Skip to main content Accesibility Help
×
×
Home

Who are the children at risk? Lessons learned from measles outbreaks

  • C. STEIN-ZAMIR (a1), H. SHOOB (a1), N. ABRAMSON (a1) and G. ZENTNER (a1)
Summary

We investigated a measles outbreak in the Jerusalem district in 2007–2008 (992 cases). Most cases (72·6%) were aged <15 years, 42·9% aged <5 years, and 12·8% were infants aged <1 year. The peak incidence rate was in infants aged 6–12 months (916·2/100 000). This represents a significant shift from former outbreaks in 2003–2004, where the peak incidence was in the 1–4 years age group. Of children aged <5 years the proportion aged 6–12 months tripled (7·7% vs. 25·6%). In a case-control study (74 cases, 148 controls) children who developed measles were less likely to be registered in a well-baby clinic and had lower overall immunization coverage. The differences in proportions for registration, DTaP3 and MMR1 coverage were 35·1%, 48·6% and 80·8%, respectively (all P<0·001). Rising birth order of cases and their siblings was associated with non-registration and non-compliance with MMR immunization. The vulnerability of young infants and the risk markers noted above should be taken into account in planning intervention programmes.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Who are the children at risk? Lessons learned from measles outbreaks
      Available formats
      ×
      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Who are the children at risk? Lessons learned from measles outbreaks
      Available formats
      ×
      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Who are the children at risk? Lessons learned from measles outbreaks
      Available formats
      ×
Copyright
Corresponding author
*Author for correspondence: Dr C. Stein-Zamir, Jerusalem District Health Office, 86 Jaffa Road, Jerusalem 94341, Israel. (Email: chen.zamir@lbjr.health.gov.il)
References
Hide All
1. Centers for Disease Control and Prevention. Progress in global measles control and mortality reduction, 2000–2006. Morbidity and Mortality Weekly Report 2007; 56: 12371241.
2. Centers for Disease Control and Prevention. Progress toward measles mortality reduction and elimination – Eastern Mediterranean Region, 1997–2007. Morbidity and Mortality Weekly Report 2008; 57: 262267.
3. Muller, CP, et al. WHO Steering Committee for Measles and Rubella. Reducing global disease burden of measles and rubella: report of the WHO Steering Committee on research related to measles and rubella vaccines and vaccination, 2005. Vaccine 2007; 25: 19.
4. Wichmann, O, et al. Large measles outbreak at a German public school, 2006. Pediatric Infectious Disease Journal 2007; 26: 8286.
5. Parker, AA, et al. Implications of a 2005 measles outbreak in Indiana for sustained elimination of measles in the United States. New England Journal of Medicine 2006; 355: 447455.
6. Parker Fiebelkorn, A, et al. Measles in the United States during the post-elimination era. Journal of Infectious Diseases 2010; 202: 15201528.
7. Muscat, M, Bang, H, Glismann, S. Measles is still a cause for concern in Europe. Eurosurveillance 2008; 13: pii=18837.
8. Andrews, N, et al. Towards elimination: measles susceptibility in Australia and 17 European countries. Bulletin of the World Health Organization 2008; 86: 197204.
9. Wichmann, O, et al. Further efforts needed to achieve measles elimination in Germany: results of an outbreak investigation. Bulletin of the World Health Organization 2009; 87: 108115.
10. Muscat, M, et al. EUVAC.NET Group. Measles in Europe: an epidemiological assessment. Lancet 2009; 373: 383389.
11. Kremer, JR, Muller, CP. Measles in Europe – there is room for improvement. Lancet 2009; 373: 356358.
12. Meissner, HC, Strebel, PM, Orenstein, WA. Measles vaccines and the potential for worldwide eradication of measles. Pediatrics 2004; 114: 10651069.
13. Obaro, SK, Palmer, A. Vaccines for children: policies, politics and poverty. Vaccine 2003; 21: 14231431.
14. Slater, PE, Anis, E, Leventhal, A. Measles control in Israel: a decade of the two-dose policy. Public Health Review 1999; 27: 235241.
15. Belmaker, I, et al. Two-dose measles immunization as a strategy to eliminate measles in the Middle East and Israel. Israel Medical Association Journal 2008; 10: 640645.
16. WHO. Monitoring and assessing immunization systems and safety. Immunization coverage. WHO, 2007 (www.who.int/immunization_monitoring/routine/en/). Accessed 31 January 2011.
