Stephen G. Baum, MD

Two young adopted children from China had measles symptoms on arrival in the U.S. and spread the infection to others.

In 2000, endemic measles was declared eliminated in the U.S. Nonetheless, outbreaks continue to occur in this country due to importation by travelers and a population that is less than universally vaccinated.

On July 5, 2013, the CDC was notified of two laboratory-confirmed cases of measles in children (a boy and a girl, both 2 years old) recently adopted from an orphanage in Henan Province, China. Investigation revealed that both were ill prior to departure. The boy had rhinorrhea and cough 10 days before travel; the rash that developed 5 days later was misdiagnosed at his preimmigration examination as contact dermatitis. The girl was febrile — but without other symptoms — 5 days before travel, at her preimmigration examination. Hours thereafter (as investigators subsequently learned), she developed cough, fever, and conjunctivitis, followed 2 days later by a rash on her face and neck. On July 4, the two children traveled to the U.S. on separate flights. Both were hospitalized soon after arrival and, when measles was confirmed by serology and polymerase chain reaction, were placed on isolation precautions.

The CDC identified 83 airline passengers and crew members who met exposure criteria, including two who were potentially susceptible, but no secondary cases were reported among them. However, two cases related to the index cases were identified. One was in another child adopted from China, who was exposed to the first two during the predeparture emigration process. The second occurred — despite measles vaccination — in the adoptive mother of one of the children. None of the children had been vaccinated against measles.

Citation(s):

Nyangoma EN et al. Measles outbreak associated with adopted children from China — Missouri, Minnesota, and Washington, July 2013. MMWR Morb Mortal Wkly Rep 2014 Apr 11; 63:301.