Epidemiologic Notes and Reports Rubella Outbreak among Foreign-
Exchange Students -- Tennessee
On August 3, 1981, the University of Tennessee at Martin
reported
that 7 Japanese exchange students had been hospitalized with a
preliminary diagnosis of rubella. These students were part of a
group
of approximately 200 Japanese students and professors who had
arrived
in Tennessee on July 5, 1981, for the 10-week summer session. They
all stayed in the same dormitory and attended classes that were
separate from other summer-session meetings, but they mingled with
students and the general public outside of class. The 200 Japanese
visitors represented 7.4% of the 2,700 summer students then in
attendance at this section of the university.
All 7 patients had a maculo-papular rash, low-grade fever
(temperature of 102 F, 38.9 C), and either arthralgia or posterior
auricular or occipital adenopathy. The initial patient had rash
onset
on July 11 (Figure 3), 6 days after leaving Japan; was hospitalized
with a preliminary diagnosis of Rocky Mountain spotted fever; and
was
treated with chloramphenicol. The second patient had rash onset on
July 25 and was hospitalized with a preliminary diagnosis of
measles.
Neither case was reported to the health department at the time of
illness, and no serum specimens were available for rubella testing.
Five tertiary cases occurred the first week of August; all these
patients were kept in the university infirmary for at least 1 day
each. By the end of the first week in August, all 7 cases were
suspected to be rubella and were subsequently reported to the
Tennessee Department of Public Health. The diagnosis was confirmed
for 4 of the 5 tertiary cases on the basis of a greater than or
equal
to 4-fold rise in rubella hemagglutination inhibition titer between
the acute- and convalescent-phase serum specimens.
An investigation on campus revealed that 21 Japanese students
(10%) had previously received rubella vaccine. In contrast, a
review
of 200 health records chosen at random from records of the 2,500
American summer students in residence showed that 67% had
documentation of having received rubella vaccine. On August 4, 188
Japanese students and faculty were vaccinated with combined measles
and rubella (MR) vaccine. The MR vaccine was also offered to other
summer students and staff. No other clinical cases of rubella
occurred among the Japanese students, and there was no known spread
to
hospital employees or to other students on campus.
Reported by IF Porter, MD, H Westmoreland, RN, University of
Tennessee-Martin; P Duncan, RN, RH Hutcheson, Jr, MD, MPH, State
Epidemiologist, Tennessee Dept of Public Health; Immunization Div,
Center for Prevention Svcs, CDC.
Editorial Note
Editorial Note: College-age adults form a large part of the
population that remains susceptible to rubella in the United States
(1). Like measles, rubella will probably be introduced
periodically
from foreign countries, often by college-age foreign-exchange
students. The lack of disease spread in this instance is
attributed
to the separate dormitory and classes that the Japanese students
attended, as well as to the higher rates of rubella vaccination
among
other summer students on that campus.
Universities should be encouraged to develop programs to ensure
rubella vaccination at the time of entry for all students, staff,
and
faculty, including foreign-exchange and other visiting students and
professors. Before vaccination, female students, staff, and
faculty
should be asked if there is any possibility that they are pregnant.
Pregnant women should not be given rubella vaccine, and all other
women should be informed of the risks of vaccination and advised
not
to become pregnant for 3 months after vaccination (2). Programs
are
most likely to be successful if proof of rubella immunity* is
required.
In the example cited here, 3 generations of cases occurred
before
the diagnosis of rubella was considered. Since the incidence of
rubella has declined to record low levels (3), clinicians and
public
health workers should be reminded to consider rubella in the
differential diagnosis of rash illness and to collect appropriately
timed blood specimens for serologic study. Only if rubella is
diagnosed early in an outbreak can appropriate measures be
instituted
to control spread in the community and in institutions such as
universities.
References
Schiff GM, Linnemann CC, Jr, Shea L, Trimble S. Rubella
surveillance and immunization among college women. Obstet
Gynecol
1974;43:143-7.
ACIP. Rubella prevention. MMWR 1981;30:37-42, 47.
CDC. Rubella--United States, 1978-1981. MMWR 1981;30:513-5.
*Documented history of rubella vaccination on or after the first
birthday or presence of antibody to rubella. Clinical diagnosis of
rubella should not be accepted as proof of immunity.
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