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Measles Outbreak in the U.S. — Why?

Measles was introduced into Indiana by an unvaccinated girl who spread it to 33 others, nearly all of them unvaccinated.

Although 30 million measles cases occur annually worldwide, endemic disease was eliminated from the U.S. in 2000, principally due to widespread use of measles vaccine. In 2005, a measles outbreak involving at least 34 persons occurred in Indiana, where 98% of school-age children have received the recommended two doses of vaccine.

The index case was an unvaccinated 17-year-old girl who had traveled on a church mission to a Romanian orphanage and was incubating measles upon her return. The next day, while experiencing prodromal symptoms, she attended a large church gathering. Thirty-three additional people subsequently developed measles in three generations of spread; disease was confirmed by laboratory studies, or by epidemiologic linkage to a laboratory-confirmed case and presence of the characteristic rash and 2 associated symptoms. Measles virus, isolated from six patients, belonged to a genotype (D4) known to be endemic in Romania. Thirty of the measles patients (88%) were <20 years old; of these, 20 (67%) were home-schooled. Thirty-two patients (94%) had not received vaccine, and three (9%) required hospitalization. Interviews with six families that had declined vaccination revealed concerns related to media reports of the vaccine’s dangers (e.g., a postulated association with autism, and perceived adverse effects of the vaccine preservative thimerosal). Public health measures contained the outbreak, at a cost of $167,685.

Comment: Failure to vaccinate, not vaccine failure, facilitated this measles outbreak. False claims about the risks of measles vaccine, abetted by media coverage, led parents to decline vaccination for their children. Enhanced communication strategies concerning measles vaccine are needed if future measles outbreaks are to be prevented.

— Neil R. Blacklow, MD

Published in Journal Watch Infectious Diseases August 2, 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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