 |
|
A Large Rubella Outbreak With Spread From the Workplace to the Community
M. Carolina Danovaro-Holliday, MD;
Charles W. LeBaron, MD;
Carol Allensworth;
Richard Raymond, MD;
T. Grey Borden;
Alisa B. Murray, MS;
Joseph P. Icenogle, PhD;
Susan E. Reef, MD
JAMA. 2000;284:2733-2739.
Context Childhood vaccination has reduced rubella disease to low levels in the United States, but outbreaks continue to occur. The largest outbreak in the past 5 years occurred in Nebraska in 1999.
Objectives To examine risk factors for disease, susceptibility of the risk population, role of vaccine failure, and the need for new vaccination strategies in response to the Nebraska rubella outbreak.
Design, Setting, and Patients Investigation of 83 confirmed rubella cases occurring in Douglas County, Nebraska, between March 23 and August 24, 1999; serosurvey of 413 pregnant women in the outbreak locale between October 1998 and March 1999 (prior to outbreak) and April and November 1999 (during and after outbreak).
Main Outcome Measures Case characteristics, compared with that of the general county population; area childhood rubella vaccination rates; and susceptibility among pregnant women before vs during and after the outbreak.
Results All 83 rubella cases were unvaccinated or had unknown vaccination status and fell into 3 groups: (1) 52 (63%) were young adults (median age, 26 years), 83% of whom were born in Latin American countries where rubella vaccination was not routine. They were either employed in meatpacking plants or were their household contacts. Attack rates in the plants were high (14.4 per 1000 vs 0.19 per 1000 for general county population); (2) 16 (19%), including 14 children (9 of whom were aged <12 months) and 2 parents, were US-born and non-Hispanic, who acquired the disease through contacts at 2 day care facilities (attack rate, 88.1 per 1000); and (3) 15 (18%) were young adults (median age, 22 years) whose major disease risk was residence in population-dense census tracts where meatpacking–related cases resided (R2 = 0.343; P<.001); 87% of these persons were born in Latin America. Among pregnant women, susceptibility rates were 13% before the outbreak and 11% during and after the outbreak. Six (25%) of 24 susceptible women tested were seropositive for rubella IgM. Rubella vaccination rates were 90.2% for preschool children and 99.8% for school-aged children.
Conclusions A large rubella outbreak occurred among unvaccinated persons in a community with high immunity levels. Crowded working and living conditions facilitated transmission, but vaccine failure did not. Workplace vaccination could be considered to prevent similar outbreaks.
Author Affiliations: National Immunization Program, Centers for Disease Control and Prevention, Atlanta, Ga (Drs Danovaro-Holliday, LeBaron, and Reef); Douglas County Health Department, Omaha, Neb (Ms Allensworth); Nebraska Health and Human Services System (Dr Raymond and Mr Borden), Lincoln, Neb; National Center for Infectious Diseases, Centers for Disease Control and Prevention (Dr Icenogle and Ms Murray).
 CiteULike  Connotea  Del.icio.us  Digg  Reddit  Technorati  Twitter
What's this?
RELATED ARTICLE
December 6, 2000
JAMA. 2000;284(21):2803.
EXTRACT
| FULL TEXT
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
|
Prevalence of Rubella Susceptibility Among Pregnant Mothers in a Community-Based Antenatal Clinic in Malaysia: A Cross-Sectional Study
Ai Theng Cheong and Ee Ming Khoo
Asia Pac J Public Health 2008;20:340-346.
ABSTRACT
Rubella immune status of indigenous and immigrant pregnant women in Catalonia, Spain
Dominguez et al.
Eur J Public Health 2007;17:560-564.
ABSTRACT
| FULL TEXT
Comparison of Four Methods Using Throat Swabs To Confirm Rubella Virus Infection
Zhu et al.
J. Clin. Microbiol. 2007;45:2847-2852.
ABSTRACT
| FULL TEXT
Elimination of Rubella From the United States: A Milestone on the Road to Global Elimination
Meissner et al.
Pediatrics 2006;117:933-935.
FULL TEXT
Migration as a risk factor for measles after a mass vaccination campaign, Burkina Faso, 2002
Yameogo et al.
Int J Epidemiol 2005;34:556-564.
ABSTRACT
| FULL TEXT
Identifying Risk Factors for Rubella Susceptibility in a Population at Risk in the United States
Danovaro-Holliday et al.
AJPH 2003;93:289-291.
FULL TEXT
The Changing Epidemiology of Rubella in the 1990s: On the Verge of Elimination and New Challenges for Control and Prevention
Reef et al.
JAMA 2002;287:464-472.
ABSTRACT
| FULL TEXT
Falik
AAP News 2001;18:100-100.
FULL TEXT
Rubella Outbreak in Unvaccinated Adults
JWatch Emergency Med. 2001;2001:9-9.
FULL TEXT
Rubella and the Workplace
JWatch Infect. Diseases 2001;2001:8-8.
FULL TEXT
|
