A Large Rubella Outbreak With Spread From the Workplace to the Community

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...

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Published in:JAMA : the journal of the American Medical Association 2000-12, Vol.284 (21), p.2733-2739
Main Authors: Danovaro-Holliday, M. Carolina, LeBaron, Charles W, Allensworth, Carol, Raymond, Richard, Borden, T. Grey, Murray, Alisa B, Icenogle, Joseph P, Reef, Susan E
Format: Article
Language:English
Subjects:
Adolescent
Adult
Biological and medical sciences
Child
Child, Preschool
Community-Acquired Infections - epidemiology
Disease
Disease Outbreaks
Emigration and Immigration
Female
Hispanic Americans - statistics & numerical data
Human viral diseases
Humans
Infant
Infectious diseases
Living conditions
Male
Medical sciences
Nebraska - epidemiology
Pregnancy
Risk Factors
Rubella - epidemiology
Rubella - prevention & control
Rubella - transmission
Rubella Vaccine
Rubella virus
Seroepidemiologic Studies
South America
Vaccination - statistics & numerical data
Vaccines
Viral diseases
Viral diseases with cutaneous or mucosal lesions and viral diseases of the eye
Workplace - statistics & numerical data
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Summary: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
ISSN:0098-7484
1538-3598
DOI:10.1001/jama.284.21.2733