Epidemiologic Notes and Reports Multiple Measles
Outbreaks on College Campuses -- Ohio, Massachusetts,
Illinois
Since January 15, 1985, measles outbreaks have occurred on at
least three college campuses in the United States, with probable
spread to three additional campuses. The first outbreak, which
occurred at The Ohio State University and involved 12 confirmed
cases,
has been reported previously (1). The index patient acquired
measles
while traveling to London and Sierra Leone. Three additional
suspected cases are being investigated, and over 2,000 doses of
measles vaccine have been administered to students as part of the
control effort. Approximately 50,000 students are enrolled at this
university.
Boston University, in Massachusetts, has been the site of a
large
outbreak that began at the end of January. The index patient was a
student who had acquired measles while traveling in Venezuela and
developed onset of rash on January 29, 1985. As of March 12, 82
confirmed cases have been reported among students at Boston
University, which has approximately 28,000 students. In addition,
related cases appear to have occurred in two students at the
Massachusetts Institute of Technology, one student at Boston
College,
and two students at Northeastern University. To control the
outbreak,
Boston University required all students to provide proof of
immunity
to reenter school at the end of spring break on March 11. In
addition, 5,000 doses of measles vaccine have been administered to
students at college-based vaccination clinics. The Massachusetts
Department of Public Health is also working with all other
Boston-area
colleges to adopt similar programs to review their students' immune
status and vaccinate susceptibles. Eventually, all college
campuses
in Massachusetts will be contacted.
The largest outbreak has occurred at Principia College, a
Christian Science college in Illinois with an enrollment of 712
students, with 128 confirmed or probable cases (113 among students
and
15 among other residents) reported between January 15 and March 10.
In addition, three deaths apparently related to respiratory
complications from measles have occurred among students and
residents
at the college. Students are being required to remain on campus
unless they receive vaccine or produce other evidence of immunity.
To
date, approximately 421 doses of vaccine have been given to
students.
Possible related cases have occurred in Indiana, Michigan, and New
Jersey. One hundred thirty-nine students of 712 enrolled pupils
had
histories of previous immunity to measles. The source of the
outbreak
remains unknown.
Reported by TJ Halpin, MD, State Epidemiologist, Ohio Dept of
Health;
MA Barry, MD, Boston Health and Hospitals, JW Taylor, MD, Boston
University, PH Etkind, P Gallagher, GF Grady, MD, State
Epidemiologist, Massachusetts Dept of Public Health; CR March, CE
Jennings, RJ Martin, DVM, N Kramer, Jersey County Health Dept, BJ
Francis, MD, State Epidemiologist, Illinois Dept of Public Health;
Div
of Immunization, Center for Prevention Svcs, CDC.
Editorial Note
Editorial Note: A major problem in controlling measles outbreaks
in
colleges relates to the inability to determine who truly needs
vaccine, because immunization records are lacking. The presence of
records would allow rapid determination of susceptibles. The
current
spring breaks provide an excellent opportunity for students to
obtain
their immunization records before returning to campus. An
aggressive
approach, like that being taken by Boston University, will help
ensure
high levels of immunity and should end the outbreak quickly. The
requirement to provide proof of immunity, such as that at Boston
University, is much more effective than a voluntary vaccination
clinic
in ensuring that susceptibles are vaccinated.
The high attack rate (15.9%) at Principia College is
undoubtedly
due to these students' very low immunization levels. This outbreak
illustrates the potential severity of measles and the rapidity of
spread in an unvaccinated population. The very high apparent
death-to-case ratio (2.3%) is unusual in the United States, which
usually has a reported death-to-case ratio of 0.1% or lower. The
reasons for this high mortality are under investigation.
Since 1980, when data on measles in colleges first began to be
collected, at least 14 campuses have reported measles cases each
year. During 1983, the 296 cases reported among college students
accounted for 19.8% of all measles cases reported. If the present
trend continues, college students will again account for a
substantial
proportion of the remaining morbidity from measles. Because
susceptibility among college students may be as high as 15%, the
potential for sustained outbreaks exists. To try to prevent
outbreaks, the American College Health Association and the
Immunization Practices Advisory Committee have both recommended
that
colleges require proof of measles immunity as a criterion for
matriculation. To date, few colleges have such requirements, and
it
appears likely that measles will remain a problem in this
population.
It should be recognized that, for the next 5-7 years, a cohort of
college students will exist that will not have optimal vaccination
levels because its members were children during the start of the
vaccination programs. State health department and
college/university
authorities should carefully consider measures to help decrease the
vulnerability of this special cohort.
Reference
CDC. Measles on a college campus--Ohio. MMWR 1985;34:89-90.
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