Measles outbreak in a highly vaccinated population, San Diego, 2008: role of the intentionally undervaccinated.

摘要: OBJECTIVE: In January 2008, an intentionally unvaccinated 7-year-old boy who was unknowingly infected with measles returned from Switzerland, resulting in the largest outbreak San Diego, California, since 1991. We investigated objective of understanding effect intentional undervaccination on transmission and its potential threat to elimination. METHODS: mapped vaccination-refusal rates according school district, analyzed measles-transmission patterns, used discussion groups network surveys examine beliefs parents decline vaccination, evaluated containment costs. RESULTS: The importation resulted 839 exposed persons, 11 additional cases (all children), hospitalization infant too young be vaccinated. Two-dose vaccination coverage 95%, absence vaccine failure, a vigorous response halted spread beyond third generation, at net public-sector cost $10 376 per case. Although 75% were persons unvaccinated, 48 children vaccinated quarantined, average family $775 child. Substantial occurred public charter private schools, as well schools upper-socioeconomic areas. Vaccine refusal clustered geographically overall rate seemed rising. survey responses, majority declined for their concerned adverse events. CONCLUSIONS: Despite high community coverage, outbreaks can occur among clusters undervaccinated children, major health agencies, medical systems, families. Rising undermine