Measles outbreak stems from employee who works at 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 15 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 age of the cases ranged from 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 CDC also recently warned travelers and doctors that people who traveled to Germany for the World Cup soccer championship games might have been exposed to the measles virus. Three of the 12 cities hosting the games are in the North Rhine-Westphalia region that has experienced more than 1,200 cases of measles so far this year.

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 advises 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. Three of the cases are Boston residents; the other 12 cases work in the city. The latest case is a man in his mid 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. Koplik spots may become visible inside the cheeks of the mouth one to two days before or after skin rash onset.

Health authorities advised physicians to report cases to their local board of health and the Massachusetts Department of Public Health at 617-983-6800 or 1-888-658-2850.

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 lower 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. The most up-to-date measles information is available at www.bphc.org.