In July 2013, the National Immunization Program of China was notified by the US Centers for Disease Control and Prevention that
measles was detected in 3 newly adopted, special needs children with
cerebral palsy (CP) from China. We report an investigation of
measles transmission in China that led to
infection of these children. Interviews were conducted with welfare institute staff and panel physicians; health records of the potentially exposed population were reviewed; and immunization coverage was assessed among institute residents. Five residents with CP, all unvaccinated against
measles, among who were the 3 adoptees, were linked epidemiologically into 3 generations of
measles transmission antecedent to the US outbreak. In a random sample of residents, first dose of
measles containing
vaccine (MCV1) and MCV2 coverage was 16 of 17 (94%) and 7 of 11 (64%) among children with CP, and 100% (32 of 32) and 96% (21 of 22) among children without CP. Vaccinators reported reluctance to vaccinate children with CP because the China pharmacopeia lists
encephalopathy as a
contraindication to vaccination. Panel physicians reported to investigators no necessity of vaccination for adoptees to the United States if US parents sign an affidavit exempting the child from vaccination. We recommend that the China pharmacopeia
vaccine contraindications be reviewed and updated, the United States should reconsider allowing vaccination exemptions for internationally adopted children unless there are true
medical contraindications to vaccination, and US pediatricians should counsel adopting parents to ensure that their child is up-to-date on recommended vaccinations before coming to the United States.