Three recent cases illustrate that many vaccine preventable illnesses that are uncommon in the US are literally only a plane ride away. They also illustrate how prompt reporting to Public Health can facilitate rapid laboratory testing, isolation of cases, and identification of persons at risk for infection.

On Friday, December 8, 2006, a traveler from Europe arrived at Seattle-Tacoma International Airport (Sea-Tac) on a flight from San Francisco. After taking a taxi to the hotel, the traveler immediately sought medical attention for severe cough, coryza, conjunctivitis, and a rash that had started on the face and spread to the trunk and upper extremities. An astute clinician suspected measles and notified Public Health immediately. A blood specimen was collected and transported to the Washington State Public Health Laboratory (WAPHL) the following morning for measles IgM testing. Public Health worked with the healthcare facility, hotel, taxi company and airline to contact persons potentially exposed to the measles case.

On Saturday, January 6, 2007, an adult Snohomish County resident arrived at Sea-Tac airport on a flight from Thailand via Korea. On January 9th, the traveler sought care at a King County hospital emergency department (ED) for a full body maculopapular rash, cough and severe diarrhea. The patient was promptly placed in an isolation room and Public Health notified. A blood specimen was collected for measles IgM testing and measles was confirmed at the WAPHL the following day. Public Health worked with the medical facility and Snohomish Health District to identify and contact other persons who may have been exposed.

On Monday, January 15, 2007, a patient who had visited a King County ED with suspected mumps was identified by Public Health through review of ED syndromic surveillance data. Follow-up revealed that the patient, an exchange student who had arrived from Japan on January 3, had bilateral parotitis. The student had no record of mumps immunization, not surprising since Japan does not routinely vaccinate for mumps. Unfortunately, the blood specimen collected for mumps testing had been sent to an out-of-state commercial lab for mumps IgG testing only. Public Health requested that the ordering physician submit an additional order for mumps IgM testing. The specimen was mumps IgG negative (indicating that the patient was susceptible), and mumps IgM negative. However, the specimen was collected on day 2 of symptoms and mumps IgM is only reliably detectible on day 4 or later. A buccal specimen collected on January 17 by a Public Health Nurse tested positive for mumps using RT-PCR at the WAPHLA.

There were no secondary cases from the December case of measles in the European traveler. The risk of measles to King County residents after contact with the traveler flying from Thailand is considered low; the last day that a possible contact might show symptoms of measles is through January 30th. Because measles remains endemic in much of the world, clinicians should assure both children and adult patients are up to date for measles (MMR) vaccine. Please remember that persons who travel outside of the US should receive 2 doses of MMR. Infants 6 to 11 months traveling to a measles endemic area should receive a dose of monovalent measles vaccine before departure (MMR may be given).

Exposed, susceptible contacts of the patient with mumps may develop symptoms through February 9th. Mumps is characterized by fever, headache, myalgia, malaise and anorexia followed several days later by onset of bilateral or unilateral parotitis. Suspect mumps for any patient who has parotitis without another apparent cause.

Please notify Public Health at 206-296-4774 immediately to report patients with suspected measles or mumps. (24 hours a day, 7 days per week).