Measles outbreak in the Republic of the Marshall Islands, 2003

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Abstract
Background Measles is a highly contagious viral infection. Measles transmission can be prevented through high population immunity (≥95%) achieved by measles vaccination. In the Republic of the Marshall Islands (RMI), no measles cases were reported during 1989–2002; however, a large measles outbreak occurred in 2003. Reported 1-dose measles vaccine coverage among children aged 12–23 months varied widely (52–94%) between 1990 and 2000. Methods RMI is a Pacific island nation (1999 population: 50 840). A measles case was defined as fever, rash, and cough, or coryza, or conjunctivitis, in an RMI resident between July 13 and November 7, 2003. A vaccination campaign was used for outbreak control. Results Of the 826 reported measles cases, 766 (92%) occurred in the capital (Majuro). There were 186 (23%) cases in infants aged Interpretation Populations without endemic measles transmission can accumulate substantial susceptibility and be at risk for large outbreaks when measles virus is imported. ‘Islands’ of measles susceptibility may develop in infants, adults, and any groups with low vaccine coverage. To prevent outbreaks, high population immunity must be sustained by maintaining and documenting high vaccine coverage.