17. Stein-Zamir, C, et al. Measles outbreaks affecting children in Jewish ultra-orthodox communities in Jerusalem. Epidemiology and Infection 2008; 136: 207214.
18. Stewart-Freedman, B, Kovalsky, N. An ongoing outbreak of measles linked to the United Kingdom in an ultra-orthodox Jewish community in Israel. Eurosurveillance 2007; 12: E070920.1.
19. Stein-Zamir, C, et al. An outbreak of measles in an ultra-orthodox Jewish community in Jerusalem, Israel, 2007 – an in-depth report. Eurosurveillance 2008; 13(8): pii=8045.
20. Anis, E, et al. Measles in a highly vaccinated society: the 2007–2008 outbreak in Israel. Journal of Infection 2009; 59: 252258.
21. Centers for Disease Control and Prevention. Case definitions for infectious conditions under public health surveillance. Morbidity and Mortality Weekly Report. Recommendations and Reports 1997; 46(RR-10).
22. Central Bureau of Statistics. Israel – population by district, sub-district and religion 1948–2007. In: Statistical Abstract of Israel, No. 59. Jerusalem, 2008; Table 2.6, p. 98.
23. Central Bureau of Statistics. Israel: population, by population group, religion, age and sex, district and sub-district, 2007. In: Statistical Abstract of Israel, No. 59. Jerusalem, 2008: Table 2.10, p. 114.
24. SPSS Inc. Statistical Package for the Social Sciences (SPSS), version 14.0 for Windows, Chicago, SPSS Inc., 2005.
25. Abramson, JH. WINPEPI (PEPI-for-Windows): computer programs for epidemiologist. Epidemiologic Perspectives and Innovations 2004; 1: 6.
26. de Quadros, CA, et al. Feasibility of global measles eradication after interruption of transmission in the Americas. Expert Review of Vaccines 2008; 7: 355362.
27. Israel Ministry of Health. Israel Center for Disease Control, Ministry of Health, Israel. Notifiable infectious diseases in Israel – 54 years of surveillance. Jerusalem, 2006, Publication No. 245.
28. Dagan, R, et al. Decay of maternally derived measles antibody in a highly vaccinated population in southern Israel. Pediatric Infectious Disease Journal 1995; 14: 965969.
29. Leuridan, E, et al. Early waning of maternal measles antibodies in era of measles elimination: longitudinal study. British Medical Journal 2010; 340: c1626.
30. Gagneur, A, et al. Kinetics of decline of maternal measles virus-neutralizing antibodies in sera of infants in France in 2006. Clinical and Vaccine Immunology 2008; 15: 18451850.
31. Johansen, K, Lopalco, PL. Passive immunity against measles in infants: is there a need for policy changes in the European vaccination schedules? Eurosurveillance 2007; 12: E9–E10.
32. Metcalf, CJ, et al. Modelling the first dose of measles vaccination: the role of maternal immunity, demographic factors, and delivery systems. Epidemiology and Infection 2011; 139: 265274.
33. Leuridan, E, Van Damme, P. Passive transmission and persistence of naturally acquired or vaccine-induced maternal antibodies against measles in newborns. Vaccine 2007; 25: 62966304.
34. Stein-Zamir, C, et al. The Israel National Immunization Registry. Israel Medical Association Journal 2010; 12: 296300.
35. Guyer, B, et al. Immunization coverage and its relationship to preventive health care visits among inner-city children in Baltimore. Pediatrics 1994; 94: 5358.
36. Feemster, KA, et al. Identifying infants at increased risk for late initiation of immunizations: maternal and provider characteristics. Public Health Reports 2009; 124: 4253.
37. Poethko-Müller, C, et al. Vaccination coverage against measles in German-born and foreign-born children and identification of unvaccinated subgroups in Germany. Vaccine 2009; 27: 25632569.
38. Jeong, YW, et al. Timeliness of MMR vaccination and barriers to vaccination in preschool children. Epidemiology and Infection 2011; 139: 247256.
39. Henderson, L, Millett, C, Thorogood, N. Perceptions of childhood immunization in a minority community: qualitative study. Journal of the Royal Society of Medicine 2008; 101: 244251.
40. Smailbegovic, MS, Laing, GJ, Bedford, H. Why do parents decide against immunization? The effect of health beliefs and health professionals. Child: Care, Health and Development 2003; 29: 303311.
41. Kennedy, AM, Gust, DA. Measles outbreak associated with a church congregation: a study of immunization attitudes of congregation members. Public Health Reports 2008; 123: 126134.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Epidemiology & Infection
  • ISSN: 0950-2688
  • EISSN: 1469-4409
  • URL: /core/journals/epidemiology-and-infection
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Keywords

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed