Measles outbreaks affecting children in Jewish ultra-orthodox communities in Jerusalem

Area of Science:

• Epidemiology
• Public Health
• Vaccinology

Background:

• Measles outbreaks occurred in 2003 and 2004 within ultra-Orthodox Jewish communities in Jerusalem.
• The outbreaks involved unvaccinated children and spread rapidly in crowded neighborhoods.
• Low immunization coverage was identified as a key factor in the spread.

Purpose of the Study:

• To investigate the epidemiology of two distinct measles outbreaks.
• To identify factors contributing to measles transmission in specific communities.
• To evaluate the effectiveness of interventions in controlling outbreaks and increasing vaccination rates.

Main Methods:

• Retrospective analysis of measles cases during the 2003 and 2004 outbreaks.
• Case investigation, including vaccination status and household transmission.
• Comparison of immunization coverage between outbreak and non-outbreak neighborhoods.
• Monitoring of vaccination coverage following targeted interventions.

Main Results:

• The first outbreak (2003) had 107 cases (genotype D8), and the second (2004) had 117 cases (genotype D4).
• Over 91% of cases were unvaccinated, with 79% of affected households having multiple cases.
• Immunization coverage was significantly lower in outbreak neighborhoods (88.3%) compared to non-outbreak areas (90.3%).

Conclusions:

• Measles outbreaks in these communities were driven by low vaccination rates among a specific population.
• A culture-sensitive approach and targeted vaccination efforts successfully increased measles, mumps, and rubella (MMR) vaccine coverage to 95.2%.
• Maintaining high national immunization rates requires focused strategies for vulnerable sub-populations to prevent future outbreaks.