Measles outbreak stems from Boston’s tallest skyscraper

July 2006

The Boston Public Health Commission is attempting to stop a measles outbreak in downtown Boston that stems from a worker in New England’s tallest skyscraper.

As of June 21, there have been 14 confirmed measles cases reported in the outbreak, according to Tom Lyons, director of communications for the commission. The index case is a 32-year-old, unvaccinated man from India who arrived in Boston on April 26. The cases range from ages 25 to 45. Approximately 5,000 people work in the John Hancock Tower, where the outbreak originated, Lyons said.

“It’s unclear about exactly how many people [could be affected] except to say there could be potentially a lot of people in that building,” Lyons said. “However, the number is getting smaller every day because of the measures that we are taking inside the building, which includes vaccination.”

The commission has so far administered more than 2,500 doses of measles vaccine to contacts, he said.

More cases in the outbreak are likely, he added, but, “we’ll feel better if we can get through about two incubation periods,” Lyons said, which is about 42 days.

The index and the cases

The first man’s prodromal symptoms started May 3 and included cough, conjunctivitis, upper respiratory symptoms and a fever. A maculopapular rash onset occurred May 5, when he presented to an urgent care center. His temperature was 102.9° and the rash involved his face, arms and trunk.

The department of public health advised the public that the man traveled, while infectious, by public transportation from a western suburb to downtown Boston from May 1 to May 4.

The first seven cases were employees at Investors Bank & Trust Co., located within the Hancock Tower. Two of the cases are Boston residents; the other 12 cases work in the city. The latest case is a woman in her early 20s.

Early symptoms of measles include a high fever, runny nose, cough and red, watery eyes. A skin rash usually occurs about two to four days after the initial symptoms develop. The rash begins on the face and soon spreads to other parts of the body, lasting four to seven days then disappearing in the same order it appeared. Koplik spots may become visible inside the cheeks of the mouth one to two days before or after skin rash onset.

Health authorities advise health care providers throughout the area to be on alert for potential measles cases and report them to their local board of health and the Massachusetts Department of Public Health at 617-983-6800 or 1-888-658-2850.

Control measures

The Boston Public Health Commission is working with the Massachusetts Department of Public Health to provide updated information to the public and health care providers throughout the city about the outbreak.

“We have very good coverage in terms of pediatric populations in Massachusetts but it’s a reminder to health care providers to not just think about immunization status among pediatric populations, but also other patients,” Lyons said. By other patients, Lyons specifically referred to those born after 1957 and before 1968. Health officials consider people born before 1957 immune while those who received vaccine between 1963 and 1968 may not be because they received a vaccine with questionable efficacy, Lyons said.

Health officials are identifying contacts of the cases to check for up-to-date immunization histories. They are also asking businesses in the Hancock Tower to encourage employees to seek vaccination. Health officials recommend that companies even provide immunization opportunities in the office.

The most up-to-date measles information is available at www.bphc.org. Information is also available on the Massachusetts Department of Public Health Web site at www.state.ma.us/dph.