title: An outbreak of rubella aboard a ship of the German Navy.
abstract: BACKGROUND
  During May and June 1996, an outbreak of rubella occurred offshore aboard a ship of the German Navy. The outbreak spread among 330 crew members over a period of 9 weeks, ending 2 days after the ship's return. This is the first detailed epidemiological investigation of a rubella outbreak on a ship, describing temporal progression, clinical manifestations, immunization status and seroprevalence of the population exposed.
  
  
  METHODS
  Outbreak investigation using a questionnaire, health records and rubella serology (hemagglutination inhibition (HI) test and EIA).
  
  
  RESULTS
  Of the 330 crew members 298 (90%) participated in the investigation. The outbreak was continuous without a peak and ended abruptly after the ship's return. It resulted in 20 cases, 11 of which were clinically symptomatic. A total of 35 (12%) crew members were susceptible to rubella prior to the outbreak, resulting in an attack rate of 57%. The highest risk for infection was linked to accommodation aboard the ratings deck (chi(2)-test, p = 0.004) with most favorable conditions of transmission. Only 9% of the participating crew were able to provide complete proof of their immunization status. The positive predictive value of a past history of rubella for the presence of antibodies against rubella was 59%.
  
  
  CONCLUSIONS
  The transmission of rubella that we describe aboard a ship was facilitated by the unusually close proximity of the crew and their insufficient immunity. Documentation of immunization was inadequate in this population.
authors.affiliation: Department of Pediatrics, Division of Pediatric Infectious Diseases,University, Hospital Kiel, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Ziebold
authors.forename: B
authors.initials: B
authors.lastname: Hassenpflug
authors.forename: H
authors.initials: H
authors.lastname: Wegner-Bröse
authors.forename: K
authors.initials: K
authors.lastname: Wegner
authors.forename: H J
authors.initials: HJ
authors.lastname: Schmitt
mesh_terms: D000914:Antibodies, Viral / Q000032:analysis; D004196:Disease Outbreaks; D004797:Enzyme-Linked Immunosorbent Assay; D005858:Germany / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D008889:Military Personnel / Q000706:statistics & numerical data*; D012307:Risk Factors; D012409:Rubella / Q000453:epidemiology* / Q000517:prevention & control; D012411:Rubella Vaccine / Q000008:administration & dosage; D012412:Rubella virus / Q000276:immunology*; D012767:Ships; D014611:Vaccination / Q000639:trends
chemical_list: D000914:Antibodies, Viral; D012411:Rubella Vaccine