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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 |
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| container_end_page | 2739 |
| container_issue | 21 |
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| container_title | JAMA : the journal of the American Medical Association |
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| creator | Danovaro-Holliday, M. Carolina LeBaron, Charles W Allensworth, Carol Raymond, Richard Borden, T. Grey Murray, Alisa B Icenogle, Joseph P Reef, Susan E |
| description | 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 |
| doi_str_mv | 10.1001/jama.284.21.2733 |
| format | article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_proquest_miscellaneous_72457565</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><ama_id>193333</ama_id><sourcerecordid>72457565</sourcerecordid><originalsourceid>FETCH-LOGICAL-a400t-f80d1b1956c735906cbf381b1cd3849b9d8acdaaf92cbde369a9cf4576ff5ea3</originalsourceid><addsrcrecordid>eNqF0c1LwzAUAPAgipvTu14kKHhrzUfTJMcxnBMGAx3sWF7T1HVr15m2h_33Zm4qePFd8nj8eO8lQeiakpASQh9XUEHIVBQyGjLJ-QnqU8FVwIVWp6hPiFaBjFTUQxdNsyI-KJfnqEcpJYJK1UeTIZ6Ce7f4tUttWQKedW3qLKzxomiX-G3r8wyPXV3hdmnxonbrbQnG4rb-Kozqquo2Rbu7RGc5lI29Op4DNB8_zUeTYDp7fhkNpwFEhLRBrkhGU6pFbKTfksQmzbnyFZNxFelUZwpMBpBrZtLM8liDNnkkZJznwgIfoIdD262rPzrbtElVNGa_-cbWXZNI5q2Ixb-QKi9jpj28-wNXdec2_g4Jo5QLpoT06PaIurSyWbJ1RQVul3w_pAf3RwCNgTJ3sDFF8-MUi6Xcz7o5KP9vvz0038cnSASIzA</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>211352857</pqid></control><display><type>article</type><title>A Large Rubella Outbreak With Spread From the Workplace to the Community</title><source>American Medical Association Current Titles</source><creator>Danovaro-Holliday, M. Carolina ; LeBaron, Charles W ; Allensworth, Carol ; Raymond, Richard ; Borden, T. Grey ; Murray, Alisa B ; Icenogle, Joseph P ; Reef, Susan E</creator><creatorcontrib>Danovaro-Holliday, M. Carolina ; LeBaron, Charles W ; Allensworth, Carol ; Raymond, Richard ; Borden, T. Grey ; Murray, Alisa B ; Icenogle, Joseph P ; Reef, Susan E</creatorcontrib><description>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 <12 months) and 2 parents, were US-born and non-Hispanic,
who acquired the disease through contacts at 2 day care facilities (attack
rate, 88.1 per 1000); and (3) 15 (18%) were young adults (median age, 22 years)
whose major disease risk was residence in population-dense census tracts where
meatpacking–related cases resided (R2 = 0.343; P<.001); 87% of these persons
were born in Latin America. Among pregnant women, susceptibility rates were
13% before the outbreak and 11% during and after the outbreak. Six (25%) of
24 susceptible women tested were seropositive for rubella IgM. Rubella vaccination
rates were 90.2% for preschool children and 99.8% for school-aged children. CONCLUSIONS A large rubella outbreak occurred among unvaccinated persons in a community
with high immunity levels. Crowded working and living conditions facilitated
transmission, but vaccine failure did not. Workplace vaccination could be
considered to prevent similar outbreaks.</description><identifier>ISSN: 0098-7484</identifier><identifier>EISSN: 1538-3598</identifier><identifier>DOI: 10.1001/jama.284.21.2733</identifier><identifier>PMID: 11105178</identifier><identifier>CODEN: JAMAAP</identifier><language>eng</language><publisher>Chicago, IL: American Medical Association</publisher><subject>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</subject><ispartof>JAMA : the journal of the American Medical Association, 2000-12, Vol.284 (21), p.2733-2739</ispartof><rights>2001 INIST-CNRS</rights><rights>Copyright American Medical Association Dec 6, 2000</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-a400t-f80d1b1956c735906cbf381b1cd3849b9d8acdaaf92cbde369a9cf4576ff5ea3</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=826779$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/11105178$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Danovaro-Holliday, M. Carolina</creatorcontrib><creatorcontrib>LeBaron, Charles W</creatorcontrib><creatorcontrib>Allensworth, Carol</creatorcontrib><creatorcontrib>Raymond, Richard</creatorcontrib><creatorcontrib>Borden, T. Grey</creatorcontrib><creatorcontrib>Murray, Alisa B</creatorcontrib><creatorcontrib>Icenogle, Joseph P</creatorcontrib><creatorcontrib>Reef, Susan E</creatorcontrib><title>A Large Rubella Outbreak With Spread From the Workplace to the Community</title><title>JAMA : the journal of the American Medical Association</title><addtitle>JAMA</addtitle><description>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 <12 months) and 2 parents, were US-born and non-Hispanic,
who acquired the disease through contacts at 2 day care facilities (attack
rate, 88.1 per 1000); and (3) 15 (18%) were young adults (median age, 22 years)
whose major disease risk was residence in population-dense census tracts where
meatpacking–related cases resided (R2 = 0.343; P<.001); 87% of these persons
were born in Latin America. Among pregnant women, susceptibility rates were
13% before the outbreak and 11% during and after the outbreak. Six (25%) of
24 susceptible women tested were seropositive for rubella IgM. Rubella vaccination
rates were 90.2% for preschool children and 99.8% for school-aged children. CONCLUSIONS A large rubella outbreak occurred among unvaccinated persons in a community
with high immunity levels. Crowded working and living conditions facilitated
