俄亥俄州一个未免疫的阿米什社区发生麻疹疫情。

A Measles Outbreak in an Underimmunized Amish Community in Ohio.

机构信息

From the Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta (P.A.G., S.B.R., J.R., P.A.R., C.H., G.S.W., A.P.F.); and the Ohio Department of Health, Columbus (J.B., N.F., B.F., L.T., S.F., M.D.), Knox County Health Department, Mount Vernon (J.F., J.M.), and Holmes County Health Department, Millersburg (D.J.M.) - all in Ohio.

出版信息

N Engl J Med. 2016 Oct 6;375(14):1343-1354. doi: 10.1056/NEJMoa1602295.

DOI:10.1056/NEJMoa1602295

PMID:27705270

Abstract

BACKGROUND

Although measles was eliminated in the United States in 2000, importations of the virus continue to cause outbreaks. We describe the epidemiologic features of an outbreak of measles that originated from two unvaccinated Amish men in whom measles was incubating at the time of their return to the United States from the Philippines and explore the effect of public health responses on limiting the spread of measles.

METHODS

We performed descriptive analyses of data on demographic characteristics, clinical and laboratory evaluations, and vaccination coverage.

RESULTS

From March 24, 2014, through July 23, 2014, a total of 383 outbreak-related cases of measles were reported in nine counties in Ohio. The median age of case patients was 15 years (range, <1 to 53); a total of 178 of the case patients (46%) were female, and 340 (89%) were unvaccinated. Transmission took place primarily within households (68% of cases). The virus strain was genotype D9, which was circulating in the Philippines at the time of the reporting period. Measles-mumps-rubella (MMR) vaccination coverage with at least a single dose was estimated to be 14% in affected Amish households and more than 88% in the general (non-Amish) Ohio community. Containment efforts included isolation of case patients, quarantine of susceptible persons, and administration of the MMR vaccine to more than 10,000 persons. The spread of measles was limited almost exclusively to the Amish community (accounting for 99% of case patients) and affected only approximately 1% of the estimated 32,630 Amish persons in the settlement.

CONCLUSIONS

The key epidemiologic features of a measles outbreak in the Amish community in Ohio were transmission primarily within households, the small proportion of Amish people affected, and the large number of people in the Amish community who sought vaccination. As a result of targeted containment efforts, and high baseline coverage in the general community, there was limited spread beyond the Amish community. (Funded by the Ohio Department of Health and the Centers for Disease Control and Prevention.).

摘要

背景

尽管麻疹于 2000 年在美国被消灭，但病毒的输入仍在继续导致疫情爆发。我们描述了起源于两名未接种疫苗的阿米什男子的麻疹疫情的流行病学特征，这两名男子在从菲律宾返回美国时麻疹处于潜伏期，并探讨了公共卫生应对措施对限制麻疹传播的影响。

方法

我们对人口统计学特征、临床和实验室评估以及疫苗接种覆盖率的数据进行了描述性分析。

结果

从 2014 年 3 月 24 日至 2014 年 7 月 23 日，俄亥俄州的九个县共报告了 383 例与疫情相关的麻疹病例。病例患者的中位年龄为 15 岁（范围为<1 至 53 岁）；共有 178 名病例患者（46%）为女性，340 名（89%）未接种疫苗。传播主要发生在家庭内部（68%的病例）。病毒株为 D9 型，在报告期内在菲律宾流行。麻疹腮腺炎风疹（MMR）疫苗接种覆盖率估计在受影响的阿米什家庭中为 14%，在俄亥俄州普通（非阿米什）社区中超过 88%。遏制措施包括对病例患者进行隔离、对易感染人群进行检疫以及对 1 万多人接种 MMR 疫苗。麻疹的传播几乎完全局限于阿米什社区（占病例患者的 99%），仅影响该定居点估计的 32630 名阿米什人中的约 1%。