A persistent outbreak of measles despite appropriate prevention and control measures

Ronald M. Davis, Eric Whitman, Walter A. Orenstein, Stephen R. Preblud, Lauri E. Markowitz, Alan R. Hinman

Research output: Contribution to journalArticle

65 Citations (Scopus)

Abstract

Davis, R. M. (CDC, Atlanta, GA 30333), E. D. Whitman, W. A. Orenstein, S. R. Preblud, L. E. Markowitz, and A. R. Hinman. A persistent outbreak of measles despite appropriate prevention and control measures. Am J Epidemiol 1987; 126:438-49.From January 4 to May 13, 1985, an outbreak of 137 cases of measles occurred in Montana and persisted for 12 generations of spread. A total of 114 cases occurred on the Blackfeet Indian reservation in northwest Montana. Of the 137 cases, 82 (59.9%) were in school-aged children (aged 5-19 years). Of the 114 cases on the reservation, 108 (94.7%) were classified as programmatically nonpreventable. A total of 64 (82.1%) of the 78 patients on the reservation who were born after 1956 and were above the recommended age at vaccination had a history of adequate measles vaccination. Additionally, an audit of immunization records at the schools in Browning, Montana, where most of the cases occurred, showed that 98.7% of students were appropriately vaccinated. A retrospective cohort study in the Browning schools failed to identify age at vaccination or time since vaccination as significant risk factors for vaccine failure. Overall vaccine efficacy was 96.9% (95% confidence interval = 89.5-98.2%). None of 80 Browning students who were vaccinated at less than 12 months of age and revaccinated at 15 months of age or older became infected. A case-control study showed a significant association between attendance at Browning basketball games and infection early in the outbreak. This outbreak suggests that measles transmission may persist in some settings despite appropriate implementation of the current measles elimination strategy.

Original languageEnglish (US)
Pages (from-to)438-449
Number of pages12
JournalAmerican Journal of Epidemiology
Volume126
Issue number3
DOIs
StatePublished - Jan 1 1987
Externally publishedYes

Fingerprint

Measles
Disease Outbreaks
Vaccination
Vaccines
Students
Basketball
Centers for Disease Control and Prevention (U.S.)
Case-Control Studies
Immunization
Cohort Studies
Retrospective Studies
Confidence Intervals
Infection

All Science Journal Classification (ASJC) codes

  • Epidemiology

Cite this

Davis, Ronald M. ; Whitman, Eric ; Orenstein, Walter A. ; Preblud, Stephen R. ; Markowitz, Lauri E. ; Hinman, Alan R. / A persistent outbreak of measles despite appropriate prevention and control measures. In: American Journal of Epidemiology. 1987 ; Vol. 126, No. 3. pp. 438-449.
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abstract = "Davis, R. M. (CDC, Atlanta, GA 30333), E. D. Whitman, W. A. Orenstein, S. R. Preblud, L. E. Markowitz, and A. R. Hinman. A persistent outbreak of measles despite appropriate prevention and control measures. Am J Epidemiol 1987; 126:438-49.From January 4 to May 13, 1985, an outbreak of 137 cases of measles occurred in Montana and persisted for 12 generations of spread. A total of 114 cases occurred on the Blackfeet Indian reservation in northwest Montana. Of the 137 cases, 82 (59.9{\%}) were in school-aged children (aged 5-19 years). Of the 114 cases on the reservation, 108 (94.7{\%}) were classified as programmatically nonpreventable. A total of 64 (82.1{\%}) of the 78 patients on the reservation who were born after 1956 and were above the recommended age at vaccination had a history of adequate measles vaccination. Additionally, an audit of immunization records at the schools in Browning, Montana, where most of the cases occurred, showed that 98.7{\%} of students were appropriately vaccinated. A retrospective cohort study in the Browning schools failed to identify age at vaccination or time since vaccination as significant risk factors for vaccine failure. Overall vaccine efficacy was 96.9{\%} (95{\%} confidence interval = 89.5-98.2{\%}). None of 80 Browning students who were vaccinated at less than 12 months of age and revaccinated at 15 months of age or older became infected. A case-control study showed a significant association between attendance at Browning basketball games and infection early in the outbreak. This outbreak suggests that measles transmission may persist in some settings despite appropriate implementation of the current measles elimination strategy.",
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A persistent outbreak of measles despite appropriate prevention and control measures. / Davis, Ronald M.; Whitman, Eric; Orenstein, Walter A.; Preblud, Stephen R.; Markowitz, Lauri E.; Hinman, Alan R.

In: American Journal of Epidemiology, Vol. 126, No. 3, 01.01.1987, p. 438-449.

Research output: Contribution to journalArticle

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