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Discover Pediatric Collections on COVID-19 and Racism and Its Effects on Pediatric Health

American Academy of Pediatrics
Special Article

An Outbreak of Measles in an Undervaccinated Community

Pamala Gahr, Aaron S. DeVries, Gregory Wallace, Claudia Miller, Cynthia Kenyon, Kristin Sweet, Karen Martin, Karen White, Erica Bagstad, Carol Hooker, Gretchen Krawczynski, David Boxrud, Gongping Liu, Patricia Stinchfield, Julie LeBlanc, Cynthia Hickman, Lynn Bahta, Albert Barskey and Ruth Lynfield
Pediatrics July 2014, 134 (1) e220-e228; DOI: https://doi.org/10.1542/peds.2013-4260
Pamala Gahr
aMinnesota Department of Health, St Paul, Minnesota;
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Aaron S. DeVries
aMinnesota Department of Health, St Paul, Minnesota;
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Gregory Wallace
bCenters for Disease Control and Prevention, Atlanta, Georgia;
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Claudia Miller
aMinnesota Department of Health, St Paul, Minnesota;
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Cynthia Kenyon
aMinnesota Department of Health, St Paul, Minnesota;
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Kristin Sweet
aMinnesota Department of Health, St Paul, Minnesota;
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Karen Martin
aMinnesota Department of Health, St Paul, Minnesota;
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Karen White
aMinnesota Department of Health, St Paul, Minnesota;
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Erica Bagstad
cHennepin County Human Services and Public Health, Hopkins, Minnesota; and
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Carol Hooker
cHennepin County Human Services and Public Health, Hopkins, Minnesota; and
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Gretchen Krawczynski
cHennepin County Human Services and Public Health, Hopkins, Minnesota; and
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David Boxrud
aMinnesota Department of Health, St Paul, Minnesota;
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Gongping Liu
aMinnesota Department of Health, St Paul, Minnesota;
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Patricia Stinchfield
dChildren’s Hospital and Clinics of Minnesota, St Paul, Minnesota
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Julie LeBlanc
dChildren’s Hospital and Clinics of Minnesota, St Paul, Minnesota
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Cynthia Hickman
aMinnesota Department of Health, St Paul, Minnesota;
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Lynn Bahta
aMinnesota Department of Health, St Paul, Minnesota;
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Albert Barskey
bCenters for Disease Control and Prevention, Atlanta, Georgia;
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Ruth Lynfield
aMinnesota Department of Health, St Paul, Minnesota;
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Abstract

Measles is readily spread to susceptible individuals, but is no longer endemic in the United States. In March 2011, measles was confirmed in a Minnesota child without travel abroad. This was the first identified case-patient of an outbreak. An investigation was initiated to determine the source, prevent transmission, and examine measles-mumps-rubella (MMR) vaccine coverage in the affected community. Investigation and response included case-patient follow-up, post-exposure prophylaxis, voluntary isolation and quarantine, and early MMR vaccine for non-immune shelter residents >6 months and <12 months of age. Vaccine coverage was assessed by using immunization information system records. Outreach to the affected community included education and support from public health, health care, and community and spiritual leaders. Twenty-one measles cases were identified. The median age was 12 months (range, 4 months to 51 years) and 14 (67%) were hospitalized (range of stay, 2–7 days). The source was a 30-month-old US-born child of Somali descent infected while visiting Kenya. Measles spread in several settings, and over 3000 individuals were exposed. Sixteen case-patients were unvaccinated; 9 of the 16 were age-eligible: 7 of the 9 had safety concerns and 6 were of Somali descent. MMR vaccine coverage among Somali children declined significantly from 2004 through 2010 starting at 91.1% in 2004 and reaching 54.0% in 2010 (χ2 for linear trend 553.79; P < .001). This was the largest measles outbreak in Minnesota in 20 years, and aggressive response likely prevented additional transmission. Measles outbreaks can occur if undervaccinated subpopulations exist. Misunderstandings about vaccine safety must be effectively addressed.

  • measles
  • measles transmission
  • measles outbreak
  • measles-mumps-rubella vaccine
  • vaccine-preventable diseases
  • vaccine hesitancy
  • immunization information system
  • immunization coverage assessment
  • post-exposure prophylaxis
  • voluntary isolation and quarantine
  • undervaccinated subpopulation
  • Accepted April 10, 2014.
  • Copyright © 2014 by the American Academy of Pediatrics

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Pediatrics
Vol. 134, Issue 1
1 Jul 2014
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An Outbreak of Measles in an Undervaccinated Community
Pamala Gahr, Aaron S. DeVries, Gregory Wallace, Claudia Miller, Cynthia Kenyon, Kristin Sweet, Karen Martin, Karen White, Erica Bagstad, Carol Hooker, Gretchen Krawczynski, David Boxrud, Gongping Liu, Patricia Stinchfield, Julie LeBlanc, Cynthia Hickman, Lynn Bahta, Albert Barskey, Ruth Lynfield
Pediatrics Jul 2014, 134 (1) e220-e228; DOI: 10.1542/peds.2013-4260

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An Outbreak of Measles in an Undervaccinated Community
Pamala Gahr, Aaron S. DeVries, Gregory Wallace, Claudia Miller, Cynthia Kenyon, Kristin Sweet, Karen Martin, Karen White, Erica Bagstad, Carol Hooker, Gretchen Krawczynski, David Boxrud, Gongping Liu, Patricia Stinchfield, Julie LeBlanc, Cynthia Hickman, Lynn Bahta, Albert Barskey, Ruth Lynfield
Pediatrics Jul 2014, 134 (1) e220-e228; DOI: 10.1542/peds.2013-4260
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Subjects

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    • Infectious Disease
    • Vaccine/Immunization

Keywords

  • measles
  • measles transmission
  • measles outbreak
  • measles-mumps-rubella vaccine
  • vaccine-preventable diseases
  • vaccine hesitancy
  • immunization information system
  • immunization coverage assessment
  • post-exposure prophylaxis
  • voluntary isolation and quarantine
  • undervaccinated subpopulation
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