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CDC Urges Awareness of Measles in Americans Returning from Germany

By Alfred Valles, resident, internal medicine, Mayo Clinic College of Medicine

The Centers for Disease Control and Prevention (CDC) has issued an alert urging American travelers to remain aware of the possibility of measles exposure. Many Americans have traveled to and from Germany for the World Cup soccer championship games. Three of the twelve hosting cities—Cologne, Dortmund, and Gelsenkirchen—are of particular concern, given the recent measles outbreaks that have been reported in those cities and their surrounding areas.

Since January 1 of this year, some 1,200 cases have been identified in or near these cities. American travelers were undoubtedly among the large crowds of people gathered to pay homage to their favorite sport, and many others will visit Germany on vacation or business, making transmission of this respiratory droplet-born pathogen a very real threat.

The CDC recommends the following precautions:

  1. Travelers who plan to go to Germany should check their immunization records and visit their doctors if they are not immune to measles or are not sure they are.
  2. People returning from Germany, especially those who went to see the World Cup, should see a healthcare provider if they develop the symptoms of measles, including a fever, a raised rash that begins on the face and spreads to the arms and legs, a cough, red eyes, or a runny nose.
  3. People with these symptoms should limit their contact with others.
  4. Clinicians seeing patients with these symptoms should inquire about travel history and immunization status.

This warning is not to be taken lightly. Approximately two of every 1,000 patients infected with measles will die of the disease. Complications such as encephalitis are of particular concern for those who are malnourished or immunosuppressed.

Remember, live virus measles vaccine given within 72 hours of exposure may prevent the disease, while immune globulin given up to six days after exposure may prevent complications of measles in those who are at risk, including pregnant women, people with weak immune systems, and children.

The World cup can be dangerous, even for non-players. For more information about the measles outbreak and travel precautions, visit www.cdc.gov.

This warning is not to be taken lightly. Approximately two of every 1,000 patients infected with measles will die of the disease.

Lymphocytic Choriomeningitis Virus: Facts and Prevention

By the Special Pathogens Branch, CDC

In May 2005, the CDC investigated a cluster of lymphocytic choriomeningitis virus (LCMV) illnesses in four solid organ transplant recipients from a common donor, three of whom died. The source of the LCMV was traced to a hamster that had recently been acquired by a member of the donor’s household. It was subsequently determined that several LCMV-infected pet rodents had originated from a single distributor, who may have distributed other infected rodents to pet stores in the northeastern and midwestern United States.1 However, the risk of contracting LCMV from rodent exposure is not limited only to this outbreak, nor is the danger confined only to patients undergoing organ transplant.

Clinicians need to be familiar with LCMV because of its potential to cause meningitis, its teratogenicity, and the risk that it may bring about serious disease in immunocompromised individuals.

LCMV is normally carried by wild house mice, but can be transmitted to laboratory and pet rodents at breeding facilities, in pet stores, and in homes. Humans become infected in one of the following ways:

  1. Through direct contact with the secretions or excretions of infected rodents;
  2. By inhalation of dust or droplets containing LCMV from rodents;
  3. As a result of transplacental spread from an infected pregnant woman to her fetus; and
  4. By receipt of an organ transplant from an infected donor.2

Among those tested, about 5% have shown serologic evidence of previous infection with LCMV.3,4 In healthy adults, LCMV is typically a nonspecific viral syndrome sometimes followed by aseptic meningitis or other neurologic signs. Patients with weakened immune systems can suffer severe, possibly fatal systemic illness.2,5 Maternal infection with LCMV during pregnancy can result in spontaneous abortion or early neonatal death, as well as in defects similar to those of other congenital infections such as toxoplasmosis and cytomegalovirus (“TORCH” infections).6-10 The proportion of developmental defects caused by LCMV is not known.

Clinicians should consider LCMV in the differential diagnosis of patients with aseptic meningitis; in cases of fetal demise or congenital defects, including congenital hydrocephalus, chorioretinitis, blindness, or mental retardation; or in recent transplant recipients who present with signs of post-transplant infection. A detailed rodent exposure history should be taken. Contact your state health department or Special Pathogens Branch, CDC (404-639-1510), for information about testing for LCMV.

Currently, there is no specific treatment for LCMV infection other than supportive care. Ribavirin inhibits LCMV multiplication in laboratory experiments but has not been tested in clinical trials.

Clinicians should counsel their patients about the risks of contracting LCMV from laboratory, pet, and wild rodents. Wild mice in the home should be controlled and removed promptly. Immunocompromised individuals and women who are pregnant or planning to become pregnant should avoid any contact with wild or pet rodents, their excretions, and their nesting materials. While a woman is pregnant, pet rodents should be housed outside the home or in a separate part of the home where other individuals can care for the pets and clean their cages. Counseling a woman already exposed to rodents during pregnancy can be challenging; for assistance, contact your state health department.

Further information about LCMV infection and its prevention, including management and prevention of rodent infestation in the home, is available from Special Pathogens Branch, CDC, at www.cdc.gov/ncidod/dvrd/spb/mnpages/dispages/lcmv.htm. For more information about diseases commonly carried by rodents, please visit www.cdc.gov/rodents. TH

References

  1. Centers for Disease Control and Prevention. Update: interim guidance for minimizing risk for human lymphocytic choriomeningitis virus infection associated with pet rodents. MMWR. Aug 19, 2005;54(32):799-801.
  2. Fischer SA, Graham MB, Kuehnert MJ, et al. Transmission of lymphocytic choriomeningitis virus by organ transplantation. N Engl J Med. 2006;354(21):2235-2249.
  3. Childs JE, Glass GE, Ksiazek TG, et al. Human-rodent contact and infection with lymphocytic choriomeningitis and Seoul viruses in an inner-city population. Am J Trop Med Hyg. 1991 Feb;44(2):117–121.
  4. Park JY, Peters CJ, Rollin PE, et al. Age distribution of lymphocytic choriomeningitis virus serum antibody in Birmingham, Alabama: evidence of a decreased risk of infection. Am J Trop Med Hyg. 1997 Jul;57(1):37–41.
  5. Horton J, Hotchin JE, Olson KB, et al. The effects of MP virus infection in lymphoma. Cancer Res. 1971 Aug;31(8):1066–1068.
  6. Barton LL, Mets MB. Congenital lymphocytic choriomeningitis virus infection: decade of rediscovery. Clin Infect Dis. 2001 Aug 1;33(3):370–374.
  7. Barton LL, Mets MB, Beauchamp CL. Lymphocytic choriomeningitis virus: emerging fetal teratogen. Am J Obstet Gynecol. 2002 Dec ;187(6):1715–1716.
  8. Wright R, Johnson D, Neumann M, et al. Congenital lymphocytic choriomeningitis virus syndrome: a disease that mimics congenital toxoplasmosis or cytomegalovirus infection. Pediatrics. 1997 Jul;100(1):E9.
  9. Ford-Jones EL, Ryan G . Implications for the fetus of maternal infections in pregnancy. In: Cohen J, Powderly WG, eds. Infectious Diseases, 2nd ed. New York, NY: Mosby; 2004: 709–723.
  10. Greenhow TL, Weintrub PS. Your diagnosis, please. Neonate with hydrocephalus. Pediatr Infect Dis J. 2003 Dec;22(12):1099, 1111–1112.

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