Identifying risk factors associated with acquiring measles in an outbreak among age-appropriately vaccinated school children: a cohort analysis

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Abstract

Background

A measles outbreak occurred in age-appropriately vaccinated children in a school in a town in the South East of Ireland in September–November 2013.

Aims

The purpose of this study was to investigate the risk factors associated with catching measles during the outbreak.

Methods

Ninety-five children (4–5 years) in three classes, in the first year of primary school, were included in the study. Immunisation records on the South East Child Health Information System for first Measles Mumps and Rubella (MMR) vaccine for the 95 children were reviewed. Data collected included age at MMR, date of administration of MMR, MMR brand and batch number, and the General Practice at which MMR was administered. The risk factors analysed included age at vaccination, time of vaccination, class and the GP practice where MMR was administered. Statistical analysis was performed using Epi info 7 and SPSS v24.

Results

Thirteen children in the cohort developed measles during the outbreak. All children in the cohort were age-appropriately vaccinated, with one dose of MMR vaccine. Analysis demonstrated statistically significant differences in the relative risk of developing measles according to the class a child was in, and the General Practice at which they were vaccinated.

Conclusions

The reason for intense measles activity in one class was not established. Although a concurrent investigation into cold chain and vaccine stock management did not identify a cause for the high relative risk of measles in children vaccinated, recommendations were made for improving cold chain and vaccine stock management in General Practices.

Keywords

Cohort Measles Outbreak Vaccination 

Notes

Acknowledgements

The authors acknowledge Dr. Elyce McGovern and Dr. Helena Murray and thank all the members of the outbreak and incident control teams, the Child Health Office, Consultant Microbiologists, General Practitioners, HSE South East Information and Communications Technology Department, schools, National Immunisation Office, National Virus Reference Laboratory and the Health Protection Surveillance Centre.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

