title: Large outbreak of measles in a community with high vaccination coverage: implications for the vaccination schedule.
abstract: BACKGROUND
  Attempts to eliminate measles from a country or region may be disrupted by an imported case that affects indigenous persons. The objective of this study was to analyze epidemiological and clinical characteristics of a measles outbreak in Catalonia, Spain, in 2006.
  
  
  METHODS
  Data on cases of measles reported to the Department of Health, Generalitat of Catalonia, during the period 28 August 2006 through 8 July 2007 were collected. Suspected cases were confirmed by determination of measles-specific immunoglobulin M antibodies and/or detection of virus genome. Incidences were calculated using the estimated population of Catalonia for 2006, and 95% confidence intervals were determined assuming a Poisson distribution. The association between proportions was determined using the chi(2) test and Fisher's exact test. The level of statistical significance was set at alpha = .05.
  
  
  RESULTS
  A total of 381 cases were confirmed, for an incidence of 6.6 cases per 100,000 persons. A total of 89.5% of cases occurred in nonvaccinated persons, mainly those aged < or =15 months (incidence, 278.2 cases per 100,000 persons; mean age of patients, 12 months). Indigenous subjects accounted for 89.8% of cases, and laboratory confirmation of results was obtained for 87.1%. Measles genotype D4 was identified in all sequenced samples.
  
  
  CONCLUSIONS
  The age distribution of cases of measles among children aged <15 months suggests that the first dose of vaccine should be routinely administered at the age of 12 months.
authors.affiliation: Department of Public Health, University of Barcelona, Casanova 143, 08036 Barcelona, Spain. angela.dominguez@ub.edu
authors.forename: Angela
authors.initials: A
authors.lastname: Domínguez
authors.forename: Nuria
authors.initials: N
authors.lastname: Torner
authors.forename: Irene
authors.initials: I
authors.lastname: Barrabeig
authors.forename: Ariadna
authors.initials: A
authors.lastname: Rovira
authors.forename: Cristina
authors.initials: C
authors.lastname: Rius
authors.forename: Joan
authors.initials: J
authors.lastname: Cayla
authors.forename: Elsa
authors.initials: E
authors.lastname: Plasencia
authors.forename: Sofia
authors.initials: S
authors.lastname: Minguell
authors.forename: M Rosa
authors.initials: MR
authors.lastname: Sala
authors.forename: Ana
authors.initials: A
authors.lastname: Martínez
authors.forename: Josep
authors.initials: J
authors.lastname: Costa
authors.forename: Mar
authors.initials: M
authors.lastname: Mosquera
authors.forename: Carmen
authors.initials: C
authors.lastname: Cabezas
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D004196:Disease Outbreaks / Q000517:prevention & control; D005260:Female; D006801:Humans; D007115:Immunization Schedule; D007223:Infant; D008297:Male; D008457:Measles / Q000453:epidemiology* / Q000276:immunology / Q000517:prevention & control*; D008458:Measles Vaccine / Q000008:administration & dosage*; D008459:Measles virus / Q000235:genetics / Q000302:isolation & purification; D008875:Middle Aged; D013030:Spain / Q000453:epidemiology; D013997:Time Factors; D014611:Vaccination
chemical_list: D008458:Measles Vaccine