Wisconsin DHS Health Alert #34: Measles Outbreak Associated with Operation Allies Welcome at Fort McCoy
Bureau of Communicable Diseases
October 8, 2021
Key Points
- DHS is working with the Monroe County Health Department and federal partners to investigate an outbreak of measles among people who recently traveled from Afghanistan as part of the United States government’s emergency evacuation efforts (Operation Allies Welcome).
- Between September 5 and October 8, a total of 22 cases of measles have been confirmed. To date, cases have occurred among persons currently living at Fort McCoy with recent history of travel from Afghanistan. No community transmission has been identified in Wisconsin. As of October 8, there are no known active cases of measles among the evacuees living at Fort McCoy.
- Health care providers in Wisconsin that may receive patients from Fort McCoy should be alert for patients who present with measles-like symptoms, take appropriate infection control precautions, and report suspected measles cases to their local health department.
- The risk of measles transmission in the general community is considered to be low at this time. However, individuals who have never been vaccinated and are exposed to a person with measles can spread the virus to others in the community, leading to outbreaks. DHS therefore strongly urges anyone born after 1957 who had contact with people living at Fort McCoy during September and October to confirm their vaccination history and notify their health care provider or local health department if they are not certain that they have immunity.
Background
Measles is a highly contagious, vaccine-preventable disease caused by the measles morbillivirus, transmitted through respiratory secretions and aerosols. On September 5, 2021, DHS was notified of a suspected case of measles in a person who had recently arrived to Fort McCoy from Afghanistan. A public health investigation was initiated in partnership with the Monroe County Health Department, CDC and other federal partners. The patient, who was likely infected prior to arrival in Wisconsin, was placed into isolation at Fort McCoy, and the patient’s contacts were placed in quarantine.
On September 14, in order to prevent further spread of measles to military bases and their surrounding communities, CDC ordered a halt on incoming flights and resettlement efforts until all evacuees could be vaccinated against measles and other communicable diseases and issued guidance for clinicians caring for individuals recently evacuated from Afghanistan.
Federal officials at Fort McCoy initiated a vaccination campaign that was completed during September 16-21, 2021. More than 11,000 doses of MMR, along with vaccines for COVID-19, polio, and varicella have been administered at Fort McCoy. This vaccination effort is expected to allow the quarantine for Afghan evacuees without prior evidence of immunity against measles to be lifted as early as October 12.
Between September 15 and October 8, 21 additional confirmed measles cases have been identified among Afghan evacuees based at Fort McCoy. These persons were likely exposed to measles before immunity from vaccination could take effect. Case-patients have ranged in age from 4 months to 26 years old (median 3 years old), and 14 (64%) have required treatment at hospitals in Wisconsin. As of October 8, all confirmed cases have completed their required period of isolation. There are currently no known active cases among evacuees at Fort McCoy.
It is possible that additional cases and hospitalizations from measles in Wisconsin may occur. DHS is working closely with CDC, the Monroe County Health Department, Wisconsin hospitals, and other federal agencies to investigate cases of measles and prevent spread to the Wisconsin community. To accomplish this, it is important for health care facilities in Wisconsin to be vigilant for patients with suspected measles, take appropriate infection control precautions, and report any suspected cases to their local health department.
Recommendations for health care facilities that may receive patients from Fort McCoy
Unvaccinated young children and other non-immune adults are at highest risk of serious disease from measles, which can include high fever, rash, and hospitalization for 1 in 4 people infected. People with known or suspected measles infection should be masked, isolated and placed in airborne and standard precautions immediately upon arrival to a facility; they should enter though a separate, dedicated entrance, if possible, to minimize exposure to other patients and staff. Facilities should coordinate with local EMS to ensure communication to and from receiving facilities in regards to suspected or known cases or evacuees from Fort McCoy to ensure appropriate infection prevention protocols. Healthcare personnel who may care for patients with known or suspected measles should ensure they possess presumptive evidence of immunity to measles. The following would qualify as presumptive evidence of immunity:
- Documentation of two doses of live measles vaccine
- Laboratory evidence of immunity
- Laboratory confirmation of past infection
- Birth before 1957 (those in this group who have never received the MMR vaccine should consider vaccination with two doses of MMR as per ACIP schedule)
All health care personnel caring for patients with known or suspected measles should use respiratory protection at least as protective as a fit-tested NIOSH-certified disposable N95 filtering facepiece respirator. Visitors and healthcare personnel without evidence of immunity should not enter these patients’ rooms. All patients presenting from Fort McCoy should be considered as having had potential exposure to measles and should be isolated in airborne and standard precautions. If a patient is unable to be placed in airborne isolation, the patient should be isolated in a private room (avoiding placement where room exhaust is recirculated without HEPA filtration), with the door closed and transferred to a facility with airborne isolation capabilities available as soon as possible.
Recommendations for the public
The risk of measles transmission in the broader Wisconsin community is considered to be low at this time. However, individuals who have never been vaccinated and are exposed to a person with measles can spread the virus to others in the community, leading to outbreaks.
The best way to prevent measles is to get vaccinated with the Measles, Mumps, Rubella (MMR) vaccine. Two doses of MMR vaccine are about 97% effective at preventing measles; one dose is about 93% effective. Prior to 1971, when MMR became widely available, millions of children in the United States were infected each year and 400-500 deaths occurred annually from measles. Today, due to successful childhood immunization programs, measles is considered eliminated in the United States (since 2000), although sporadic outbreaks can occur among populations with low vaccination coverage. Until now, no measles cases had occurred in Wisconsin since 2014.
DHS therefore strongly urges anyone born after 1957 who had contact with people living at Fort McCoy during September and October to confirm their vaccination history and notify their health care provider or local health department if they are not certain that they have immunity. Wisconsin residents can check their vaccination status in the Wisconsin Immunization Registry (WIR). Local health departments can provide MMR vaccine to uninsured children and adults based on vaccine ability and capacity.
DHS also recommends the following resources:
As a reminder, any Category I reportable disease should be reported to the local/tribal health department immediately for public health surveillance and response. You can stay up to date about measles in Wisconsin by visiting the DHS Disease Outbreaks webpage.
Thank you for your attention and collaboration.
Sincerely,
Ryan Westergaard, MD, PhD, MPH
Chief Medical Officer and State Epidemiologist for Communicable Diseases
Wisconsin Department of Health Services
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