References

  1. 1.
    O’Connor B, Cotter S, Heslin J et al (2016) Catching measles in an appropriately vaccinated group: a well-circumscribed outbreak in the South East of Ireland, September-November 2013. Epidemiol Infect 144:3131–3138CrossRefPubMedGoogle Scholar
  2. 2.
    Health Protection Surveillance Centre (2012) Annual report on immunisation uptake at 12 and 24 months. http://www.hpsc.ie/A-Z/VaccinePreventable/Vaccination/ImmunisationUptakeStatistics/Immunisationuptakestatisticsat12and24monthsofage/AnnualReports/File,15442,en.pdf. Accessed 16 Mar 2018
  3. 3.
    Vandermulen C, Roelants M, Theeton H et al (2008) Vaccination coverage and sociodemographic determinants of measles-mumps-rubella vaccination three different age groups. Eur J Pediatr 67:1161–1168CrossRefGoogle Scholar
  4. 4.
    National Immunisation Advisory Committee, Republic of Ireland (2016). Immunisation guidelines for Ireland: 2016. http://www.hse.ie/eng/health/immunisation/hcpinfo/guidelines/chapter12.pdf. Accessed 16 Mar 2018
  5. 5.
    Defay F, De Serres G, Skowronski M et al (2013) Measles in children vaccinated with 2 doses of MMR. Pediatrics 132:1126–1133CrossRefGoogle Scholar
  6. 6.
    Department of Health and Children, Republic of Ireland (2007) Eliminating measles and rubella and preventing congenital rubella infection, a situational analysis and recommendations: strategy for Ireland, Recommendations of the Measles and Rubella Elimination Committee of the Department of health and Children: 2007. http://www.hpsc.ie/A-Z/VaccinePreventable/Measles/Publications/File,2511,en.pdf. Accessed 16 Mar 2018
  7. 7.
    Health Protection Surveillance Centre (2012) Case definitions for notifiable disease. http://www.hpsc.ie/NotifiableDiseases/CaseDefinitions/File,823,en.pdf. Accessed 16 Mar 2018
  8. 8.
    Centers for Disease Control and Prevention (CDC) (2015) Epidemiology and prevention of vaccine-preventable diseases, the pink book: course textbook: 13th Edition. Atlanta: CDC. (http://www.cdc.gov/vaccines/pubs/pinkbook/downloads/meas.pdf. Accessed 16 Mar 2018
  9. 9.
    Hales CM, Johnson E, Helgenberger L et al (2016) Measles outbreak associated with low vaccine effectiveness among adults in Pohnpei State, Federated States of Micronesia 2014. Open Forum Infect Dis. 24; 3(2):ofw064 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4866552/pdf/ofw064.pdf. Accessed 16 Mar 2018CrossRefGoogle Scholar
  10. 10.
    De Serres G, Boulianne N, Defay F et al (2012) Higher risk of measles when the first dose of a 2-dose schedule of measles vaccine is given at 12-14 months versus 15 months of age. Clin Infect Dis 55:394–402CrossRefPubMedGoogle Scholar
  11. 11.
    Breakwell L, Moturi E, Helgenberger L, Gopalani SV, Hales C, Lam E, Sharapov U, Larzelere M, Johnson E, Masao C, Setik E, Barrow L, Dolan S, Chen TH, Patel M, Rota P, Hickman C, Bellini W, Seward J, Wallace G, Papania M (2015) Measles outbreak associated with vaccine failure in adults—federated states of Micronesia, February-August 2014. MWR Morb Mortal Wkly Rep 64:1088–1092CrossRefGoogle Scholar
  12. 12.
    Hickman CJ, Hyde T, Sowers SB et al (2011) Laboratory characterization of measles virus infection in previously vaccinated and unvaccinated individuals. J Infect Dis 204:S549–S558CrossRefPubMedGoogle Scholar
  13. 13.
    Muscat M (2011) Who gets measles in Europe? J Infect Dis 204:S353–S365CrossRefPubMedGoogle Scholar
  14. 14.
    Bonačić Marinović AA, Swaan C, Wichmann O, van Steenbergen J, Kretzschmar M (2012) Effectiveness and timing of vaccination during school measles outbreak. Emerg Infect Diseases 18:1405–1413CrossRefGoogle Scholar
  15. 15.
    Dominguez A, Torner N, Barrabeig I et al (2008) Large outbreak of measles in a community with high vaccination coverage: implications for the vaccination schedule. Clin Infect Dis 47:1143–1149CrossRefPubMedGoogle Scholar
  16. 16.
    Ong G, Rasidah N, Wan S, Cutter J (2007) Outbreak of measles in primary school students with high first dose MMR vaccination coverage. Singap Med J 48:656–661Google Scholar
  17. 17.
    Rosen JB, Rota JS, Hickman CJ, Sowers SB, Mercader S, Rota PA, Bellini WJ, Huang AJ, Doll MK, Zucker JR, Zimmerman CM (2014) Outbreak of measles among persons with prior evidence of immunity, New York City, 2011. Clin Infect Dis 58:1205–1210CrossRefPubMedGoogle Scholar
  18. 18.
    Leuridan E, Hens N, Hutse V et al (2010) Early waning of maternal measles antibodies in era of measles elimination: longitudinal study. BMJ 340:c 1626 http://www.bmj.com/content/bmj/340/bmj.c1626.full.pdf. Accessed 16 Mar 2018CrossRefGoogle Scholar
  19. 19.
    Zhao H, Lu PS, Hu Y et al (2010) Low titers of measles antibody in mothers whose infants suffered from measles before eligible age for measles vaccination. Virol J 7:87CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Yeung LF, Lurie P, Dayan G, Eduardo E, Britz PH, Redd SB, Papania MJ, Seward JF (2005) A limited measles outbreak in a highly vaccinated US boarding school. Pediatrics 116:1287–1291CrossRefPubMedGoogle Scholar

Copyright information

© Royal Academy of Medicine in Ireland 2018

Authors and Affiliations

  1. 1.Department of Public HealthHealth Service Executive South EastKilkennyIreland

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