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
CDC. Transmission of measles across state lines--Kentucky, New
Hampshire, Tennessee, Virginia. MMWR 1982;31:123-5.
CDC. Measles outbreaks on university campuses--Indiana, Ohio,
Texas. MMWR 1983;32:193-5.
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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