What Happened?

An outbreak of measles in Utah began with a case in an unvaccinated Utah resident returning from Poland. Nine cases of measles were reported before the outbreak was declared over. The Utah Department of Health notified the Idaho Department of Health and Welfare that four Idahoans were exposed to people who had measles and were contagious at the time. One Idahoan was a resident of Eastern Idaho Public Health District and three resided in South Central Health District.

Why is this Important for Our Health?

Measles is a respiratory illness caused by a virus. Many older people recall having measles as a child and do not think it is a severe illness, but measles can be fatal. For every 1,000 children who get measles, one or two will die. Measles is highly contagious. The measles virus is spread by droplets of respiratory secretions when an infected person coughs, sneezes, or talks. Measles also can be spread through the air. Persons have acquired measles from being in a closed room 2 hours after a person with measles was in the room. Prompt recognition, reporting, and investigation of measles can limit the spread of disease through isolation of persons with measles and vaccination of susceptible persons who came in contact with the ill person.

What Health Care Providers Did

An infection control practitioner at a hospital reported a suspected case of measles to the Utah Department of Health. Health care providers tested the patient for measles to confirm the diagnosis.

What Public Health Districts Did

The Eastern Idaho Public Health District contacted the eastern Idaho resident, who was exposed in a hospital setting, and learned that she was pregnant and her husband had accompanied her to the hospital. Eastern Idaho Public Health District checked the vaccination status of both individuals and found that they had been vaccinated previously with a measles, mumps, and rubella-containing vaccine (MMR) and should be immune.

South Central Health District  contacted the southcentral Idaho residents, who were exposed at a religious event. Two exposed children less than five years old had never received MMR. South Central Health District recommended that the children stay home and the parents monitor and report any signs of illness during the incubation period. Unimmunized family members intended to obtain vaccination with MMR to provide immunity if exposure to measles occurred in the future.

What the Idaho Department of Health and Welfare Did

The Idaho Department of Health and Welfare informed public health districts about residents who were exposed to measles, provided consultation on control measures, and monitored for measles cases statewide. No cases were reported in Idaho. IDHW published an article in the Idaho Disease Bulletin which informed clinicians about the exposures and gave them recommendations for counseling potential overseas travelers, information on which countries were experiencing measles outbreaks, and recommendations for prevention of measles in healthcare facilities. 

What Happened?

A University of Idaho student was hospitalized for meningitis caused by the bacterium Neisseria meningitidis (also called meningococcal meningitis). Two students at the neighboring Washington State University had infections with Neisseria meningitidis resulting in pneumonia or meningitis in the previous 5 months. All three students have recovered.

Why is this Important for Our Health?

Neisseria meningitidis is carried in the nose and throat by up to 10% of adolescents and adults without causing any symptoms. Neisseria meningitidis bacteria are transmitted by direct contact with large droplets of respiratory secretions. About 10%–14% of persons who get meningitis or a bloodstream infection from Neisseria meningitidis die. A vaccine is available to help protect against some, but not all, strains of Neisseria meningitidis. College freshman living in dormitories are at increased risk for illness from Neisseria meningitidis and should be routinely vaccinated against it, as should adolescents.

What Health Care Providers Did

Health care providers diagnosed meningitis or pneumonia in the students, tested cerebrospinal fluid and blood for the cause of illness, reported the cases to public health officials as required by law, and successfully treated the patients. Health care providers gave preventive antibiotics to persons identified as being at risk for acquiring Neisseria meningitidis from the ill students. Health care providers also vaccinated students who were not current on their meningococcal vaccination.

What Public Health Districts Did

Public Health - Idaho North Central District reported the case to the Idaho Department of Health and Welfare (IDHW) and asked the hospital laboratory to send the bacteria from the student to IDHW for strain determination. They interviewed the student and persons who knew the student to determine who needed preventive antibiotics and who needed to watch themselves for fever and report to the doctor if they became ill. They worked with the University of Idaho to inform parents about the case, recommendations for meningococcal vaccination, and where their children could get vaccinated. The Public Health District also responded to questions from the public, the media, and health care providers

What the Idaho Department of Health and Welfare Did

The Idaho Department of Health and Welfare determined that the strain of Neisseria meningitidis from the Idaho student was serogroup Y, a strain included in the vaccine. IDHW contacted the Washington Department of Health to find out which strain the Washington students had: also serogroup Y. Both state health departments sent the bacteria recovered from the students to the Centers for Disease Control and Prevention for DNA “fingerprinting” which showed that the bacteria were closely related, but not identical. IDHW also provided meningococcal vaccine to healthcare providers for children through 18 years of age. State and local public health officials continue to monitor the student community for cases of severe illness caused by Neisseria meningitidis: no new cases have been reported as of July 2011.

What Happened?

An 80-year old Idaho man sought medical care for nasal congestion and changes to his voice. Medical treatment for allergies did not help and he was hospitalized for a surgical procedure to relieve blockage in his nasal passages. He subsequently became seriously ill. A tube had to be put in his airway and he was placed in the hospital’s intensive care unit. Corynebacterium ulcerans, a bacteria related to Corynebacterium diphtheriae, the cause of the similar illness, diphtheria, was recovered from the back of his nose and throat. He was treated with antibiotics and diphtheria antitoxin, but spent one month in the hospital before being discharged.

Why is this Important for Our Health?

Toxin-producing strains of the bacteria Corynebacterium diphtheriae and Corynebacterium ulcerans cause identical illness: sore throat, fever, a thick crust over the tonsils or the back of the throat or nose, with swelling of the neck in severe cases. Airway obstruction can occur. Death occurs in 5%–10% of persons who have respiratory illness from Corynebacterium diphtheriae. People can carry Corynebacterium diphtheriae bacteria in their throat without having any symptoms. Corynebacterium diphtheriae bacteria are spread from person to person by respiratory secretions. Corynebacterium ulcerans is acquired from contact with animals and is not known to spread from person to person. Disease caused by both bacteria can be prevented by vaccination with a vaccine that contains diphtheria toxoid.

What Health Care Providers Did

Health care providers treated the patient, obtained samples for testing for bacteria, and reported the case immediately to the Idaho Dept. of Health and Welfare when diphtheria was suspected, allowing prompt investigation and request for life-saving antitoxin. They also sent the recovered bacteria to the Idaho Department of Health and Welfare to see if the bacteria produced diphtheria toxin.

What Public Health Districts Did

The Public Health District interviewed the ill Idaho patient to find the source of his infection, but no exposure to animals was identified. The District also facilitated follow-up review of medical records to comply with special rules regarding the use of diphtheria antitoxin.

What the Idaho Department of Health and Welfare Did

The Idaho Department of Health and Welfare (IDHW) was paged on the weekend to provide assistance. The State Epidemiologist called the Centers for Disease Control and Prevention (CDC) for current guidance on treatment and prevention of Corynebacterium ulcerans. The State Epidemiologist requested diphtheria antitoxin be sent from the CDC, the only place it is available, to the hospital. The antitoxin arrived within 12 hours. The State Epidemiologist advised the hospital that preventive antibiotics were not needed for persons who were in close contact with the patient, avoiding unnecessary use of antibiotics, and reminded the hospital that all adults should receive a vaccine against diphtheria toxin every 10 years. IDHW also sent the recovered bacteria to the CDC to find out if the bacteria produced diphtheria toxin, which it did. This case was published in the CDC’s Morbidity and Mortality Weekly Report (MMWR) at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6003a4.htm.