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Large measles outbreak at a German public school, 2006
Ole Wichmann1, Wiebke Hellenbrand, Daniel Sagebiel
1Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany. wichmannO@rki.de
The Pediatric Infectious Disease Journal
|August 28, 2007
Summary
High measles vaccine effectiveness (VE) was observed, but coverage was insufficient to prevent a large 2006 outbreak in Germany. Immunization gaps in older students highlight the need for increased vaccination coverage to achieve measles elimination.
Area of Science:
- Epidemiology
- Public Health
- Vaccinology
Background:
- A significant measles outbreak occurred in Duisburg, Germany, in 2006, affecting a large number of individuals, with a notable proportion being older children and adolescents.
- The outbreak prompted an investigation into the underlying causes, including an assessment of vaccination coverage and the effectiveness of the measles vaccine.
Purpose of the Study:
- To investigate the reasons behind the resurgence of measles in Duisburg.
- To evaluate measles vaccination coverage rates among school-aged children and adolescents.
- To determine the vaccine effectiveness (VE) of measles-containing vaccines (MCV) during the outbreak.
Main Methods:
- A retrospective cohort study was conducted in a public school in Duisburg that was identified as an early site of the outbreak.
- Questionnaires were distributed to 1250 students aged 10-21 years, and vaccination records were reviewed.
- Measles cases were identified using a standard clinical case definition, and measles virus genotyping was performed.
Main Results:
- Of 1098 students who returned questionnaires, vaccination records for 859 showed that 95.4% had received at least one MCV dose, 70.4% had received two doses, and 4.5% had received no doses.
- A total of 53 cases were identified, resulting in an attack rate of 5%. The unvaccinated group experienced a significantly higher attack rate (53%) compared to those with one dose (1.0%) or two doses (0.4%).
- Vaccine effectiveness was high, estimated at 98.1% for one dose and 99.4% for two doses. Estimated one-dose coverage among all participants was 91%.
Conclusions:
- The study demonstrated high vaccine effectiveness for measles-containing vaccines (MCV).
- Despite high VE, vaccination coverage was insufficient to prevent the large-scale measles outbreak, particularly among older students.
- Increased vaccination coverage is crucial to prevent future outbreaks and achieve the goal of measles elimination in Germany.
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