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To the Editor: The article on vaccine "exemptors" by Dr Feikin and colleagues¹ concludes that 11% of the vaccinated children who contracted measles (11% of 137 during a 12-year period, or about 1.25 per year) were infected by an exemptor. The annual risk that a vaccinated child would contract measles from an exemptor would thus be about 1 in 1 million if the incidence were equal in all years. It isn't. There were 55 622 cases of measles reported nationwide from 1989-1991, and 326 from 1997-1999. Is the reason the authors chose to use the years 1987-1998 for measles, when the period 1996-1998 was used for pertussis, to include the 1989-1991 measles epidemic?

In 67% of the cases of measles in vaccinated children, the exposure source was unknown. It seems likely that many of these cases were related to importation, since most cases of measles are now traced to importation, according . . . [Full Text of this Article]

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