Health officials in the Northeast are on the lookout for measles, spread by a young Italian woman who arrived from Europe by plane on April 12, and developed the telltale fever and rash the next day in Rhode Island. A man from Camden County, N.J., already has been diagnosed with a "probable case" of measles linked to the woman.
Health officials in New Jersey have issued a public health alert for anyone who patronized several popular big-box stores and restaurants the man had visited in the days before and including Easter Sunday, when he began to develop measles symptoms.
"These infectious diseases have no borders," Dr. Christina Tan, the New Jersey state epidemiologist, said Friday. As of Friday, the New Jersey Department of Health and Senior Services had not heard of any new cases linked to the Camden County man, she said. From April 21 to 24, days when he would have been highly contagious, the man visited a Home Depot, Kohl's, Wal-Mart, and a Toys-R-Us in the Cherry Hill area, as well as a nursery in Magnolia, a Lowe's in Lawnside, and a children's restaurant in Collingswood.
Those four days coincided with two major holidays, the Jewish holiday of Passover, April 18-26, and Easter Sunday on April 24, when the stores were filled with shoppers, many buying food, flowers, clothing and other items for family celebrations.
The state advised people who may have gone to the stores to remain vigilant until May 15 for signs and symptoms of the measles. Anyone who suspects they were exposed should call a health provider before heading to a medical office or hospital emergency room, to allow for proper precautions to reduce the chances of infecting fellow patients as well as health care workers.
The Italian traveler, described by Rhode Island health officials as in her 20s, began feeling ill and sought medical attention after arriving by car in Rhode Island on April 13. The doctor who treated her notified the Rhode Island Department of Health about the likely measles infection, subsequently confirmed with blood tests. The woman agreed to be isolated while recuperating, the health department said. The Providence Journal reported that Rhode Island hadn't had a measles case in 20 years.
New Jersey's Tan said she believed that the Camden County man was exposed in Rhode Island. The sick man, described only as being in his 30s, began developing measles symptoms on Easter Sunday, the same day that Camden County health officials said he attended a party with about 25 people.
The measles virus can hitch a ride on tiny droplets in the air when an infected person talks, coughs or sneezes. It produces a telltale rash, along with fever, runny nose, watery eyes, aches, and other flu-like symptoms. Measles complications include pneumonia and dangerous brain inflammation called encephalitis. Pregnant women who become infected can miscarry or deliver a premature baby.
Because measles spreads easily in confined areas, such as airports and airplanes, the federal Centers for Disease Control and Prevention in Atlanta has been working with health officials in New York to identify passengers and crew who were on the same flight as the Italian woman.
Tan called the latest measles cases reminders about "the importance of getting vaccinated." Even though New Jersey has good vaccination rates, "we always have to be cautious about imported disease," she said.
The United States, which for years has made universal vaccination with the measles/mumps/rubella (MMR) vaccine a public health goal, pronounced measles vanquished in 2000. However, the CDC has repeatedly warned of the increasing dangers from infections that originate elsewhere, including countries where measles remains endemic, such as Great Britain, Switzerland, France and Spain. Some parents there object to the vaccination of their children, complicating the job of public health officials.
Many of those parents are convinced that the MMR vaccine causes autism, even though health agencies say that's coincidental: autism typically appears when children are toddlers, at about the time they receive scheduled vaccinations. Parents' fears were stoked by a now-discredited 1998 report from Dr. Andrew Wakefield, a U.K. doctor who claimed to have established a link between autism and the MMR vaccine. The paper he wrote for The Lancet, a major journal, has been withdrawn.
On April 11, the CDC recommended that U.S. families traveling or living abroad take extra precautions to make sure they're fully vaccinated. In the meantime, the CDC and several state health agencies have issued public health alerts to minimize contagion when foreigners with confirmed cases of the disorder have become sick while in this country.
In another case, the New Jersey health department continues investigating potential exposures involving two French women who developed measles symptoms on April 10, three days after they arrived in the state. Both subsequently recovered, but were infectious when they attended a party on April 10 at a restaurant in Livingston, N.J. Patrons exposed on that day could develop symptoms as late as this Sunday.