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An Outbreak of Measles: Who’s at Risk and Why?

Pockets of unvaccinated children put communities at risk.

Although measles is rare in the U.S., it continues to be a major cause of morbidity and mortality in the developing world. In 2005, a measles outbreak in Indiana involved 34 confirmed cases; the index patient was an unvaccinated 17-year-old girl who had recently returned from Romania.

Investigation of the outbreak indicated that of the 500 individuals (mostly aged 5–19 years) who attended a church event with the index patient during her prodrome, 16 of 50 (32%) unvaccinated attendees became infected, but only 2 of 450 (0.44%) vaccinated attendees became infected. Most (71%) of the school-aged cases were home-schooled. Reasons for refusing vaccination included concerns about autism or thimerosal and negative publicity about vaccination. The morbidity and public health costs associated with the outbreak were significant (nearly $5000 per patient).

Comment: Increasing pockets of unvaccinated children create a population at risk for more outbreaks. Most of the affected individuals were far past the age where autism would be a concern. Although it is difficult to change the minds of parents who oppose vaccination, pediatricians should continue to revisit the issue with these families and address their concerns by providing accurate information; for example, the MMR vaccine has never contained thimerosal. International travelers also should be encouraged to catch up on routine vaccinations.

— Peggy Sue Weintrub, MD

Published in Journal Watch Pediatrics and Adolescent Medicine September 27, 2006

Citation(s):

Parker AA et al. Implications of a 2005 measles outbreak in Indiana for sustained elimination of measles in the United States. N Engl J Med 2006 Aug 3; 355:447-55.

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