title: Measles outbreak in the Republic of the Marshall Islands, 2003.
abstract: BACKGROUND
  Measles is a highly contagious viral infection. Measles transmission can be prevented through high population immunity (>or=95%) achieved by measles vaccination. In the Republic of the Marshall Islands (RMI), no measles cases were reported during 1989-2002; however, a large measles outbreak occurred in 2003. Reported 1-dose measles vaccine coverage among children aged 12-23 months varied widely (52-94%) between 1990 and 2000.
  
  
  METHODS
  RMI is a Pacific island nation (1999 population: 50,840). A measles case was defined as fever, rash, and cough, or coryza, or conjunctivitis, in an RMI resident between July 13 and November 7, 2003. A vaccination campaign was used for outbreak control.
  
  
  RESULTS
  Of the 826 reported measles cases, 766 (92%) occurred in the capital (Majuro). There were 186 (23%) cases in infants aged <1 year and 309 (37%) of cases in persons aged >or=15 years. The attack rate was highest among infants (Majuro atoll: 213 cases/1,000 infants). Among cases aged 1-14 years, 281 (59%) reported no measles vaccination before July 2003. There were 100 hospitalizations and 3 deaths. The measles H1 genotype was identified. The vaccination campaign resulted in 93% coverage among persons aged 6 months to 40 years. Interpretation Populations without endemic measles transmission can accumulate substantial susceptibility and be at risk for large outbreaks when measles virus is imported. 'Islands' of measles susceptibility may develop in infants, adults, and any groups with low vaccine coverage. To prevent outbreaks, high population immunity must be sustained by maintaining and documenting high vaccine coverage.
authors.affiliation: Viral Vaccine Preventable Diseases Branch, National Immunization Program, NIP, Centers for Disease Control and Prevention, CDC, Atlanta, GA 30333, USA. thyde@cdc.gov
authors.forename: Terri B
authors.initials: TB
authors.lastname: Hyde
authors.forename: Gustavo H
authors.initials: GH
authors.lastname: Dayan
authors.forename: Justina R
authors.initials: JR
authors.lastname: Langidrik
authors.forename: Robin
authors.initials: R
authors.lastname: Nandy
authors.forename: Russell
authors.initials: R
authors.lastname: Edwards
authors.forename: Kennar
authors.initials: K
authors.lastname: Briand
authors.forename: Mailynn
authors.initials: M
authors.lastname: Konelios
authors.forename: Mona
authors.initials: M
authors.lastname: Marin
authors.forename: Huong Q
authors.initials: HQ
authors.lastname: Nguyen
authors.forename: Anthony P
authors.initials: AP
authors.lastname: Khalifah
authors.forename: Michael J
authors.initials: MJ
authors.lastname: O'leary
authors.forename: Nobia J
authors.initials: NJ
authors.lastname: Williams
authors.forename: William J
authors.initials: WJ
authors.lastname: Bellini
authors.forename: Daoling
authors.initials: D
authors.lastname: Bi
authors.forename: Cedric J
authors.initials: CJ
authors.lastname: Brown
authors.forename: Jane F
authors.initials: JF
authors.lastname: Seward
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Papania
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D002648:Child; D002675:Child, Preschool; D004196:Disease Outbreaks; D004198:Disease Susceptibility; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D032521:Immunity, Herd; D007223:Infant; D007231:Infant, Newborn; D008457:Measles / Q000150:complications / Q000453:epidemiology* / Q000276:immunology / Q000517:prevention & control; D008458:Measles Vaccine / Q000008:administration & dosage; D008875:Middle Aged; D010139:Pacific Islands / Q000453:epidemiology; D012574:Schools; D014186:Transportation; D014611:Vaccination / Q000706:statistics & numerical data
chemical_list: D008458:Measles Vaccine