A Measles Outbreak in an Underimmunized Amish Community in Ohio. 2016

Paul A Gastañaduy, and Jeremy Budd, and Nicholas Fisher, and Susan B Redd, and Jackie Fletcher, and Julie Miller, and Dwight J McFadden, and Jennifer Rota, and Paul A Rota, and Carole Hickman, and Brian Fowler, and Lilith Tatham, and Gregory S Wallace, and Sietske de Fijter, and Amy Parker Fiebelkorn, and Mary DiOrio
From the Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta (P.A.G., S.B.R., J.R., P.A.R., C.H., G.S.W., A.P.F.); and the Ohio Department of Health, Columbus (J.B., N.F., B.F., L.T., S.F., M.D.), Knox County Health Department, Mount Vernon (J.F., J.M.), and Holmes County Health Department, Millersburg (D.J.M.) - all in Ohio.

Although measles was eliminated in the United States in 2000, importations of the virus continue to cause outbreaks. We describe the epidemiologic features of an outbreak of measles that originated from two unvaccinated Amish men in whom measles was incubating at the time of their return to the United States from the Philippines and explore the effect of public health responses on limiting the spread of measles. We performed descriptive analyses of data on demographic characteristics, clinical and laboratory evaluations, and vaccination coverage. From March 24, 2014, through July 23, 2014, a total of 383 outbreak-related cases of measles were reported in nine counties in Ohio. The median age of case patients was 15 years (range, <1 to 53); a total of 178 of the case patients (46%) were female, and 340 (89%) were unvaccinated. Transmission took place primarily within households (68% of cases). The virus strain was genotype D9, which was circulating in the Philippines at the time of the reporting period. Measles-mumps-rubella (MMR) vaccination coverage with at least a single dose was estimated to be 14% in affected Amish households and more than 88% in the general (non-Amish) Ohio community. Containment efforts included isolation of case patients, quarantine of susceptible persons, and administration of the MMR vaccine to more than 10,000 persons. The spread of measles was limited almost exclusively to the Amish community (accounting for 99% of case patients) and affected only approximately 1% of the estimated 32,630 Amish persons in the settlement. The key epidemiologic features of a measles outbreak in the Amish community in Ohio were transmission primarily within households, the small proportion of Amish people affected, and the large number of people in the Amish community who sought vaccination. As a result of targeted containment efforts, and high baseline coverage in the general community, there was limited spread beyond the Amish community. (Funded by the Ohio Department of Health and the Centers for Disease Control and Prevention.).

UI MeSH Term Description Entries
D007223 Infant A child between 1 and 23 months of age. Infants
D008297 Male Males
D008457 Measles A highly contagious infectious disease caused by MORBILLIVIRUS, common among children but also seen in the nonimmune of any age, in which the virus enters the respiratory tract via droplet nuclei and multiplies in the epithelial cells, spreading throughout the MONONUCLEAR PHAGOCYTE SYSTEM. Rubeola
D008875 Middle Aged An adult aged 45 - 64 years. Middle Age
D009820 Ohio State bounded on the north by Michigan and Lake Erie, on the east by Ohio River and Pennsylvania, on the south by Ohio River, and on the west by Indiana.
D002648 Child A person 6 to 12 years of age. An individual 2 to 5 years old is CHILD, PRESCHOOL. Children
D002675 Child, Preschool A child between the ages of 2 and 5. Children, Preschool,Preschool Child,Preschool Children
D004196 Disease Outbreaks Sudden increase in the incidence of a disease. The concept includes EPIDEMICS and PANDEMICS. Outbreaks,Infectious Disease Outbreaks,Disease Outbreak,Disease Outbreak, Infectious,Disease Outbreaks, Infectious,Infectious Disease Outbreak,Outbreak, Disease,Outbreak, Infectious Disease,Outbreaks, Disease,Outbreaks, Infectious Disease
D005260 Female Females
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man

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