Measles among adults associated with adoption of children in China--California, Missouri, and Washington, July-August 2006.

On August 15, 2006, the Missouri Department of Health and Senior Services (MoDHSS) was notified of a measles case in a Missouri resident who had recently traveled to China. The patient had traveled with a group of 11 families seeking to adopt children from three orphanages in Guangdong Province. Members of the group, which was sponsored by a Missouri-based adoption agency, traveled separately but stayed at the same hotel in Guangdong Province during July 13-27. This report describes the multistate investigation that followed, which identified two additional measles cases. None of the three patients recalled contact during travel with anyone who appeared ill. All three patients recovered fully, and no secondary cases were identified among family members, other travelers, patients, or medical staff who might have been exposed. Because of delays in diagnoses (the earliest case was identified 2 weeks after rash onset), no control measures (e.g., vaccination of contacts or administration of immunoglobulin) were indicated. Communicable diseases that are no longer endemic in the United States continue to occur among travelers, often resulting in delayed recognition and delayed notification of public health authorities. Because of the risk for spread in the community of imported communicable diseases such as measles, thorough investigation is needed to determine possible sources of infection and the extent of disease spread in the community.