Hi, Atlanta!

Neighboring South Carolina has seen nearly 1,000 measles cases in a large outbreak that started in October, raising fears that Georgia could see a spike in cases, especially around spring break travel. Georgia has had two cases this year. The first was in a child who was too young for a vaccine who had a history of international travel. The second, reported in early March, was in an unvaccinated resident of Bryan County, near Savannah. 

The origins of the Bryan County case are unknown. It’s not clear whether the person was exposed to measles in Georgia through undetected spread or during travel to or from Washington, D.C., the state Department of Public Health said at the time. 

Now measles has been detected — on March 29 and 31 — at the Clayton Water Reclamation Center in Atlanta, according to data from WastewaterSCAN, a joint project of Stanford and Emory universities. 

That means there was likely at least one person with measles infection in the area. However, the data do not show whether the person lives there or was just nearby, DPH spokesperson Nancy Nydam Shirek said. 

It’s the first time measles has been detected in wastewater since last fall, when measles spread from an unvaccinated Georgia State University student to three other people who were unvaccinated or had an unknown vaccination status. That outbreak led to a large contact tracing effort that required at least 200 extra hours of work by public health employees.  

DPH sent an April 2 alert to health departments, clinics, and hospitals to remind clinicians to consider measles in people with relevant symptoms, Nydam Shirek said. Initial symptoms include fever (often as high as 104-105) accompanied by cough, runny nose, and/or conjunctivitis about 7-14 days after first exposure. That may be followed by tiny white spots (called Koplik spots) inside the mouth, followed by a characteristic red rash that typically begins on the face. 

“Overall, wastewater can heighten our awareness, but it is not meant to capture a single case, let alone a small number, which remains a concern even as measles cases rise,” Nydam Shirek said.

Still, wastewater can provide an early warning sign for a number of infectious diseases. 

For example, last August, measles was detected in wastewater in Colorado. Within the next four days, measles was confirmed in two unvaccinated residents living near that water treatment plant. The early warning sign helped public health officials notify the public and prepare for a possible outbreak, according to a January report in the CDC’s Morbidity and Mortality Weekly Report.  

One important caveat: Georgia has only eight wastewater detection sites, mostly in the metro Atlanta area, meaning that the data do not give a complete picture of what is going on in the state. For example, wastewater monitoring did not pick up the Bryan County case because there are no monitoring sites in that part of the state. 

And an important reminder: Two doses of the measles-mumps-rubella vaccine are 97% effective in preventing this highly contagious virus. 

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