Measles Outbreak in Juneau, Alaska, 1996: Implications for Future Outbreak Control Strategies

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Abstract
Objective.: To determine the most effective outbreak control strategy for school-based measles outbreaks as the proportion of children with two doses of measles-containing vaccine (MCV) increases.Setting.: A school-based measles outbreak during 1996 involving 63 cases in Juneau, Alaska (population 29 288), where systematic revaccination with MCV was not implemented.Design.: A retrospective evaluation using chain-of-transmission data of three possible outbreak control strategies: no school revaccination, targeted school revaccination (affected schools only), and community-wide school revaccination (all schools). Two-dose MCV coverage among students was estimated from school vaccination records and a survey issued to parents.Primary Outcome Measures.: Potentially preventable cases of measles and doses of MCV administered per case prevented.Results.: Two-dose MCV coverage among Juneau students was estimated to be 44% and 53% immediately before and after the outbreak, respectively. Of all the measles cases, an estimated 24 to 28 and 27 to 31 were potentially preventable by the targeted and community-wide school revaccination strategies, respectively. Either strategy might have optimally decreased the outbreak duration by 1 month, sparing one of seven affected schools and 10 of 12 unvaccinated children who had measles. Approximately 133 to 155 and 139 to 160 doses of MCV per case prevented would have been required for targeted and community-wide school revaccination, respectively.Conclusions.: Either targeted or community-wide school revaccination would have been effective control strategies for this outbreak. Targeted school revaccination is probably the intervention of choice for school-based measles outbreaks in larger communities with higher two-dose MCV coverage. As two-dose MCV coverage continues to increase in the United States, public health control measures to respond to outbreaks need to be reevaluated.