NEW YORK (Reuters Health) - A measles outbreak earlier this year was contained by instituting quarantine measures after exposed persons refused post-exposure preventative treatment, according to a report from the Iowa Department of Pubic Health and other state offices.

As described in the CDC's Morbidity and Mortality Weekly Report, local and state health departments contacted people exposed to a student returning to Iowa from India who had come down with measles.

Two of these contacts caught measles, and people exposed to them were also identified.

Altogether, approximately 200 persons were given post-exposure prophylaxis (PEP), consisting of measles-mumps-rubella (MMR) vaccination within three days of exposure or immune globulin within six days.

Two of the three infected people belonged to "an insular community with low vaccination rates," the authors explain. All susceptible members of the community were offered PEP, but seven individuals refused.

The seven were served with state-issued involuntary home quarantine orders for two weeks. Compliance was monitored with unannounced home visits or telephone calls.

"A lot of things went into our decision to use quarantine," Dr. Patricia Quinlisk, with the Iowa Department of Public Health in Des Moines, told Reuters Health.

"For example, the highly infectious nature of measles; the fact that in some of the communities a large percentage of the people were totally susceptible to measles; the fact that measles can be a serious disease, especially in adults; and that the community had large daily gatherings which would have allowed measles to be transmitted."

This episode "was sort of a dry run should something happen that is more catastrophic," Quinlisk commented. "I think it has made us more aware of how the system did work quite well in lot of ways."

An editorial note with the report points out that all states have the authority to detain persons under quarantine laws.

The authors recommend that states that have not recently reviewed their quarantine laws do so, specifically reviewing issues of quarantine authority, such as what diseases would be covered and how quarantine is to be enforced, as well as jurisdictional considerations and due process concerns.

"The bottom line is that we have to stop people from getting sick if at all possible, and if (quarantine) is what it takes, we should not be afraid to use it, after all other methods such as PEP are tried first," Quinlisk added.

"The other thing we have to realize is that even in places as homogeneous as Iowa, we have to be able to work with people within their own subcultural setting to protect people's health. Most people, once you explain what needs to be done, will comply."

SOURCE: Morbidity and Mortality Weekly Report, October 22, 2004.

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