KEYWORDS:
measles, vaccination policy, isolation

BACKGROUND:
A 19 year-old male arrived with 70 students in New York City from Japan on July 17, 2001 to attend a mini conference at a university. On July 18 the index developed a maculopapular rash which started on the face and spread to the trunk and the rest of the body, fever of 103 °F, cough and conjunctivitis; no known vaccination history

OBJECTIVE(S):
To conduct case investigation and outbreak control for measles

METHOD(S):
Index was taken to a local hospital emergency room on July 19 and sent back home without treatment; no isolation was implemented.
All local hospitals were put on alert and reinforced with weekly telephone calls.
Index was brought back to the ER, diagnosed with measles, admitted and put on respiratory isolation. Measles virus (identified as Japanese strain, Genotype D5) was isolated from nasopharyngeal swabs, blood, and urine samples.

RESULT(S):
15 patients were exposed in the ER and were notified; none required vaccination. No additional cases were reported in association with the outbreak.
120 people were screened; 93 of them were vaccinated (72 Japanese and 21 Americans). Although students were vaccinated with in 72 hours, three secondary cases were reported. Clinical specimens were obtained from these students; measles virus was isolated which matched the index case.

CONCLUSIONS(S):
Routine isolation procedures for fever/rash illness need to be strengthened and reinforced by health department officials.
Individuals who attend university for less than a semester should be required to provide proof of vaccination as is required for full semester students.

LEARNING OBJECTIVES:
Risk of measles importation in university settings and need for changes in existing secondary school immunization policies.