From outside the USA comes a measles threat inside the USA
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Health officials say the largest measles outbreak in more than a decade has spread to the following states and cities:

New York
New York City
New Mexico
Washington, D.C.

Source: Centers for Disease Control and Prevention

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A flurry of imported measles cases has kindled outbreaks in 15 states and two cities that together have given the USA its largest case toll in a decade, health officials said Monday.

Since January, doctors have reported 132 measles cases, just shy of the 138 reached in 1997, the Centers for Disease Control and Prevention reports. So far, no child has died. Most cases have occurred in children whose parents decided against having them vaccinated. Twenty children less than a year old were too young to be vaccinated.

Although the total number of cases is small, officials say each new outbreak increases the odds that measles may come roaring back.

This month, 14 years after the United Kingdom announced the halt of local measles transmission, the government's Health Protection Agency announced that imported cases and low vaccine rates have spawned "continuous spread" of the disease. The CDC announced an end to local transmission in 2000, but health officials fret that the U.S. interruption, too, may be temporary.

"Measles is alive and well in the world, and we are at risk," says Jane Seward, head of CDC's measles control effort.

Before a vaccine was introduced in 1963, measles caused 400,000 cases and 400 deaths in the USA each year. From 1989 to 1991, a major outbreak struck 55,000 children, landing 11,000 in the hospital and causing 120 deaths.

The new outbreaks in the USA were started by children, many of them U.S. citizens, who traveled from Switzerland, Belgium, Italy, India, Germany, China, Pakistan, Russia and the Philippines.

Unvaccinated children exposed to measles are quarantined at home for two weeks, until the incubation period is over.

Worldwide, about 20 million children get measles each year, with fever, rash, cough and red watery eyes. Some develop complications, including pneumonia and encephalitis, which kill one of every 10,000 children with measles.

Unlike many diseases, measles doesn't necessarily kill those weakened by other illnesses. Most children who die are "perfectly normal," says William Schaffner of Vanderbilt University. "The current generation of parents is perhaps two generations away from understanding what a bad disease measles is."

Although every state requires vaccinations for school admission, state laws vary, and almost every state grants exemptions on religious grounds, says Duke University pediatrician Samuel Katz of the Infectious Diseases Society of America. Nearly two dozen states permit "philosophical exemptions."

Schaffner says many infectious-disease experts worry that other diseases eliminated from the USA, including mumps and German measles, may rebound because parents are refusing vaccination and pediatricians are no longer trained to diagnose and treat them.

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