title: Challenges in managing a school-based measles outbreak in Melbourne, Australia, 2014.
abstract: OBJECTIVE
  To identify barriers to control of a Victorian primary school-based measles outbreak.
  
  
  METHODS
  Confirmed measles cases notified in Victoria in 2014 were reviewed. Surveillance data, correspondence, and investigation notes for the school-based outbreak were assessed regarding timeliness of diagnosis and notification, and adequacy of school-based immunisation records.
  
  
  RESULTS
  Twenty-three (31%) of the 75 measles cases notified in 2014 were school-aged (5-18 years); three had documentation of measles vaccination, 17 were unvaccinated, and three had unknown vaccination history. Eight measles outbreaks were identified, including a primary school-based outbreak with ten cases. Of the six unvaccinated pupils in the affected school, five (83%) contracted measles. The proportion of the school's prep students with documented vaccination records, as required by law, ranged from 39% in 2013 to 97% in 2014.
  
  
  CONCLUSIONS
  Inadequately vaccinated students constitute a vulnerable population and schools are a potential site for measles outbreaks. Inadequate enforcement of school-based immunisation records impact the management and control of school-based measles outbreaks. Implications for Public Health: There is a need to educate clinicians on measles diagnosis and notification, and schools on the requirement to maintain up-to-date vaccination records. School entry is an opportunity to review student vaccination history and offer immunisations.
authors.affiliation: Health Protection Branch, Department of Health & Human Services Victoria.|The Peter Doherty Institute for Infection and Immunity, University of Melbourne, Victoria.
authors.forename: Katherine B
authors.initials: KB
authors.lastname: Gibney
authors.affiliation: Health Protection Branch, Department of Health & Human Services Victoria.
authors.forename: Aicha
authors.initials: A
authors.lastname: Brahmi
authors.affiliation: Health Protection Branch, Department of Health & Human Services Victoria.
authors.forename: Miriam
authors.initials: M
authors.lastname: O'Hara
authors.affiliation: Health Protection Branch, Department of Health & Human Services Victoria.
authors.forename: Rosemary
authors.initials: R
authors.lastname: Morey
authors.affiliation: Health Protection Branch, Department of Health & Human Services Victoria.
authors.forename: Lucinda
authors.initials: L
authors.lastname: Franklin
mesh_terms: D000293:Adolescent; D001315:Australia / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D018563:Disease Notification / Q000706:statistics & numerical data*; D004196:Disease Outbreaks; D005260:Female; D006306:Health Surveys; D006801:Humans; D007114:Immunization; D008297:Male; D008457:Measles / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control; D008458:Measles Vaccine / Q000008:administration & dosage*; D011159:Population Surveillance; D012574:Schools; D013334:Students; D014611:Vaccination
chemical_list: D008458:Measles Vaccine
keywords: Australia; disease outbreaks; measles; measles vaccine; schools; students