transmission, but vaccine failure did not. Workplace vaccination could be
considered to prevent similar outbreaks.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Biological and medical sciences</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Community-Acquired Infections - epidemiology</subject><subject>Disease</subject><subject>Disease Outbreaks</subject><subject>Emigration and Immigration</subject><subject>Female</subject><subject>Hispanic Americans - statistics & numerical data</subject><subject>Human viral diseases</subject><subject>Humans</subject><subject>Infant</subject><subject>Infectious diseases</subject><subject>Living conditions</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Nebraska - epidemiology</subject><subject>Pregnancy</subject><subject>Risk Factors</subject><subject>Rubella - epidemiology</subject><subject>Rubella - prevention & control</subject><subject>Rubella - transmission</subject><subject>Rubella Vaccine</subject><subject>Rubella virus</subject><subject>Seroepidemiologic Studies</subject><subject>South America</subject><subject>Vaccination - statistics & numerical data</subject><subject>Vaccines</subject><subject>Viral diseases</subject><subject>Viral diseases with cutaneous or mucosal lesions and viral diseases of the eye</subject><subject>Workplace - statistics & numerical data</subject><issn>0098-7484</issn><issn>1538-3598</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2000</creationdate><recordtype>article</recordtype><recordid>eNqF0c1LwzAUAPAgipvTu14kKHhrzUfTJMcxnBMGAx3sWF7T1HVr15m2h_33Zm4qePFd8nj8eO8lQeiakpASQh9XUEHIVBQyGjLJ-QnqU8FVwIVWp6hPiFaBjFTUQxdNsyI-KJfnqEcpJYJK1UeTIZ6Ce7f4tUttWQKedW3qLKzxomiX-G3r8wyPXV3hdmnxonbrbQnG4rb-Kozqquo2Rbu7RGc5lI29Op4DNB8_zUeTYDp7fhkNpwFEhLRBrkhGU6pFbKTfksQmzbnyFZNxFelUZwpMBpBrZtLM8liDNnkkZJznwgIfoIdD262rPzrbtElVNGa_-cbWXZNI5q2Ixb-QKi9jpj28-wNXdec2_g4Jo5QLpoT06PaIurSyWbJ1RQVul3w_pAf3RwCNgTJ3sDFF8-MUi6Xcz7o5KP9vvz0038cnSASIzA</recordid><startdate>20001206</startdate><enddate>20001206</enddate><creator>Danovaro-Holliday, M. Carolina</creator><creator>LeBaron, Charles W</creator><creator>Allensworth, Carol</creator><creator>Raymond, Richard</creator><creator>Borden, T. Grey</creator><creator>Murray, Alisa B</creator><creator>Icenogle, Joseph P</creator><creator>Reef, Susan E</creator><general>American Medical Association</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>7QL</scope><scope>7QP</scope><scope>7TK</scope><scope>7TS</scope><scope>7U7</scope><scope>7U9</scope><scope>8FD</scope><scope>C1K</scope><scope>FR3</scope><scope>H94</scope><scope>K9.</scope><scope>M7N</scope><scope>NAPCQ</scope><scope>P64</scope><scope>RC3</scope><scope>7X8</scope></search><sort><creationdate>20001206</creationdate><title>A Large Rubella Outbreak With Spread From the Workplace to the Community</title><author>Danovaro-Holliday, M. Carolina ; LeBaron, Charles W ; Allensworth, Carol ; Raymond, Richard ; Borden, T. 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Carolina</creatorcontrib><creatorcontrib>LeBaron, Charles W</creatorcontrib><creatorcontrib>Allensworth, Carol</creatorcontrib><creatorcontrib>Raymond, Richard</creatorcontrib><creatorcontrib>Borden, T. 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Carolina</au><au>LeBaron, Charles W</au><au>Allensworth, Carol</au><au>Raymond, Richard</au><au>Borden, T. Grey</au><au>Murray, Alisa B</au><au>Icenogle, Joseph P</au><au>Reef, Susan E</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>A Large Rubella Outbreak With Spread From the Workplace to the Community</atitle><jtitle>JAMA : the journal of the American Medical Association</jtitle><addtitle>JAMA</addtitle><date>2000-12-06</date><risdate>2000</risdate><volume>284</volume><issue>21</issue><spage>2733</spage><epage>2739</epage><pages>2733-2739</pages><issn>0098-7484</issn><eissn>1538-3598</eissn><coden>JAMAAP</coden><abstract>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 <12 months) and 2 parents, were US-born and non-Hispanic,
who acquired the disease through contacts at 2 day care facilities (attack
rate, 88.1 per 1000); and (3) 15 (18%) were young adults (median age, 22 years)
whose major disease risk was residence in population-dense census tracts where
meatpacking–related cases resided (R2 = 0.343; P<.001); 87% of these persons
were born in Latin America. Among pregnant women, susceptibility rates were
13% before the outbreak and 11% during and after the outbreak. Six (25%) of
24 susceptible women tested were seropositive for rubella IgM. Rubella vaccination
rates were 90.2% for preschool children and 99.8% for school-aged children. CONCLUSIONS A large rubella outbreak occurred among unvaccinated persons in a community
with high immunity levels. Crowded working and living conditions facilitated
transmission, but vaccine failure did not. Workplace vaccination could be
considered to prevent similar outbreaks.</abstract><cop>Chicago, IL</cop><pub>American Medical Association</pub><pmid>11105178</pmid><doi>10.1001/jama.284.21.2733</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0098-7484 |
| ispartof | JAMA : the journal of the American Medical Association, 2000-12, Vol.284 (21), p.2733-2739 |
| issn | 0098-7484 1538-3598 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_72457565 |
| source | American Medical Association Current Titles |
| 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 |
| title | A Large Rubella Outbreak With Spread From the Workplace to the Community |
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