CCID Spectrum
Volume 1, Number 2 May 2006

DGMQ tackles measles outbreak in Nairobi among U.S.-bound refugees

By Drew Posey, MD, MPH, and Jennifer Williams

Photo: Andrew Plummer and John Bateman
Newark, New Jersey, Quarantine Station team members, Andrew Plummer (left) and John Bateman (right), played pivotal roles in the response to the Eastleigh measles outbreak. They identified a refugee with measles upon arrival to the United States and coordinated activities with the Newark City Health Department, New Jersey State Health Department, and CDC in Atlanta to resolve the situation.
A large contingent of African refugees bound for the United States has a better chance for a healthy start to their new lives here.

On October 17, 2005, CDC was notified of a large outbreak of measles in the Eastleigh community of Nairobi, Kenya, where approximately 3,000 persecuted Somali and Ethiopian refugees are awaiting resettlement to the United States. To protect the health of the refugees and prevent introduction of measles into the United States, CDC led a multi-agency response team consisting of 43 DGMQ staff members, as well as representatives of the National Immunization Program, Office of the Director (CDC), Division of Viral and Rickettsial Diseases, Office of the Director (NCID), and several state health departments. The team began to tackle the outbreak overseas by developing screening and immunization requirements to protect the refugees while they were still in Kenya. A travel moratorium was imposed to allow recommended measures to be implemented and prevent further disease among refugees.

The team provided advance notice to states of the arrival of potentially exposed, nonimmune refugees and provided guidance for monitoring refugees' health after their arrival. After receiving this information about the incoming refugees, nine states were able to establish a monitoring system before receiving 148 refugees who arrived before the travel moratorium. Sixteen states, plus the District of Columbia and the New York City Department of Health and Mental Hygiene, received advance notification of 341 refugees scheduled to resettle to the United States.

The team developed and implemented the medical screening and immunization requirements that prevented disease among the refugees and prevented introduction of measles to the United States. After implementation of overseas immunization requirements, no additional cases of measles were detected among refugees. More than 1,500 refugees were vaccinated with measles, mumps, and rubella (MMR) vaccine, reducing their risk for developing measles and for introducing it into the United States.

The response team's work also enabled them to identify a refugee with measles who arrived on November 9, 2005, in Newark, New Jersey, during medical screenings of arriving refugees at U.S. ports of entry. The rapid detection of the imported case and prompt quarantine of contacts prevented secondary transmission and the potential for a larger measles outbreak in a major metropolitan area.

Working in collaboration with other federal agencies, state health departments, and international organizations, the team implemented effective public health measures. Their work limited the outbreak among U.S.-bound refugees, prevented secondary transmission in the United States, and prevented further importation of measles into the United States.

About the authors

Drew Posey, MD, MPH, is a medical officer (LCDR, U.S. Public Health Service) in the Immigrant, Refugee, and Migrant Health Branch, Division of Global Migration and Quarantine (DGMQ), National Center for Infectious Diseases (NCID).

Jennifer Williams is a technical writer in DGMQ/NCID, and is employed by Constella Group, LLC.