing transmission.

The high susceptability rates in some college populations, coupled with the high mobility of college students who may travel to countries where measles is endemic, increases the potential for measles outbreaks. While sources of the Indiana college outbreaks have not yet been determined, outbreaks at Harding College in Arkansas in 1981 and Baylor University in 1982 resulted from importations by students who acquired measles abroad (3,5).

Preventing measles in college-age populations is particularly important because the disease can be more serious in adults than in gradeschool-aged children. Persons 20 years of age and older have had the highest death-to-case ratio in recent years (6). In 1980, a 22-year-old student at the University of Minnesota developed measles complicated by encephalitis and died. In the Indiana outbreak, four of the 85 measles patients required either hospitalization or prolonged observation in the Student Health Center.

With spring break beginning at Purdue on March 4 and at Indiana University on March 11, physicians around the country should be alert to the possibility of measles as those students travel to other parts of the state and nation.

Identifying persons susceptible to measles during a measles outbreak is not only costly and a source of disruption to college routine but is also a major obstacle in control of the outbreak. In view of the importance of preventing measles in college students, the Immunization Practices Advisory Committee has recommended that officials strongly consider immunization requirements for college entry (7). Such requirements should include written documentation, with dates, of prior measles vaccination* or prior physician diagnosed measles disease, since undocumented parental or student histories have been demonstrated to be inaccurate (4,8). Even before vaccination requirements are instituted, university officials should aggressively urge that all college students be protected against measles.

References

1. CDC. Atypical measles--California, 1974-1975. MMWR 1976;25:245-6.

2. Hinman AR, Preblud SR. Epidemic potential of measles and rubella. J Am Coll Health Assoc 1980;29:105-9.

3. Walch T, Moellenberg R. Measles outbreak--Baylor University, September-October 1982. Texas Preventable Disease News, October 23, 1982.

4. Krause PJ, Cherry JD, Desada-Tous J, et al. Epidemic measles in

5. Hinman AR, Preblud SR. Epidemic potential of measles and rubella. J Am Coll Health Assoc 1980;29:105-9.

6. Walch T, Moellenberg R. Measles outbreak--Baylor University, September-October 1982. Texas Preventable Disease News, October 23, 1982.

7. Krause PJ, Cherry JD, Desada-Tous J, et al. Epidemic measles in young adults. Clinical, epidemiologic and serologic studies. Ann Intern Med 1979;90:873-6.

8. CDC. Measles, United States--Weeks 37-40, 1981. MMWR 1981;30:533-5.

9. CDC. Measles surveillance report no. 11, 1977-1981. Issued September 1982.

10. CDC. Rubella--United States, 1977-1980. MMWR 1980;29:378-80.

11. Preblud SR, Gross F, Halsey NA, Hinman AR, Herrmann KL, Koplan JP. Assessment of susceptiblity to measles and rubella. JAMA 1982;247:1134-7. *Vaccination should be with live vaccine on or after the first birthday.

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