title: Use of vaccination in a large outbreak of primary varicella in a detention setting for African immigrants.
abstract: BACKGROUND
  Primary varicella (PV) presents a public health risk for adults in closed residential settings, especially for immigrants from tropical areas where infection during childhood is less likely.
  
  
  METHODS
  In this study, an outbreak of PV at a detention facility for illegal immigrants from Eritrea and Sudan in southern Israel is described. Basic demographic information and clinical course for all cases were obtained.
  
  
  RESULTS
  One hundred and nine cases of PV, all in young adult men aged 18-40 years, were diagnosed over a 7-month period (June to December 2012). Diagnosed patients were placed in quarantine until the resolution of illness without other public health measures being implemented. The Israeli Ministry of Health was notified of the outbreak in early December and recommended two doses of varicella vaccine for all susceptible detainees and staff. Within 2 weeks of completion of the first dose of vaccine, there was only one additional case in a detainee immunized 13 days prior to diagnosis. The effectiveness of vaccination in halting the outbreak was immediate, despite the fact that 15.6% of detainees refused to be immunized.
  
  
  CONCLUSIONS
  The possible roles of vaccination or natural infection in achieving herd immunity and thereby ending the outbreak in this population are discussed. We recommend considering early vaccination for all when an outbreak or a series of connected cases is detected in a closed-residential setting such as the detention facility described here.
authors.affiliation: Maternal and Child Medicine, Ministry of Health Southern District, 4 Hatikva Street, Beersheva, Israel, 8489312 Division of Community Health, Ben Gurion University of the Negev, Beersheva, Israel eric.haas@bsh.health.gov.il.
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Haas
authors.affiliation: Maternal and Child Medicine, Ministry of Health Southern District, 4 Hatikva Street, Beersheva, Israel, 8489312.
authors.forename: Larissa
authors.initials: L
authors.lastname: Dukhan
authors.affiliation: Israel Prison Service, Israel Ministry of Public Security, P.O. Box 18182, Jerusalem, Israel, 9118100.
authors.forename: Liav
authors.initials: L
authors.lastname: Goldstein
authors.affiliation: Maternal and Child Medicine, Ministry of Health Southern District, 4 Hatikva Street, Beersheva, Israel, 8489312.
authors.forename: Michael
authors.initials: M
authors.lastname: Lyandres
authors.affiliation: Maternal and Child Medicine, Ministry of Health Southern District, 4 Hatikva Street, Beersheva, Israel, 8489312 Division of Community Health, Ben Gurion University of the Negev, Beersheva, Israel.
authors.forename: Michael
authors.initials: M
authors.lastname: Gdalevich
mesh_terms: D000293:Adolescent; D000328:Adult; D000349:Africa / Q000208:ethnology; D002644:Chickenpox / Q000453:epidemiology* / Q000517:prevention & control*; D019433:Chickenpox Vaccine / Q000008:administration & dosage*; D004196:Disease Outbreaks; D054242:Emigrants and Immigrants; D005260:Female; D006801:Humans; D007557:Israel / Q000453:epidemiology; D008297:Male; D011330:Prisons; D011790:Quarantine / Q000458:organization & administration; D055815:Young Adult
chemical_list: D019433:Chickenpox Vaccine
keywords: Adults; Outbreak; Prison; Varicella