title: Risk factors for measles in a previously vaccinated population and cost-effectiveness of revaccination strategies.
abstract: Using data from a large measles outbreak that occurred in Dane County (Wisconsin) in 1986, we conducted a case-control study to evaluate risk factors for vaccine failure and assessed the cost-effectiveness of school-based revaccination strategies. Vaccination before a change in the measles vaccine stabilizer in 1979 (odds ratio, 5.5; 95% confidence interval, 1.05 to 28.9) and vaccination before age 15 months (odds ratio, 13.9; 95% confidence interval, 5.9 to 32.6) were identified as risk factors. Revaccination strategies for all students ($3444 per case prevented), students vaccinated before 1980 ($3166 per case prevented), and students vaccinated before age 15 months ($2546 per case prevented) were evaluated, assuming use of measles-mumps-rubella vaccine after the initial case was detected in a school. However, a large proportion of cases (43% to 53%) may not have been preventable using these strategies. Therefore, revaccination in all schools assessed to be at risk for measles may be necessary to prevent large outbreaks until a two-dose vaccination schedule is fully implemented.
authors.affiliation: Bureau of Community Health and Prevention, Wisconsin Division of Health, Madison 53701-0309.
authors.forename: E E
authors.initials: EE
authors.lastname: Mast
authors.forename: J L
authors.initials: JL
authors.lastname: Berg
authors.forename: L P
authors.initials: LP
authors.lastname: Hanrahan
authors.forename: J T
authors.initials: JT
authors.lastname: Wassell
authors.forename: J P
authors.initials: JP
authors.lastname: Davis
mesh_terms: D000293:Adolescent; D016022:Case-Control Studies; D003362:Cost-Benefit Analysis; D004196:Disease Outbreaks / Q000517:prevention & control; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D008457:Measles / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D008458:Measles Vaccine / Q000008:administration & dosage; D012621:Seasons; D012680:Sensitivity and Specificity; D014611:Vaccination / Q000191:economics*; D014922:Wisconsin / Q000453:epidemiology
chemical_list: D008458:Measles Vaccine