Minnesota Department of Health (MDH) Bug Bytes
February 27, 2001
Vol. 2: No. 5
1. Measles Alert
On February 22, a pediatrician reported to us a suspect case of measles in a Hennepin County resident. The 13-month-old unvaccinated child was recently adopted from China and arrived in Minnesota on February 16. She had been exposed to two cases of measles in China between February 5 and 15. On February 21, she developed fever, cough, coryza, and possible conjunctivitis. The parent was advised to keep the child at home and, if a rash developed, to return on Monday, February 26, for drawing of blood for serological confirmation. The child did develop a rash on February 23 and she had blood drawn on Monday; IgM serology conducted at MDH was positive for measles on February 26. Cases secondary to this case are possible as there were opportunities for exposures in clinics and the general community. Prodromal symptoms of secondary cases would begin as early as February 27 with rash onset as early as March 2; however, cases would most likely present during the week of March 5. Additional information is available at http://www.health.state.mn.us/han/index.html. Health care providers should have a high index of suspicion for measles in patients presenting with rash illness and fever >101° F. Unvaccinated patients are at highest risk. Other states have recently reported measles cases in children adopted from China, and newly adopted children from China with recent measles exposures may continue to arrive in Minnesota. Please report suspect cases immediately at (612) 676-5414 or 1-877-676-5414. Measles appears to have been eliminated as a disease indigenous to the U.S. Record low number (<100) of cases of measles have been reported in the U.S. in the last few years with most cases being imported or epidemiologically linked to an imported case. Nevertheless, the potential for subsequent transmission from imported cases remains. Kudos to the astute clinician who reported this suspect case to us! Serological confirmation is important for determining outbreak control measures including vaccination and administration of IG to contacts.
2. Intussusception and Oral Rotavirus Vaccine In last week's New England Journal of Medicine (N Engl J Med 2001;344:564-72) was an article summarizing the results of a case control study documenting the association between intussusception and the receipt of oral rotavirus vaccine. Minnesota was one of 19 states that conducted this study. As you may recall, it was preliminary data from MDH along with data from a northern California HMO and the Vaccine Adverse Event Reporting System that lead to a temporary suspension of the use of rotavirus vaccine in July 1999. The ACIP withdrew its recommendation for use of the vaccine in October 1999. This important public health intervention and subsequent study could not have been made without the cooperation and participation of ICPs, medical records professionals, and clinicians throughout Minnesota. We thank you for your efforts! The published study documented an increased risk of intussusception 3-14 days after the first dose of vaccine (odds ratio = 21.7; 95% c.i., 9.6-48.9) and a temporal association after the second dose.
3. TB 2000
The MDH Tuberculosis (TB) Prevention and Control Program prepares quarterly and annual surveillance reports summarizing the epidemiology of TB disease in Minnesota. These reports describe the incidence of disease by county, race/ethnicity, country of origin, age, and other specific risk factors as well as the incidence of drug-resistant disease and other clinical characteristics of reported cases. In 2000, 178 new TB cases (3.6 cases/100,000 population) were reported statewide. This is the second largest number of cases reported in 20 years, following the 201 cases reported in 1999. The most significant factor is the large and increasing percentage of cases among foreign-born persons. This percentage continued to increase in 2000, with 146 (82%) cases occurring in this population. (In comparison, 43% of TB cases reported in the U.S. during 1999 were born outside the U.S.) This trend reflects changing demographics in Minnesota, particularly increased immigration from regions of the world where TB is prevalent. The most common regions of origin for foreign-born persons with TB disease reported in 2000 include sub-Saharan Africa (58%), South/Southeast Asia (22%), and Latin American/Caribbean countries (18%). Other less frequent risk factors among TB cases in Minnesota included HIV infection (4%), homelessness (3%), incarceration in a correctional facility (2%), and residence in a nursing home (2%). Most (76%) TB cases occurred in the seven-county Twin Cities metropolitan area. Among culture-confirmed cases, 37 (26%) were drug-resistant, including 23 (16%) cases resistant to isoniazid and one (1%) case of multi-drug resistant disease resistant to isoniazid, rifampin, pyrazinamide, and streptomycin. Of the 37 drug-resistant TB patients reported in 2000, 34 (92%) were born outside the U.S. Reports summarizing TB surveillance data for the year 2000 and the 5-year period from 1996 to 2000 are available at www.health.state.mn.us/tb. The Web site also includes TB-related educational brochures for patients in nine languages, national and state recommendations for TB screening and treatment, and other resources.
Bug Bytes is a combined effort of the Infectious Disease Epidemiology, Prevention and Control Division and the Public Health Laboratory Division of MDH. We provide Bug Bytes as a way to say THANK YOU to the infection control professionals, laboratorians, local public health professionals, and health care providers who assist us.
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