Friday, September 2, 2011

Measles in Refugee Center

The Montgomery County Health Department issued a press release September 2, 2011 alerting the public to two confirmed cases of measles. The index cases were two unvaccinated children who arrived in the U.S. on August 24. On Monday, August 29, they visited the Suburban Washington Resettlement Center, the Washington, D.C., branch office of the International Rescue Committee (IRC), located at 8700 Georgia Avenue, Silver Spring, MD. The IRC is an organization that helps refugees who have been invited by the U.S. to seek asylum here, helping them to get settled and rebuild their lives.

As reports, as part of its routine work, the center gives all incoming clients a health exam. It was during this exam that the measles virus was identified in the two children, however the children did not yet show signs of the disease. Since it is very likely that they were contagious at the time of their visit to the center, the health department says that anyone else who visited the building on the 29th "should be aware that they may have been exposed to measles."

Another aspect of this, and one that I have not seen reported in the few news articles covering the story thus far, is that the children were likely contagious over the period when hurricane Irene hit Maryland. As the children were refugees, they likely needed to go to a public shelter during the storm. If that did happen, that would expand the pool of potential contacts. However, this is speculation and should not be cause for alarm at this stage.

The other aspect to consider is that many of the individuals who visited the resettlement center on Monday were also likely refugees. The implications of this are that there may have been a large number of individuals who were from regions with poor health care infrastructure and potentially lower immunization rates. That means a greater risk of infection, and it is probably that we will see a large number of subsequent cases stemming from this incident.

Prior to these two cases, Maryland reported possible measles exposure between May 31 and June 3, as well as another case in July (PDF).

As with the latest outbreak in Minnesota, I will try to keep tabs on how this develops. Anyone who reads this and was possibly exposed or knows someone who may have been, I would urge you to be vigilant for any symptoms of measles and to contact your physician for advice on how to proceed. Measles often starts with cold-like symptoms: cough, watery eyes, runny nose and fever. This is followed by the appearance of a rash on the head and face, which gradually spreads down across the body to the arms, legs, hands and feet. If you think you may have been infected, it is important to contact the doctor's office before going there to reduce the chances of infecting others.

UPDATE: Post-exposure prophylaxis for measles involves administration of immune globulin (IG) to prevent infection. A friend of mine in the public health sector informed me that the dose required for prophylaxis following exposure to the measles virus is about .25mL of IG per kilogram, up to a maximum of 15mL. One 10mL vial of IG is about $200. The cost to treat all of the people exposed to a single case and who have unknown, incomplete or no immunity can run upward of $33,000.

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